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Heart Disease

Cardiovascular Disease Service

The community cardiovascular disease service is part of the County Durham & Darlington Community Health Services, specialist services directorate. The team consists of a specialist services manager, six cardiovascular clinical team leaders (nurses) who manage six teams of specialist cardiac nurses, physical activity facilitators and health care assistants. We are supported by a dedicated team of administrative staff. The community cardiovascular teams are based at Darlington, Derwentside, Durham, Bishop Auckland, Easington and Sedgefield.

The service offers support for patients and carers with heart disease and heart failure, providing home visits and clinics throughout the patient journey following discharge from hospital.

The community cardiovascular disease service is one large team located geographically to serve the people in this area.

Staff members

The team is managed by the Clinical Services Manager - Mark Jones.
Each geographical area has their own cardiovascular clinical team leader:-

Aidan MacDermott Derwentside
Barbara Conway Darlington locality
Caroline Levie Durham Dales
Karen Reid Sedgefield
Paula Dailey Durham and Chester-le-Street
Sue Hall Easington

Services Provided

Cardiac rehabilitation.

Cardiac rehabilitation is offered to people who have had a myocardial infarction (heart attack), cardiac surgery or angioplasty (PCI/stent) and to people with angina. Prehab (cardiac rehabilitation begun before a planned operation) is offered to people who are waiting for angioplasty or other cardiac surgery. It is a service that enables people with heart disease to have the best possible help (physical, psychological and social) to preserve or resume their optimal functioning in society. There is evidence that cardiac rehabilitation reduces the death from heart disease, the need for subsequent heart surgery / revascularisation and incidence of heart attacks. Evidence also suggests that it improves people's ability to work, their physical capacity and their perceived quality of life. Cardiac rehabilitation is an established therapy and comprises of supervised exercise training, relaxation and education.

What is involved in cardiac rehabilitation?

Cardiac rehabilitation is organized into four phases, beginning in hospital with assessment and individualised education and exercise (phase 1) and continuing in the community for about 12 weeks (phases 2 & 3). Cardiac rehabilitation typically includes the following components:

 - Assessment of cardiovascular risk factors, dietary and exercise habits, levels of anxiety and depression, aerobic fitness,  physical symptoms of chest pain and breathlessness, and motivation to change lifestyle.

 - Education on individual goal planning, cardiovascular risk factors and the development of heart disease; medication; use of the heart manual, diet; exercise; and resuming the usual activities of daily life including sex, driving, and return to work.

 - Exercise

 - Relaxation/stress management

Referrals are made as appropriate (e.g. for smoking cessation, dietary advice). Although formal rehabilitation may be limited to several months of structured programmes, lifestyle changes are intended to be lifelong (phase 4).

Heart failure service.

Heart failure is a serious condition, but it does not actually mean that your heart has failed. It means that your heart is not pumping blood around your body very efficiently. Heart failure causes damage to the heart's pumping action. This damage cannot be repaired.

Heart failure can be caused by a number of other conditions, such as high blood pressure or a heart attack. It tends to affect people over the age of 65, and is more common in men than women.

However, there are many treatments available that can help to keep the condition under control and help to relieve the symptoms. Plus, many of the conditions that cause heart failure can also be treated effectively. This reduces the pressure on your heart.

The heart failure service in County Durham and Darlington aims to optimize the management of patients with heart failure in order to reduce hospital admissions, re-admissions and improve quality of life.The service aims to provide an individually tailored programme of care, which includes lifestyle advice, therapeutic interventions and drug titration as well as assessment for further specialist intervention e.g. palliative care. The service is staffed by GPwSI (GPs with a specialist interest) and heart failure specialist nurses (HFSN) working in conjunction with consultant cardiologists following an agreed service protocol.

Service description.

Patients will be referred into the service via the hospital consultant or the GP. They will be seen in a heart failure clinic by a GPwSI or HFSN. Clinic visits will be supplemented by home visits when necessary. The HFSN will visit those patients identified within the clinic setting and those discharged from hospital following an admission with deteriorating symptoms. The home visits can be used to:

  • Monitor patients considered to be 'high risk' of re-admission
  • Optimise the prescribed treatments
  • Give advice/education
  • Intensify follow up of such patients where appropriate.


Patient education.

An important function of the heart failure service is education and support to both the patient and their families. Education topics may include:

  • What is heart failure, its causes and treatments?
  • Recognising signs and symptoms
  • Medication compliance and side effects
  • Diet / salt restriction
  • Weight monitoring
  • Alcohol
  • Smoking cessation  
  • Benefits of exercise
  • Vaccinations  


Location of clinics.

University Hospital of North Durham (UHND) every alternate Tuesday morning
Shotley Bridge Community Hospital (SBCH) every alternate Tuesday morning

We will endeavour to contact all patients referred into the service within 48 hours and see them within 2 weeks.

Other services.

Nurses working in the community cardiovascular disease service also provide services within secondary care (local hospitals) running nurse led rapid access chest pain clinics (RACPCs) and cardiology review clinics.


Innovative practice.

The community cardiovascular disease service has been involved in innovative practice that is recognised locally and nationally as examples of good practice. Many individuals within the teams,and the teams as a whole have been published in recognised journals and are seen as innovators and models of best practice across the country. Many of the specialist nursing team members have been involved in training and presenting good practice locally, nationally and internationally. Some of the innovative practice that we are involved with at present is summarised below.

The Heartstart Project.

Cardiac patients and their families are being given emergency life support training in a move aimed at doubling patients' chances of survival.

More than 270,000 people a year suffer a heart attack but about 70 per cent of cardiac arrests happen outside hospital and 30 per cent die.

Emergency life support provides the skills needed to keep someone alive until professional help arrives.

For the first time specialist nurses are running courses at NHS Darlington's headquarters, Doctor Piper House.

The Heartstart UK initiative is co-ordinated by the British Heart Foundation to teach members of the public what to do in life-threatening emergencies.

In Darlington the courses are run by community cardiac nurses David Ferguson and Rebecca Dixon, who are both advanced life support instructors.

BHF has provided 12 resuscitation manikins and training guidelines. Each monthly course takes a maximum of a dozen people.

Practical advice is offered on learning how to perform cardiopulmonary resuscitation, dealing with choking and serious bleeding and helping someone who may be having a heart attack.

"The most important factor determining survival after a cardiac arrest is the time from the collapse of the casualty to defibrillation," said Rebecca, who is training supervisor.

"Teaching the community to perform good quality CPR buys time and more than doubles the chances of survival."

"More than 1.4 million people have been trained nationally and this is a very exciting time in Darlington."

The Atrial Fibrillation project

Atrial fibrillation (AF) is a major risk factor for stroke. AF is both under recognised and under treated. AF affects 9000 people and 1.4% of the population in County Durham and Darlington (QOF prevalence 2008). The SAFE trial demonstrated that opportunistic screening increases diagnosis. County Durham and Darlington Community Health Services has been accepted for an NHS heart improvement national priority project looking at  stroke prevention in primary care-addressing Atrial Fibrillation.

The aim of the project is to improve the detection of undiagnosed AF by introducing opportunistic screening for AF into general practice across County Durham and Darlington by incorporating opportunistic radial pulse taking into chronic disease management clinics e.g. diabetic, COPD, asthma and hypertension reviews and CVD risk assessment clinics to screen for AF.

Angina and heart failure telehealth project.

The telemonitoring project is joint funded and supported by Darlington borough council and NHS Darlington. Its aim is to explore the feasibility of mainstreaming the use of telehealth technology as part of the care package for patients with angina or heart failure.Telemonitoring has been used successfully with patients with heart failure in other areas but this pilot is the first time it has been used with angina patients.

The pilot was for 6 months from January 2009- June 2009. Patients were chosen using a selection criteria and asked to take part, consented and the equipment was installed. The patients measured their blood pressure, oxygen levels, weight, blood glucose and electrocardiograph daily using a machine that was installed in their home. They also completed a health diary. The data was sent via an encrypted web page for the specialist nurses to access their data. Data can be sent to GPs or other health professionals as needed. An alarm system was monitored by the CCTV team so that they could flag up any abnormal results daily.

Of the 12 patients who started the project 8 completed it. Pre project, baseline data was collected on all patients and  also at the end. Patients and specialist nurses completed a questionnaire about their experience of the equipment and patients also complete a hospital anxiety and depression score.

The patients found the telemonitoring effective in controlling their conditions and their symptoms. One patient with angina commented "I feel the nurses are with me and monitoring me so I don't feel so scared by my angina pains and I can control it better."

Currently the project is being written up for a nursing journal.

Useful Links and Contact Numbers

Contact numbers for CVD teams

Darlington Community Heart Team
01325 746238
Derwentside Community Heart Team
01207 584350
Durham Dales Community Heart Team
01388 452319
Durham and Chester-le-Street Community Heart Team
0191 378 6925
Easington Community Heart Team
0191 587 6068
Sedgefield Community Heart Team
01429 880888


Monday to Friday 9am - 5pm

Useful Web Links

www.bhf.org.uk

www.dh.gov.uk
www.bhsoc.org
www.arrhythmiaalliance.org.uk
www.resus.org.uk
www.nice.org.uk
www.neelb.org.uk
www.cqc.org.uk

Other local services.

Butterwick Hospice Care - Bishop Auckland & Stockton.

Butterwick Hospice provides support to the bereaved as well as to those upon whom a life limiting illness impacts.

This includes the patient, family, relatives, carers and is offered to adults, children and young people in the form of individual one-to-one support/counselling or as groups.

They specialise in supporting patients and family members who have been affected by heart disease, so if you or anyone you know has been affected please contact Butterwick Hospice for further information on the support they can offer you.





'Care received was fantastic and I was very well looked after and very impressed.'

Patient, Day Surgery, Darlington Memorial Hospital