Summary

Coronary heart disease (CHD) is a condition which occurs when fatty material builds up in the walls of the coronary arteries, causing them to narrow, and reducing blood flow to the heart. Such deposits of fatty material are called an atheroma. If an atheroma ruptures in a coronary artery, it can cause a blood clot to form. This cuts off the supply of blood and oxygen to the heart, causing a heart attack. As such, patients with CHD are at greater risk of a heart attack.

Care pathways

This pathway is designed to identify patients with CHD, and to control factors that could contribute to an ischaemic event.

1️⃣ Book the appointment

1. We are using a combination of platforms / tools / teams to book patients in correctly with minimal manual effort. If @Louis Williams hasn’t already been in touch, check out the page to find our Monthly Summary plans or reach out to him to find out what you should be doing:
• If we’re using Hippo Labs, log into app.hippolabs.co.uk to find patient lists (see for more information)
• If we’re using Hero Health or AccuRX, @Louis Williams will send your team manual excel recall lists

2. Call the patient to book an appointment with an HCA or Nursing Associate
3. Explain what the appointment is for, and advise them that they’ll have a blood test on the day

2️⃣ Patient arrives for appointment

1. Record that the patient has arrived in the appointment book
2. Allow the patient a moment to relax before asking to capture data on height, weight, blood pressure, smoking status, and alcohol status (if possible) and add to patient’s EMIS record
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How-to guides

3️⃣ Carry out review

1. Open the clinical template ‘Penrose Health - CHD’ on EMIS
2. Draw bloods (for HbA1c, Cholesterol, eGFR and U&E) and complete the ‘HCA review’ and ‘HCA’ pages of the template
3. Offer influenza and pneumococcal vaccination, if appropriate
4. Make appropriate referrals
• For BMI, refer to 🍎The Lambeth Healthy Weight Hub, 🍎Up! Up! Lewisham (Tier 2 Weight Management), 🍎NHS Tier 2 Weight Management Service or 🍎NHS Tier 3 Healthy Weight Programme as appropriate
• For smoking cessation, refer to 🚭Southwark Stop Smoking Service, 🚭Lewisham Stop Smoking Service or 🚭Lambeth Stop Smoking Service
5. Provide advice on reducing alcohol intake, as appropriate

4️⃣ Check & triage results

1. Review results, and action as per the 🔬Lab Reports (Path Links) page. If, according to this page, a follow-up appointment is required, progress to step 5 below.

5️⃣ Follow-up appointment

1. Open the clinical template ‘Penrose Health - CHD’ on EMIS and complete the ‘Pharmacist review’ and ‘Pharmacist’ pages of the template

2. Check that the patient is on a statin or other lipid-lowering therapy
• If not, initiate medication
• If they are but QRISK2 is out of range, review dosage

3. As blood pressure measurements are off-target according to the Hypertension Guidance for Primary Care in South East London, a follow-up will be needed as this could be an indicator of 📈Hypertension
4. As HbA1c is off-target, a follow-up is needed as this could be an indicator of 🍏Pre-diabetes or 🍎Diabetes