A year-long project, to improve health outcomes for high-risk, acute coronary syndrome (ACS) patients by providing an angiography within 24 hours, will be officially launched on 1st February, supported by MAHSC Cardiovascular Domain.
Led by Greater Manchester and Eastern Cheshire Strategic Clinical Network (GMEC SCN), it is being carried out at specialist heart centres, Manchester Royal Infirmary and Wythenshawe Hospital, with Stepping Hill Hospital as the referring site.
The Rapid Access for Acute Coronary Syndrome (RAACS) pilot aims to provide early access to an angiography* for high risk ACS patients and assess the clinical value of this accelerated patient pathway.
Diseases of the heart and circulatory system (or CVD) were the second most common cause of death in the United Kingdom in 2014, with a total of around 155,000 deaths. CVD caused 27% of all deaths in that year.
Each year, there are more than 3,600 in-patient angiographies for ACS procedures in Greater Manchester. ACS is sometimes referred to as NSTEMI or unstable angina – a form of heart attack.
‘Recent European guidelines recommend that high risk ACS patients should have access to angiography within 24 hours’ said Danny Keenan, Joint Clinical Lead of MAHSC Cardiovascular Domain. ‘One of our domain objectives is to provide specialist treatment to patients with threatened heart attacks. Following an initial pilot, we agreed that further work was needed. We are facilitating RAACS by providing a dedicated manager to support the clinicians, and will follow the project’s implementation and outcomes very closely.’
The project, under the direction of Dr Farzin Fath-Ordoubadi, GMEC SCN’s Cardiac Clinical Lead and Clinical Director for Manchester Heart Centre (CMFT), completed a first phase in 2015 at Manchester Royal Infirmary (MRI). This initial work tested a high-risk identification process and 79 ACS patients were involved over a nine-month period.
‘Our 2017 programme expands the scope of RAACS and builds on the findings from our first patient cohort’ said Dr Fath-Ordoubadi. ‘In this second phase, we want to improve the process for early access to angiography and look at the clinical benefits for high-risk ACS patients. Our next steps, dependent on our findings, would be to roll-out this 24 hour access across Greater Manchester, and for all ACS patients, not just the high risk group.’
During the year, medical staff at Stepping Hill Hospital will use the specially developed clinical protocol to assess whether an ACS patient is high risk and also suitable for an angiography. If the patient meets both sets of criteria, he or she will be sent to either MRI or Wythenshawe Hospital for the procedure to be carried out within 24 hours.
Stepping Hill Hospital has been chosen for the pilot because it has the highest number of ACS patient referrals to Greater Manchester’s specialist heart centres.
Dr Fath-Ordoubadi continued: ‘Potentially, there are really important benefits to this project, not only in terms of improving individual health outcomes but also for the health system, by reducing the current impact on NHS resources, such as take up of hospital beds.’
Data from the project will be studied in early 2018 to determine next steps in RAACS.
* Angiograghy: a procedure enabling heart x-rays to be taken through the insertion of a catheter into a blood vessel in the groin or arm and then guided to the heart. It enables a doctor to make a more informed assessment about the heart’s condition and plan future treatment.