Coronary heart disease ( CHD ) is a preventable disease that kills more than 110,000 people
in England every year. More than 1.4 million people suffer from angina and 275,000 people
have a heart attack annually. CHD is the biggest killer in the country.
The Government is committed to reducing the death rate from coronary heart disease
and stroke and related diseases in people under 75 by at least 40%
(to 83.8 deaths per 100,000 population) by 2010.

National service framework (NSF) for coronary heart disease
The National Service Framework for Coronary Heart Disease (NSF CHD ), published in
March 2000 set out a strategy to modernise CHD services over ten years.
It details 12 standards for improved prevention, diagnosis, treatment and
rehabilitation and goals to secure fair access to high quality services.

Extending choice for patients
Giving patients more choice about how, when and where they receive treatment is one
cornerstone of the government's health strategy. From December 2005, patients needing
elective treatment will be offered a choice of appointment and four or five hospitals
once their GPs has decided that a referral is required.

Reducing CHD in the population
Key lifestyle risk factors for CHD include smoking, poor diet and lack of exercise.
About ten million people in England smoke - over one in four people.
Approximately 20% of CHD related deaths in men and 17% of CHD cases in women are
attributable to smoking. The incidence of CHD is highest amongst people who are obese.
Overall, 22% of men and 23% of women in England are now obese.
Regular physical activity reduces the risk of cardiovascular disease mortality in
general and of coronary heart disease mortality in particular.
Physically inactive people have about double the risk of CHD .

Preventing CHD in high risk patients
The CHD NSF and the new GMS contract state that GPs and primary care teams
should develop a register of CHD patients, through which they can review medication,
offer advice on diet and lifestyle and maintain the necessary contact with patients
most at risk of suffering renewed heart problems.
Those at risk should be prescribed statins; these are drugs that reduce the levels
of cholesterol (also sometimes called lipids) in the blood.

Reducing waiting times
The shorter the wait the better the outcome for the patient. The NHS delivered a maximum
three month wait for heart surgery in March 2005, a vast improvement on the situation
in 1996 where some patients in England waited over two years for surgery.
A new target has been set for reducing waiting times even further.
From 2008 no-one should wait more than 18 weeks from GP referral to hospital treatment,
including all diagnostic procedures and tests.

Better, faster treatment – Thrombolyis and primary angioplasty
Approximately 275,000 people in the United Kingdom suffer a heart attack each year.
The main treatment for heart attack is the administration of clot dissolving drugs (thrombolysis)
which help to restore blood supply in the coronary arteries to the affected part of the heart.
A small number of mainly urban centres offer angioplasty as the first treatment for acute
myocardial infarction (known as primary angioplasty).
DH has set aside £1million to test the feasibility of offering this service more widely.

National Defibrillator Programme
The National Defibrillator Programme provides automatic external defibrillators (AEDs) in
busy public places, such as airports, railway and underground stations, coach stations,
as well as to train and retrain employees in life support techniques.
Each year over 12,000 people suffer a cardiac arrest in a public place and the
programme aims to increase the proportion of people who survive.

Tackling inequalities
CHD affects people in certain sections of society more than in others.
It is more prevalent in lower socio-economic groups and certain ethnic minorities.
Rates are also higher in certain geographic areas.
The CHD NSF requires the NHS and partners to reduce the prevalence of coronary risk
factors in the population, and reduce inequalities in risks of developing heart disease.
The NSF also requires all NHS organisations to ensure that the services they provide
are accessible and acceptable to the people they serve, regardless of their ethnicity.
This includes accessing and meeting people’s needs in ways that are culturally,
religiously and linguistically appropriate.

Cardiac rehabilitation
Cardiac rehabilitation can improve health outcomes and quality of life in people with coronary
heart disease. The evidence suggests that when people are offered comprehensive
and tailored help with lifestyle modification, involving education and psychological
input as well as exercise training, cardiac rehabilitation can make a substantial difference,
perhaps reducing mortality by as much as 20% to 25% over three years.
The NSF states that prior to leaving hospital, all heart patients should be invited to
participate in a multidisciplinary programme of secondary prevention and cardiac rehabilitation.

Work on services for adults with congenital heart disease
Congenital heart disease services do not have specific targets to drive service improvement
as they are outside the scope of the Department of Health’s National Service Framework
for Coronary Heart Disease. In April the DH established an External Reference Group
to produce a set of standards for NHS services for adults with congenital heart disease
(also known as Grown Ups with Congenital Heart Disease or GUCH) which would set
out what patients should expect from the NHS and describe the support and structure needed for the service to run. The standards will cover all NHS services not just specialist services.

Coronary Heart Disease Care Group Work force Team
Work force is a key factor in determining successful delivery of the National Service Framework for Coronary Heart Disease. June 2005 figures indicate there are now 231 cardiothoracic surgeons, compared to 182 in 1999-2000, an increase of 27%.
Since 1999 the number of cardiologists has grown from 467 to 740.

Some Myths about Heart Disease
Some helpful advice following a heart attack or heart surgery.

To gain benefit from exercise, it has to be really strenuous.
Guess what, wrong yet again! Moderate levels of physical activity are all it takes to reduce the risk of dying from heart disease. Some exercise specialists have been guilty of “over prescribing” exercise,
which can discourage people, particularly heart attack patients.

In my youth I always exercised regularly, and this will protect me.
Absolutely not! Even professional sports-persons have later suffered from heart disease, due
to adopting a sedentary lifestyle. Exercise is like a current account, and you cannot hope to
put on deposit what you did years ago. You need to exercise sensibly and regularly, at least three times a week for 20-30 minutes.
The exercise should make you breathe harder, while still being able to talk.
There is convincing evidence that regular, sensible exercise training can reduce the risk of dying
from heart disease, even after a heart attack.

Heart disease runs in my family, so there is little I can do to avoid heart problems.
 Not necessarily so! It may be the bad habits that are the culprits, in that they have been followed for many years within a family.

I will know when my heart condition gets worse – I will have chest pains.
Again, that is not necessarily the case. Studies have shown that up to 10% of all middle-aged men can suffer from a condition called silent ischemia. This means that your heart is not
getting enough oxygen, but you are not aware of it. So it is best to keep in touch with your doctor, and keep a check on your cardiac health.

My worries about heart disease are over since my heart surgery
(angioplasty or coronary artery bypass surgery).
Definitely not true! If you follow the same bad habits that originally allowed you to develop
heart disease, then you may damage the heart again.

The multidisciplinary Cardiac Rehabilitation Team is based in the Heart and Lung Centre at
New Cross Hospital . The role of the team is to help patients understand their illness and
future treatment, to provide support, to improve patients’ success in making appropriate
lifestyle changes and to help them return to a full and as normal a life as possible.

Education Sessions

Regular education sessions are held at New Cross Hospital and at venues in Bilston, Penn and Compton for patients and their carers. We informally discuss a wide range of topics, including:

• An explanation of Coronary Heart Disease

• An explanation of cardiac investigations

• The benefits of exercise

• Healthy eating

• Medication

• First aid and cardiopulmonary resuscitation

• Stress and relaxation

Contact the Cardiac Rehabilitation Team for dates of future meetings.

Exercise Programmes

The Cardiac Rehabilitation Team supervises exercise sessions for patients at New Cross Hospital and in local leisure centres. Following an initial assessment by an exercise specialist each patient is given an individualised exercise plan. Patients are expected to complete an eight to twelve week course of exercise, attending for two sessions per week.
Each exercise session lasts between 45 to 60 minutes. At the end of the course of exercise patients undergo a further assessment, following which there is the opportunity to join our long term exercise sessions to build upon or maintain their new fitness levels.
These sessions are also supervised.

Contact the Cardiac Rehabilitation Team for details on how to join the exercise programme.

Stress Management Programme

The Cardiac Rehabilitation Team runs a Stress Management Programme at New Cross Hospital for patients and their carers. It involves attending once a week for four weeks.

The aims of the programme are to:

• Understand and recognise stress in your life

• Develop strategies to deal with it

• Use conventional relaxation techniques

• Introduce you to alternative methods of dealing with stress, such as aromatherapy.

Weight Management Programme

The Cardiac Rehabilitation Team works in partnership with The Department of Nutrition and Dietetics to run the Weight Management Programme. Patients are assessed by a cardiac rehabilitation exercise specialist before joining the programme. The programme comprises
of a supervised exercise session twice a week, plus attending a one and a half-hour education session with a Dietician once a week to learn more about healthy eating.
Contact the Cardiac Rehabilitation Team for details on how to join the Weight Management Programme.

The Cardiac Rehabilitation Team can be contacted on telephone number 01902 694226.

Cardiac Rehabilitation and The Wolverhampton Coronary Aftercare Support Group

The Cardiac Rehabilitation Team and The Wolverhampton Coronary Aftercare Support Group (WCASG) work in partnership to provide continued support to patients in the form of long term supervised exercise classes in local leisure centres and access to ‘Patient Friends’.
Further details about the WCASG can be found on their website.

Angina
Angina usually occurs when the heart has to work harder for example, on physical exertion, with emotional stress or after a heavy meal. Not all chest pains are angina, however. Some
are due to muscular or rib pain. Chest infections and indigestion can also be felt in the chest.

The typical symptoms of angina are: - an uncomfortable feeling in the chest that is often described as pain, tightness, aching or heaviness. This may go through to your back or down one or both arms. Pain or aching can also be felt in the neck, throat and jaw. Breathlessness may accompany these symptoms or may be experienced on its own.
If you do get angina you may need to take GTN tablets or spray. GTN works by increasing
the blood supply to the heart muscle.

If you get angina symptoms stop what you are doing, sit down and rest. Try to remain calm
and relaxed. If angina has not gone after 2 minutes take a dose of your GTN. Wait for 5 minutes, if angina persists repeat your GTN, wait a further 5 minutes and take your GTN again
if necessary. If 3 doses of GTN spray or 2 doses of GTN tablets do not relieve your angina you must get medical attention and ring 999 for an ambulance. If it is a heart attack that you are having it is vital that this is treated as soon as possible.
If your symptoms settle, rest for at least 5 minutes.

See your GP if your symptoms of angina increase in frequency or severity.

What causes angina?

Angina is caused by the heart muscle becoming short of oxygen. You may be prescribed tablets or you may undergo treatment to relieve your symptoms. You will need to adopt a lifestyle that will reduce the risk of further heart trouble.

• Give up smoking

• Control high blood pressure

• Control your cholesterol

• Eat more fruit and vegetables

• Control your weight

• Be more physically active

• Reduce stress

High Blood Pressure

Blood pressure is the pressure at which blood is pumped through your arteries when carrying blood from the heart to the rest of the body.
The following may contribute to causing high blood pressure:

• Being overweight

• Drinking too much alcohol

• Smoking

• Taking too much salt in your diet

• Not taking enough physical exercise

• Stress

• Family history

How Often Should You Check Your Blood Pressure

Have your blood pressure checked every 3 to 6 months by your GP or Practice Nurse. If you have high blood pressure you should have it taken more frequently.
The latest blood pressure recommendations are:

• For adults with coronary heart disease: Target 140/85

• For adults with diabetes: Target 130/80

What Happens If My Blood Pressure Is Raised?
Many people don’t have any symptoms from high blood pressure, but occasionally symptoms may be:

• Headache

• Blurred vision

• Breathlessness

What Happens If Blood Pressure Is Left Untreated?

People with high blood pressure have an increased risk of having strokes, heart disease and kidney disease. If your blood pressure is raised on 3 separate occasions, your doctor may consider prescribing medication.

Ways To Reduce High Blood Pressure

• Reduce weight if overweight

• Gradually increase physical activity

• Reduce salt intake

• Reduce alcohol intake

• Stop smoking

• Reduce stress

High Blood Cholesterol

What is cholesterol?

Cholesterol is a fatty substance found in the body. The liver produces cholesterol from saturated fat eaten in food. You may have high cholesterol as a result of eating a diet high in saturated fat, an inherited tendency to high cholesterol, having an under active thyroid gland, chronic renal failure or drinking too much alcohol.

Cholesterol is measured by a simple blood test. However if you have recently had a heart attack or heart surgery you should not normally have your cholesterol checked for at least six weeks as a heart attack and surgery can cause a falsely low reading. Too much cholesterol in the blood can increase the risk of coronary heart disease. You need to aim for the figure of 4.5.

How can cholesterol be lowered?

Cutting down on the intake of saturated fats can lower the cholesterol level. Medication will also help to reduce your cholesterol level. Your doctor will decide whether you need to take cholesterol - lowering medication.
For further information see British Heart Foundation booklet “Lowering Cholesterol”.

Healthy Eating

There is good evidence that three simple changes will benefit your heart. These are:

• Eating 2 to 3 portions of oily fish per week (mackerel, salmon, sardines, pilchards, trout and herring)

• Eating 5 portions of fruit, vegetables and salad per day

• Cutting down on fats and fatty food (choose small amounts of monounsaturated fats such as olive oil and rapeseed oil)

Moderate intensity exercise should be performed for a total of 30 minutes on five or more days in the week. During exercise breathing should be heavier and more frequent but should allow
the individual to talk during exercise. It is important to increase your physical activity gradually.
It may be helpful to plan a weekly exercise programme based on walking.

It is important to begin slowly for the first few minutes to warm up, and build up gradually.
At the end of your activity, take time to slow down. Do not stop exercise suddenly
(unless you become unwell). It is not safe to exercise when you have a viral infection
(a sore throat, for example) or a temperature.
For further exercise guidance speak to your doctor or Cardiac Rehabilitation Team.