Page 36 - Regional Services Plan 2016/19

2.2 Cardiac services (Midland Cardiac Clinical Network)
Chair: Dr Gerard Devlin Project Manager: Philippa Edwards Lead Chief Executive: Dr Nigel Murray
Context:
Cardiovascular diseases are a leading cause of death in New Zealand. They were responsible for 24.7 percent of all deaths in NZ in 2013. Within the set of cardiovascular diseases, ischemic heart disease (IHD) is the biggest killer and within the Midland region the mortality rates of Tairāwhiti, Taranaki and Lakes DHBs are higher than the national average.
The Heart Foundation and Public Health messaging is increasing cardio-vascular health literacy, and improvements in prevention and intervention have been significant. From 2006 to 2013 the annual total number of Acute Coronary Syndrome (ACS) admissions in NZ has fallen by 26% to 15,202. The decrease is not gender, age or ethnic specific however the improvement being greatest for Māori and lowest for Pacific people. In spite of this rates remain higher overall for Māori and Pacific compared with European and Other peoples. The NZ age standardised angiography rates have increased from 33.5 to 48.3 per 100 ACS admissions. The increase is in all ethnic groups; however the rates in European/Others at 50 per 100 remain higher than for Māori and Pacific people at 37.4 per 100 and 39 per 100 respectively. Revascularisation rates mirror the angiography rates with 35.5 in European/Other, 21.4 in Māori and 24.1 in Pacific in 2013.
The impacts of the aging population and increasing prevalence of cardiovascular risk factors such as diabetes and obesity are predicted to impact future cardiovascular demand. It is estimated that 80 percent of the population have three or more of the risk factors, such as smoking, physical inactivity, poor diet and being overweight.
Service performance has steadily improved across the Midland DHBs. The five Midland DHB Cardiac Specialist Services recognise the value in planning and working together. A clear and unified direction is being used whilst forming a virtually integrated regional cardiac service for strategic planning, annual planning and daily operations management. This work will be embedded over the 16/19 timeframe with development of a regional production plans and a strategic Cardiac Service Plan.
The Midland region has a wide range of mortality rates across its five DHBs, low angiogram rates and low revascularisation rates. In 2012/13 the Acute Coronary Syndrome rates per 100,000 adult population ranged from 449 (Capital and Coast) to 784 (Tairāwhiti). The highest incidence was in Tairāwhiti, South Canterbury, Taranaki, Counties Manukau and Whanganui, while the lowest rates were in Capital and Coast, Auckland, Hutt, Waikato and Bay of Plenty DHBs.
Planned Outcomes for 16/17:
The Midland Cardiac Clinical Network (MCCN) work provides a leadership and monitoring role across the Midland Region Cardiac Services to deliver value and high performance in the delivery of services.
In 2016/17 tangible outcomes will be:
1. A region wide production plan for acute and elective cath lab facilities for angiograms and percutaneous interventions (PCI) such as
angioplasty and the insertion of arterial stents.
2. Compliance with the MOH acute coronary syndrome (ACS) targets - timeliness of angiogram and the data entry into the ANZACS-QI
data registry monitored by each of the five Midland DHBs and by ethnicity
3. A gap analysis across the five Midland DHBs against the NZ National Expected Clinical Standards of assessment and treatment to
assess the current state, and to make recommendations to the five Midland DHBs. These include acute chest pain, STEMI myocardial infarction, heart failure, atrial fibrillation, access to Holter and echo diagnostics, tachycardia/palpitations/syncope, structural or valvular heart disease
In 2016/17 leadership will be provided to the Midland region’s Cardiac Services:
4. Planning Sub Group - implementation of the shared regional vision for integrated cardiac services across the 5 Midland DHBs and in
alignment with the 5 strategic themes in the NZ health strategy
5. Prevention and Rehabilitation Sub Group - work with primary care to identify groups of high risk patients in need of increased access
to primary or secondary care services or a higher level of preventative intervention; provide resource for primary care pathway and
health literacy initiatives to increase the rate being risk assessed
6. Communication on a range of topics that the NZ Cardiac Network is working on to advice the MOH. Regional interest includes Health
Workforce NZ, AED national working group, ambulance service and STEMI pathway, National Expected Clinical Standards, Echo
cardiography etc.
7. Identifying and sharing solutions for service improvement issues within individual DHBs
8. Regional IS e-space initiatives
Key objectives:
The goal of the Midland Cardiac Clinical Networks is to reduce the burden of Cardiovascular Disease across the Midland Region. Its focus will be on wellness of the population while:
 Delivery services in alignment with the NZ Health Strategy 5 strategic themes
 Meet Ministry of Health targets and performance objectives
 Achieve equity by domicile and by ethnicity of populations accessing assessment, diagnostics and treatment for cardiac conditions
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INITIATIVES OF REGIONAL NETWORKS AND CLINICAL ACTION GROUPS