Best Practice and Quality Care in Cardiology at Sir Charles Gairdner Hospital

Mr. Stephen Bloomer - Project Manager stephen.bloomer@health.wa.gov.au

The contents of this page and related links were updated on 23rd September 2004.

The Cardiology Department at Sir Charles Gairdner Hospital have developed systems to monitor compliance with Best Practice in the major cardiology diagnoses. These systems have been in place since October 29th 2001.
The major aim is to quantify and account for compliance with Class I evidence in cardiology. Previously, many studies from around the world have demonstrated poor compliance. The compliance at this Hospital is excellent,
Class I evidence is defined as Class I evidence is defined as “Conditions for which there is evidence and/or general agreement that a given procedure or treatment is beneficial, useful, and effective.”. In other words the size of the treatment effect means that the procedure or intervention should be performed/administered.
The information provided at this site and the related links are for interested clinicians and health consumers.
Those patients discharged from the Cardiology Department at Sir Charles Gairdner Hospital should have received, if applicable, their individual compliance with Best Practice for their condition. The clinicians at ward level receive reminders in undertaking the discharge summary to assess compliance with Best Practice, the results of which will be on their discharge summary.
To date no other Hospital in Australia has such a system. It is hoped other Hospitals in Australia will follow this lead project.
Should you hve any feedback on this site, and related links, please contact the Project Manager, Stephen Bloomer, on stephen.bloomer@health.wa.gov.au.

International Classifications for Best Practice

Compliance with Best Practice in the Major Diagnoses treated in Cardiology at Sir Charles Gairdner Hospital.
This compliance includes patients who are ideal and non-ideal for an intervention; for instance patient with asthma may not receive a Beta Blocking agent as this will exacerbate their asthma.

Best Practice Evidence for S-T Segment Elevation Myocardial Infarction (STEMI)

Best Practice Evidence for Non S-T Segment Elevation Myocardial Infarction (NSTEMI) and Unstable Angina

Best Practice Evidence for Heart Failure – American Heart Association/American College of Cardiology

Best Practice Evidence for Heart Failure – European Society of Cardiology

New York Heart Association Classification of Heart Failure

Best Practice Evidence for Atrial Fibrillation

Risk Stratification for Primary Prevention of Thromboembolism in Patients with Non-Valvular Atrial Fibrillation (from ACC/AHA/ESC Guidelines)

Acute Coronary Syndrome Worksheet

Heart Failure, Atrial Fibrillation/Flutter Worksheet

Reducing Risk in Heart Disease NHF Australia
This document is important in that it outlines interventions and targets for patients with all forms of vascular disease

Clinical Aid
Although some of the targets are different to that of the National Heart Foundation (above) it is a useful desktop aid for clinicians and consumers, based on evidence.

Titration of Cardiac Medications
Titration of ACE Inhibitors
HOPE study titration of Ramipril
Titration of Beta Blockers in Systolic Heart Failure
Although some medications have been commenced or continued in Cardiology, with some medications it is best to titrate the medications to the optimum dose – under the directions of a Healthcare professional (Physician or Appropriate Nurse)

Follow Up
In light of this increased consensus a document has been issued through the peak bodies in Australia. This page is a quick reference point for when follow up should occur for various risk factors.
Reproduced from: Australian Family Physician Vol. 33, No. 4, Page 237, April 2004

National Heart Foundation

Diabetes Australia
Many patients with cardiovascular disease also have diabetes

Major Disease Risk Factors (MaDRiFt)

There has been increased realisation and consensus from many bodies in Australia and elsewhere that the traditional cardiovascular risk factors overlap as risk factors for many diseases; not just heart attacks and heart failure but also stroke diabetes, cancers of many types and kidney disease. For further information review the following articles.

Consensus Statement for the Prevention of Vascular Disease
The National Vascular Disease Prevention Alliance (Diabetes Australia, Kidney Health Australia, National Heart Foundation of Australia, and National Stroke Foundation of Australia).
Reproduced from: Australian Family Physician Vol. 33, No. 4, Pages 235-239, April 2004

Preventing Cancer, Cardiovascular Disease, and Diabetes
A Common Agenda for the American Cancer Society, the American
Diabetes Association, and the American Heart Association
Reproduced from: Stroke. Vol 35, Pages 1999-2010, August 2004.