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The UK Department of Health has unveiled a new framework directed toward helping improve services for those suffering from heart disease. A new toolkit, the National Workforce Competence Framework for Coronary Heart Disease, sets out the core skills needed by National Health Service (NHS) staff to deliver the best services for those with, or at risk of, coronary disease. The skills covered concentrate of the priority areas of prevention, heart failure and rehabilitation.

The inclusion of heart failure as one of the priority areas of the competence framework was highlighted by the Department of Health in its statement announcing the new toolkit. "Often seen as the 'silent killer,' heart failure has traditionally lacked resources and suffered a low profile, despite the fact it is a terminal condition affecting around 900,000 people in the UK," the statement noted. "The new toolkit will encourage the sharing of good practice in this area and ultimately lead to greater consistency in care."

The framework for coronary heart disease, which is the first in a new series of toolkits focused on delivery of coronary care, was spearheaded by the CHD Care Group Workforce Team (CGWT). The Department of Health noted that such teams look at national workforce needs in a particular care area and identify ways in which they may be addressed, such as new ways of working, recruiting and retaining staff and boosting training numbers where there are shortages.

Skills for Health, the emerging skills sector council for health, was commissioned to develop the toolkit last August.

Dr. Roger Boyle, national director of coronary heart disease, said, "I'm looking forward to seeing our teams of heart professionals put the theory into practice and take [coronary disease] care in this country to the next level. It is only by working together efficiently and positively that we can promise our patients the very best advice, treatment and care."

The coronary care framework was launched by Boyle, and Peter Stansbie, director of strategy for the Skills for Health group, in ceremonies held at Kings College Hospital (London). Stansbie said, "The launch of this new toolkit should be welcomed by everyone involved in the prevention and treatment of coronary heart disease. It includes tools to help people apply the competences in their workplace." He added that the toolkit has been designed as a "living" document "we're encouraging feedback so that it will help people both now and in the future."

Trial shows perindopril cuts heart deaths

According to the largest trial ever undertaken in patients with heart disease, at least 50,000 heart attacks and deaths in the United Kingdom could be prevented by treating patients with the ACE inhibitor Coversyl (perindopril). EUROPA (EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease) showed that treatment with perindopril over four years cut the risk of death or heart attack by 20%, reduced the incidence of heart attacks by 24% and heart failure by 39%.

Les Laboratoires Servier, the French pharmaceutical company that makes Coversyl, said perindopril reduced the combined primary endpoint of the trial, which was cardiovascular death, heart attack and cardiac arrest, by 20%. It added that the study investigators reported benefits present in all patient groups with or without hypertension, diabetes and irrespective of age.

The drug could therefore prevent at least 16,000 incidences of heart failure in the UK over four years. A 1999 report in the European Heart Journal said that about 40% of those diagnosed with heart failure die within one year of being diagnosed.

Professor Kim Fox of the Royal Brompton Hospital (London), lead investigator for EUROPA, said the trial results "represent a milestone in cardiology." Noting that the UK has one of the highest rates of heart disease in Europe, more than double that of Italy and three times that of France, Fox said "this is a major step forward for patients." He said that adding perindopril to standard optimal therapy could prevent at least 50,000 heart attacks or deaths in the UK, where coronary heart disease is the most common cause of death, killing one in four men and one in six women. Fox added, "One of the most exciting things about the EUROPA results is that the patients involved were already receiving many preventative therapies, including aspirin, statins and beta-blockers. The addition of perindopril provided a major health gain for these patients. There is now a good case for considering perindopril as part of optimal preventative treatment for patients with coronary disease."

EUROPA involved 12,218 patients from 24 European countries, including 1,772 from the UK. Patients were randomized to perindopril 8 mg once daily or placebo. Servier said perindopril was chosen for the EUROPA study based on its 24-hour efficacy, including blood-pressure control, its documented action on improving the health of blood vessels and because it is easy to use and well tolerated.

The company said perindopril has efficacy in the treatment of cardiovascular diseases, including hypertension, heart failure and more recently, with the results of PROGRESS (Perindopril Protection Against Recurrent Stroke Study), in stroke.

Task force to support UK's medical firms

The UK government last month announced the establishment of a new task force bringing together representatives of the government and the healthcare industry to "work together to support the industry and maximize the benefits for patients." The first initiative of its kind between the government and the healthcare sector, the Healthcare Industries Task Force (HITF) will operate for one year under the joint chairmanship of Health Minister Lord Warner and Sir Christopher O'Donnell, chief executive officer of Smith & Nephew (London). Other participants will include Science Minister Lord Sainsbury from the Department of Trade and Industry; Mike O'Brien, minister of state for trade, investment and foreign affairs, and senior executives from manufacturers of medical products.

The HITF has been charged with delivering recommendations which should benefit patients, encourage the best use of National Health Service (NHS) resources and stimulate science and industry in the UK to improve growth in manufacturing, investment, employment and exports. In announcing the establishment of the task force, Warner said, "The healthcare industry is important to this country, both in terms of developing products to support better healthcare in the NHS, and as an important economic sector." He said the task force "will help us to gain a better understanding of how government and industry can work together for mutual benefit." Saying that "great advances are being made in medical technology," Warner noted, "I want to ensure we harness this expertise and maximize the benefits for the NHS, patients, industry and the national economy."

O'Donnell termed the UK healthcare industry "one of Britain's most successful industrial sectors as well as making a major contribution to the health of the British people." However, he said, "there are further opportunities by partnership with the medical professions and healthcare providers to improve industry growth and to contribute to patient benefits." He called the establishment of the task force "an extremely positive step," one that shows the British government "has recognized these opportunities and established this task force to examine the issues and take action."

Study of cardio risks in dialysis patients

Genzyme Benelux (Zaventem, Belgium) reported the launch of a new study project, Calcification Outcome in Renal Disease (CORD), which will examine cardiovascular risks in kidney disease patients on dialysis treatment, with special attention to vascular calcification as one of the important causes. The study will be conducted in about 30 nephrology centers in Belgium and the Netherlands, with other European countries due to be added to the study later.

Because dialysis patients have an elevated risk of cardiovascular disease, it is important for them to control the phosphorus in their blood, since they are unable to excrete it in the urine and it is not fully removed from their body through dialysis. Thus, nearly all dialysis patients take calcium or non-calcium-based phosphate binders to help control their phosphorus levels.

With the presence of arterial and cardiac valve calcification being recognized as strong predictors of cardiovascular morbidy and mortality, the CORD study will investigate arterial stiffness in relation to the buildup of calcium, with the overall aim of evaluating the cardiovascular risk of those on dialysis treatment. The study will make use of the SphygmoCor PVx system from AtCor Medical (Sydney, Australia), a technology that non-invasively measures central pressure pulse waveforms to determine and to analyze arterial stiffness parameters and central cardiovascular function data.

Stefan Maeser, vice president of Genzyme's renal business in Europe, said, "Managing phosphorus and calcium levels in dialysis patients is critical. This has now also been confirmed by the National Kidney Foundation (NKF; New York), which published new clinical practice guidelines related to bone metabolism and disease in patients with chronic kidney disease." Those guidelines, which appear as a supplement to the October issue of the American Journal of Kidney Diseases, detail what Maeser characterized as "a set of aggressive new therapeutic goals designed to maximize the care of patients with chronic kidney disease." The guidelines cite the need to control serum phosphorus, and Genzyme's Renagel (sevelamer) calcium-free phosphate binder is listed among first-line options in reducing phosphorus in patients on hemodialysis, he said.

The NKF guidelines were drafted by a panel of independent physicians and healthcare professionals in nephrology, internal medicine and nutrition, and were subject to a broad peer-review process.

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