Cardiovascular Clinical Programme - PowerPoint Presentation

1. Cardiovascular Clinical ProgrammeProgramme TeamZoe Hamilton –Clinical Programme LeadGina Mann – Service Improvement ManagerDr Jim Moore – GP Lead (Heart Failure GPSI)Dr Sheena Yerburgh – GP LeadFran Mason – Project Support

2. StrokeSTROKE likely – bluelight patient to Gloucester Royal Hospital Emergency Department, up to 24 hours from onset. Pts will be assessed for Thrombolysis or Thrombectomy as appropriate.Do NOT give antiplatelet.Symptoms – "negative" i.e. loss of function (they can be "positive" i.e. pins and needles, shaking, scintillations in vision, but this is rare):Unilateral Face / arm / leg weakness and/or sensory lossSpeech disturbance e.g. dysphasia or dysarthriaDysphasia Dysarthria Visual disturbance e.g. Hemianopia = loss of vision to one sideCerebellar signs: e.g. Ataxia, Vertigo, Vomiting, Nystagmus Dizziness or loss of balance or coordinationConfusion / inattentionDelayed presentation, admit to GRH in most instances, particularly if there are persistent/ ongoing symptoms and if they are not improving. Non-disabling strokes where the patient is safe at home, has no dysphagia and is improving may be referred to TIA clinic which is an efficient way of assessing and investigating such patients.Useful links & documents;G-care Stroke TIA pathway-https://g-care.glos.nhs.uk/pathway/334/resource/11Patient information leaflets and local support groups https://g-care.glos.nhs.uk/pathway/334/resource/7Don’t wait to Anticoagulate website for Pts and HCP - http://www.dontwaittoanticoagulate.com/ Gloucesterhire Joint Formulary for CVD - https://www.gloshospitals.nhs.uk/gps/gloucestershire-joint-formulary/cardiovascular-system/

3. About 50% of patients referred as suspected TIAs turn out to have an alternative diagnosis. UNLIKELY to be due to a TIA:-Generalised weakness or sensory disturbance -Light-headedness -Faintness -Blackouts -Incontinence -Confusion For advice and guidance ring TIA clinic 9am-5pm Mon-Fri via SPCA Tel: 0300 421 0300.ABCD2 score is no longer recommended to assess risk of subsequent stroke or to inform urgency of referral instead - REFER Urgently to the TIA Assessment Service , via eRS using the TIA referral form on G-care to be seen within 24 hours, if patients have symptoms for which there is a strong clinical suspicion of a TIA. Based at GRH from 1.30pm in the wk, AM at weekends (for high risk pts) Treat with Aspirin (or Clopidogrel if Aspirin allergic) immediately 300mg stat then 75mg daily. Do not alter medication if currently on Aspirin; Warfarin or a NOAC (e.g. Rivaroxaban).Advise all patients to :NOT drive until they have been seen by a specialist (when definitive guidance will be given).Return to ED or call 999 if positive FAST symptoms reoccurHave someone with them over night, in case symptoms reoccur, until they have been seen by a specialist TIAUseful links & documents;TIA Assessment Service - In order to find the ‘TIA Assessment Service’ on ERS - Select ‘Priority’ -‘Urgent’, ‘Specialty’ - ‘General Medicine’, ‘Clinic Type’ - ‘Transient Ischemic Attack’, ‘Mileage ‘-‘30 miles’ . Use the referral form found on this link to G-care https://g-care.glos.nhs.uk/pathway/334/resource/5 .

4. More patients will die of CVD than of COVID during this pandemic. It is therefore vitally important that people should be made aware of the importance of seeking advice early for possibly significant CVD.High blood pressure medication Patients taking angiotensin converting enzyme inhibitors (ACE inhibitors or ACE-i) or angiotensin receptor blockers (ARBs) to treat high blood pressure should continue their usual treatment unless specifically told to stop by their consultantHeart Failure Patients with suspected HF will need to have an NTproBNP blood test (available at GHT) If NT pro BNP<400ng/l then HF unlikely if > 400ng/l then refer urgently to the HF service. BNP testing – via ICE system – search ‘BNP’. The sample should be collected into a gold top SST tube and sent to the laboratory on the day of collection.Gloucestershire Heart Failure Service – (Specialist Nurses, GPSI, cardiac physiologist)Complete a referral form and include supporting clinical information and BNP results. If an ECG is available please attach, however given current access for some patients during this pandemic, the service will accept referrals without an ECG/CXR. Please include whether the patient is in AF, and if the heart rate is less than 100 bpm.Other – we are holding CVD virtual educational /MDT case study sessions - if you are interested please contact Fran Mason – fran.mason3@nhs.net CVD Covid information :Useful links & documents;Heart Failure Service information & referral forms https://g-care.glos.nhs.uk/pathway/343/resource/6#chapter_6362 Specialist Nurses Tel: 0300 421 1212Breathlessness Algorithm- https://g-care.glos.nhs.uk/uploads/files/Breathlessness%20algorithm%20ver%205.rtf Latest CVD Covid information- https://g-care.glos.nhs.uk/pathway/334/resource/11AF Podcast with FAQs with 2 local GP CVD leads – https://g-care.glos.nhs.uk/education-type/7 Any questions then please contact – Gina Mann- Service Improvement Manager CCG - gina.man@nhs.net