National service framework heart failure

Abstract

The United Kingdom has one of the highest rates of coronary heart disease in Europe. Despite this, levels of surgical intervention are one of the lowest of the member states. Such inequality in care is also recognised at a local level; among unskilled men the death rate is almost three times higher than it is in professionals. The Prime Minister Mr Blair has acknowledged these inequalities, promising to increase spending on the National Health Service (NHS) to meet that of Europe. More recently the Government has produced a “National Service Framework” (NSF) designed to “transform the prevention, diagnosis and treatment of coronary heart disease”. The Framework sets out a 10 year programme with a target of a reduction in coronary heart disease and stroke of 40% by the year 2010. This will be delivered through twelve identified standards. These include primary and secondary prevention of coronary heart disease, management of acute coronary syndromes and myocardial infarction and strategies for revascularisation. There are separate sections on rehabilitation and heart failure. This “radical and far-reaching programme” (British Medical Journal 11th March 2000) sets out how “the system of heart care will be expanded and reformed to provide one of the best services in the world”. Can this ambitious claim be substantiated in one of the most neglected but expanding areas of coronary heart disease that of heart failure?