1. AMP (Angina Management Programme)
Chesterfield Refractory Angina Centre
Dr PJ Flann, Dr Clare Hawley
Dr Kath Markus &
Cardiac Specialist Nurse Karen Dunn

2. Why am I here ? AMP – is something different We talk to patients
We inform and educate them
We save money

3. Todays’ Remit
Improve Quality
Innovative
Saves money
Is Preventive

4. The Beginning Training via NRAC & Prof Mike Chester Training 08
Chesterfield AMP Start 1/1/09
Target of 50 patients for the first year.

5. Why ?
Everyone wins

6. Why ?
Patient’s benefit
Cost savings
Evidence
Government agenda

7. Patient Benefits Quality of life Depression Number MI’s Admissions
Number interventions
( & complications )

8. Cost Savings (NRAC results )
On Admissions (15.5 bed days to 10.34)
MI’s + admissions (14% to 2.3%)
Procedures (86% would not choose surgery)

9. Nice – cost per QALY
Exercise £440
Bypass £19000
Angioplasty £47000

10. Evidence Courage - no benefit of PCI in stable angina
CBT - Reduces admissions
Lifestlye - Reduces angina
Cost effective - Griffin et al
QOL
Misconceptions - reduces MI’s
Collaterals

11. Government Agenda
“Improve healthcare by reducing unnecessary waste” Hewitt /06
NHS operating Framework - supporting people with longterm conditions
“Our Health , Our say “ care closer to home

12. What we Do
Listen & Educate patients (rare nowadays)

13. What we do
Angina is Good

14. What we do Assess individual symptoms
Establish their beliefs and misconceptions
Explain collateral development
Explain pre-conditioning
Explain pain and nerve pathways
Help them control angina with relaxation
Give lifestyle advice

15. Misconceptions “angina damages the heart”
“angina is a kind of mini heart attack”
“angina is due to back pressure in the heart”
“the arteries are furring up and will eventually block and I’ll die “
It is important to avoid anything that brings on angina”

16. What we do
We empower the patient to take control of decisions

17. How Time 2hrs individual time 4x2 hrs in group sessions 1 hr follow up
1hr annual follow up

18. Our Cost
£2000 per patient

19. Chesterfield Results 25 patients -2 cohorts 6 x PCI saved
3 x CABG saved
1 Angiogram
All improved with programme

20. Savings £43,888 in procedures ( not including a transplant )
£40,221 on hospital activity
Total £84,109

21. After Cost 25 Patients £52,250 Overall saving = £31,859
£1,274 per patient

22. Our Satisfaction Patients all have less anxiety
Patients all have less angina
Fantastic patient satisfaction results
Number patients cry with relief

23. Referrals Cardiology - new cardiac patients
- longstanding difficult patients
GP’s
- frequent flyers
- difficult patients

24. Problems Cost of training Time for training (8 days ) GP enthusiasm
Pilot set up to train not save money
Convincing the PCT board

25. Problems
Consultants
GP referrals
Correct patients
Waiting list -DNA’s

26. Present Day Running for 18 mths Contract for 4 yrs from PCT
Interest from Sheffield + Derby

27. This is the future DOH wants this rolled out
New NICE guidelines on the way
Stents are now ethically challenged

28. Testimonials
“Looking back I shudder to think where I would be now without these sessions. I expect more visits to my GP and hospital coupled with yet more medication” - Patient
“Since you explained it, I have felt more reassured and confident that the underarm pain I experienced was not related to Angina and don’t now feel I need to call the emergency services.” - Patient
“If, in the near future, I was offered stenting or re-grafting I would be very reluctant to have any more invasive procedures carried out”. - Patient
“My wife benefited too by learning how to relax and knows she doesn’t need to panic when I have an attack. She enjoys having my company on dog walks too” - Patient
He now understands the risk/benefits of further intervention when, previously, he was pushing for bypass and I don’t need to see him again in my clinic - Consultant