1. The National Refractory Angina Centre
Royal Liverpool and Broadgreen University Hospital,
Liverpool, UK
www.angina.org
Professor Mike Chester, Director

2. The National Refractory Angina Centre
Royal Liverpool and Broadgreen University Hospital,
Liverpool, UK
www.angina.org
“Cardiology’s best kept secret”
Professor Mike Chester, Director

3. National Refractory
Angina Centre
(NRAC)
Established 1996

4. Post code L14 3PE
Western end of the M62

5. •The UK‟s first
patient-centred
angina clinic

6. National Awards
• National Nye Bevan award 2000
• National NHS Hospital Doctor
award 2002
• Health Service Journal King‟s
Fund Safety ward highly
commended 2003
• UK Customer Experience award
2009

7. Ann Keen Health Minister,
HANSARD 15 Oct 2008
“The ongoing development of
the NRAC as a national
and international centre of
excellence for the treatment
and management of
refractory angina, …

8. means that we have not only
the best possible service to
which people in this country
can be referred for that
condition,……

9. ….. but a blueprint for the
development of other such
services elsewhere.”

10. And the revolutionary
concept was……

11. Ask patients
what they
want..

12. Ask patients
what they
want..
…then explain
the options

13. “Making consent patient-centred”
John Bridson, Clare Hammond, Austin Leach & Michael R Chester
BMJ 2003;327;1159-1161
doi:10.1136/bmj.327.7424.1159

14. Commission for Health
Improvement report
Jan 2003

15. “NRAC‟s involvement of
patients and carers at every
stage of the development of
their care……

16. “NRAC‟s involvement of
patients and carers at every
stage of the development of
their care……. is something
from which the rest of the
NHS could learn ”

17. Patient empowerment &
patient engagement
Depend on
Patient education

18. Most patients don’t really
understand what is wrong
with them

19. Most blame themselves for
being ignorant

20. Few would think of criticizing
their doctor for being poor
teachers

21. What makes
a good doctor?

22. What makes
a good doctor?
“Always finds time to
listen and............
the really good ones
explain”

23. The problem

24. “Because the presentation of
ischaemic heart disease is often
dramatic……

25. “Because the presentation of
ischaemic heart disease is
often dramatic……
..and because of impressive
recent technological
advances………

26. ….. healthcare providers tend
to focus on diagnostic and
therapeutic interventions…..

27. ……. often overlooking critically
important aspects of high-
quality care.

28. ……Chief among these
neglected areas is the education
of patients.”

29. Joint American Cardiology associations‟
Stable Angina guidelines
http://www.americanheart.org/presenter.jhtml?identifi
er=3004542
……Chief among these
neglected areas is the education
of patients.”

30. Educating patients…..

31. • improves quality of life1
• reduces angina frequency and
severity1
• improves function2
• reduces hospital admissions3
• reduces incidence of MI3
1. Moore R et al., Eur J Pain. 2005 Jun;9(3):305-10)
2. Moore R et al., J Pain & Symptom Management;33(3):310-316
3. Furze J et al., Psychosomatic Res 2005 59: 323-29

32. •reduces demand for
palliative cardiac procedures
(bypass and stents) 1,2,3
1. EurHeart J 1997;18:394-413
2. Lewinet al. British Journal of Cardiology 1995; 2(8):
221-226
3. OrnishD. Am J Cardiol. 1998 Nov 26;82(10B):72T-76T.

33. Jon Develing
Specialist Cardiac
Commissioner in
2002

34. “I believe that the patient
centred treatment
approach being offered
presents a real alternative
to other forms of
treatment…

35. … including
revascularisation,
catheterisation and other
invasive procedures
including the high cost
treatments such as DES
(drug eluting stents)”

36. “The economic savings
and impact on activity and
waiting list targets have
the potential for
efficiencies and
modernisation”

37. Bob Ricketts (Head of Access
Policy Development and
Capacity Planning at the DoH) to
Duncan Selbie, (Director General
of Commissioning DoH) 2006

38. “I heard Mike [Chester] present at
Harrogate and have also discussed with
Ian Rutter and others the underpinning
evidence. This is deeply impressive work
which could generate substantial benefits
in terms of improved patient care and
value for money.”

39. “I heard Mike [Chester] present at
Harrogate and have also discussed with
Ian Rutter and others the underpinning
evidence. This is deeply impressive work
which could generate substantial benefits
in terms of improved patient care and
value for money.”

40. Judge of Judges UK
Customer Experience
Award 2009
„NRAC is the NHS
experience that the
patient has been
waiting for”

41. But…
only if

42. drugs have failed and
operations are
technically unfeasible

44. you would prefer to
avoid an operation
unless it is „life or
death‟

45. Most angina
patientswrongly believe
that angioplasty and
stent procedures prevent
heart attacks

46. The properly
educated know
better

47. Dr Martin Thomas
President of the British Association
of Interventional Cardiologist’s
Aug 2007.

48. “It has never been the
interventionist’s claim that
PCI impacts on mortality”
Medical version

49. “We never never said that
unblocking arteries with a
balloon makes patients live
longer”
Patient version

50. So why do so many
patients think it does?

51. Joint American Cardiology associations‟
Stable Angina guidelines
http://www.americanheart.org/presenter.jhtml?identifi
er=3004542
……Chief among these
neglected areas is the education
of patients.”

52. Over 99% of NRAC
patients agree with the
authorities and think
patients should be
properly educated
before operations

53. Thanks for taking
the time
www.angina.org