Implementing Chapter 8, Arrhythmias and Sudden Cardiac Death

The Coronary Heart Disease (CHD), National Service Framework (NSF), Chapter 8 - Arrhythmias and Sudden Cardiac Death was published in March 2005 by the Department of Health for implementation in the UK National Health Service (NHS)

The welcomed publication of the Coronary Heart Disease (CHD), National Service Framework (NSF), Chapter 8 - Arrhythmias and Sudden Cardiac Death, five years after the original preceding chapters of the CHD NSF were put into action, has inevitably meant that we still have a long way to go in improving quality of care for arrhythmias and prevention of sudden cardiac death.

What is immediately apparent from reading chapter 8, in relation to the heart rhythm disorders discussed, is that RATCs unquestionably meet the vision set out in the document. In fact the chapter implicitly refers to the ‘development of rapid access multidisciplinary arrhythmia and/or T-LoC clinics’ as part of its recommendation for service improvements.

Looking at the recommendations in more detail it becomes even more apparent how relevant the RATC is and the impact this could have on the lives of those affected. The quality requirement relating to ‘Diagnosis and Treatment’ laid out in Chapter 8 specifically refers to ‘accurate’ diagnosis, exactly what the triage system of the RATC aims to tackle.

We cannot ignore the rates of misdiagnosis of syncope as epilepsy and the sometimes laboured time to diagnosis that many patients have to endure when suffering from unexplained blackouts/ T-LoCs. Low levels of awareness of cardiac arrhythmias amongst healthcare professionals is certainly a contributing factor and an RATC provides an invaluable first-stop clinical evaluation, that shifts the judgment to a specialist multi-disciplinary team. As stated in Chapter 8, it is the multi-disciplinary team that is ‘key to ensuring improved service’ and in turn central to the principles of the RATC.

This requirement also intuitively refers to the need for ongoing education. It is important to recognise the versatile nature of the RATC, not only providing invaluable education for staff but also potential sufficient volume of activity to create a growing band of specialist blackout/T-LoC nurses. The RATC would also facilitate broader education of patients, GPs and the general population.

The word ‘timely’ appears repeatedly in Chapter 8 and, in relation to diagnosis, stresses the need for a clinically effective care pathway to facilitate this. The RATC is centred on exactly that. Although the clinic would not aim to diagnose the patient, it would provide a specialist clinical assessment to cut through the current pace of accurate diagnosis and essentially improve patient care.

It is this timeliness that is core to the quality requirement of ‘patient support’ included in the chapter. A patient presenting at A&E with an unexplained blackout/T-LoC, who is referred to the RATC, could see the team within days of their episode. For a patient, the psychological significance and value of setting the treatment pathway in motion, and the provision of information at such an early stage, is unquestionable.

The setting up of an RATC is not only specified within Chapter 8 but the clinics are entirely aligned with the broader markers of the chapter. In light of this, the proliferation of RATCs across the UK would help make considerable headway in implementation of Chapter 8. The aim of this website is to provide clinicians with the right tools and information to get an RATC project off the ground and so facilitate local implementation.

Delivering the 18 Week Patient Pathway

The potential for the RATC to significantly contribute towards the government’s 18 week waiting time target is compelling. However, establishing at what point in the patient pathway the ‘clock stops’ may be a challenge in circumstances where a clinical decision and treatment options may need further investigation. To assist healthcare professionals, the Department of Health has developed an interactive pathway to demonstrate where the RATC would fit into this pathway. Supplementary information to be read in conjunction with the interactive pathway, as well as a pdf version of the pathway, can be found on the 18 Weeks website.