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
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
The community cardiovascular disease service is one large team
located geographically to serve the people in this area.
The team is managed by the Clinical Services Manager - Mark
Each geographical area has their own cardiovascular clinical team
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
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
- 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.
- 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
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.
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:
An important function of the heart failure service is education and
support to both the patient and their families. Education topics
Location of clinics.
University Hospital of North Durham (UHND) every alternate Tuesday
Shotley Bridge Community Hospital (SBCH) every alternate Tuesday
We will endeavour to contact all patients referred into the service
within 48 hours and see them within 2 weeks.
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
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
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
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
In Darlington the courses are run by community cardiac nurses David
Ferguson and Rebecca Dixon, who are both advanced life support
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
"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
"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
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
Currently the project is being written up for a nursing
Contact numbers for CVD
Monday to Friday 9am - 5pm
Useful Web Links
Other local services.
Butterwick Hospice Care - Bishop Auckland &
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
'The treatment I have received from all the staff has been
excellent and could you extend my thanks to them all. A very
thankful and relieved patient'.
Patient, Dermatology Outpatients Department, University Hospital
of North Durham