The quality statement for heart conditions

The Quality Statement for Heart Conditions replaces the Heart Conditions Delivery Plan. 

Cardiovascular disease (CVD) remains a leading cause of ill health and premature death in Wales, responsible for around 1-in-4 of all deaths and 29.5% of avoidable mortality (2023).

For the past 50 years there has been a steady fall in the death rate from CVD, partly because of the introduction of improved treatments and the recognition and treatment of cardiovascular risk factors.

Falling death rates from acute events like heart attacks has resulted in more people living with heart and circulatory conditions (latest estimate 400,000 people in Wales), and this cohort of people is likely to increase due to the growing and ageing population. However, over the past decade the death rate from CVD has plateaued and the premature death rate in Wales is consistently higher than in England.

There needs to be a multi-agency approach to reducing the significant and growing burden of cardiovascular disease in Wales with a clear focus on prevention and addressing health inequalities. Within NHS Wales a systematic approach to identifying and treating known cardiovascular risk factors such as high blood pressure, high cholesterol, diabetes, and obesity is essential.

Health boards and NHS trusts are responsible for planning and delivery of cardiac services in line with clinical standards and the planning expectations set out below. NHS Performance and Improvement’s (NHSPI) Strategic Cardiovascular Disease Network will work with NHS organisations and partners to deliver national enabling actions for the service improvements described below.

The Welsh Government provides funding for eleven national clinical audits and registries as part of the National Cardiac Audit Programme (NCAP) run by the National Institute for Cardiovascular Outcomes (NICOR) to inform healthcare providers and research organisations. NICOR’s requirement for data submission is changing to monthly as the NCAP moves towards more frequent reports to facilitate a quality improvement approach.

The National Cardiac Audit Programme (NCAP) informs hospitals and commissioners of the quality of care provided in their delivery of cardiovascular services. Consisting of eleven different sub-specialties (or ‘domains’), this 2025 NCAP includes information on service delivery for the financial year 2023 to 2024 or, where metrics cover a three-year period, from 2021 to 2022 to 2023 to 2024. 

Information to support clinical quality improvement is provided by the:

• National Congenital Heart Disease Audit (NCHDA)
• Myocardial Ischaemia National Audit Project (MINAP) 
• National Audit of Percutaneous Coronary Interventions (NAPCI) 
• National Adult Cardiac Surgery Audit (NACSA)
• National Heart Failure Audit (NHFA)
• National Audit of Cardiac Rhythm Management (NACRM)
• UK Transcatheter Aortic Valve Implantation Registry (TAVI)

Three new structural heart intervention registries have been introduced over the last two years. There are insufficient cases to provide a full set of quality improvement (QI) outputs, but the current status is summarised at:

• Transcatheter Mitral and Tricuspid Valve procedure (TMTV) Registry
• Left Atrial Appendage Occlusion (LAAO) Registry
• The Percutaneous Foramen Ovale Closure (PFOC) Registry

The  National Audit of Cardiac Rehabilitation (NACR) is aligned to the NCAP, and continues to report with a separate timetable.

Equitable

1. Health board executive, clinical, and operational leaders for cardiology routinely collaborate at the national level through the NHSPI Cardiac Implementation Network to improve the quality and equity of locally delivered cardiac services.
2. Health boards and NHSPI use data from the National Cardiac Audit Programme (NICOR), Cardiovascular Atlas of Variation (NHS Wales), PROMs, peer review and other nationally comparable datasets to drive cycles of quality improvement in the standard of care and to address unwarranted variation in care quality and outcome.
3. Health boards, with support from Health Education and Improvement Wales (HEIW), review workforce planning to ensure the cardiac workforce can provide sustainable and equitable services, with a specific focus on cardiac physiology, specialist nursing, and consultant cover.
4. NHSPI, working with the Life Sciences Hub and Health Technology Wales, enables partnership working between health boards and industry to identify, test, and roll out innovation in cardiovascular care through national programmes.

Safe

5. Health boards, working with NHSPI and through the Joint Commissioning Committee, review specialist cardiac services with insufficient activity to meet required clinical standards and consider service reconfiguration.
6. NHSPI review clinical audit and service data to identify quality and safety concerns relating to cardiac care or outcomes and escalate these issues to the Quality and Delivery Board for consideration.
7. Health boards consider and respond to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommendations relating to cardiac care.

Effective

8. Health boards and NHS trusts embed nationally agreed pathways and service specifications for cardiac care in the local planning of services.
9. The NHS Wales Joint Commissioning Committee commission the Welsh Ambulance Services NHS Trust to implement an out of hospital cardiac arrest plan to support improvements to return of spontaneous circulation performance and survival rates enabled by the ‘Save a Life Cymru’ programme.
10. Health boards collaborate with Public Health Wales on the implementation of the National Cardiovascular Disease Prevention Plan for Wales.

Efficient

11. Health boards ensure cardiology job planning includes sufficient time for enhanced clinical triage of outpatient referrals.
12. Health boards apply the cardiology Optimisation Frameworks agreed through the Planned Care Programme Board to improve patient access to appropriate diagnostic testing and clinical review.
13. Health boards to apply the Value and Sustainability Board’s high-value metrics for heart failure to inform local quality improvement activity. 
14. Health boards, working with Digital Health and Care Wales (DHCW), procure and use a national Cardiac PACS and Information System across Wales to enable greater integration of care and standardised data to support service improvement. 
15. Health boards to support greater use of advanced practice roles and non-medical prescribing roles in cardiac services, including among pharmacists, nurses, and rehabilitation teams.
16. Health Boards to embed cardiology training standards within the framework to ensure provision of services meets population need as well as the needs of the doctors and other professions providing care.
17. Health Boards in conjunction with HEIW to ensure the national provision  of CPD related to public health competencies for cardiology staff, including cardiologists in training as well as consultants.

Person centred

18. Health boards provide a co-produced approach to person-centred care that supports joint decision making on diagnostic investigations and treatment options.
19. Health boards work with patients and partner-led stakeholder forums to learn from patient experience to improve pathways of care and cardiology service models.
20. Health boards provide equitable access to comprehensive, multi-disciplinary cardiac rehabilitation as outlined in the British Association for Cardiovascular Prevention and Rehabilitation Standards and Core Components (BACPR).
21. Health boards provide Heart Failure rehabilitation to those eligible.
22. Health boards collaborate through the national Community by Design programme to deliver appropriate cardiology investigations and care in the community.

Timely

23. The Welsh Ambulance Services NHS Trust support improved outcomes for people in cardiac (or respiratory) arrest by supporting callers when at scene through efficient emergency call‑handling and triage, dispatcher-assisted CPR, delivering early Advanced Life Support (ALS) and, supported by Health Boards, seamless transfer into hospital care.
24. Health boards ensure access to outpatient cardiac diagnostic tests comply with the national 8-week target and key inpatient cardiac tests are available seven days a week in all acute hospitals, delivered by a sustainable cardiac physiology workforce.
25. Health boards regularly review outpatient waiting times and utilise the National Component Waits Dashboard to identify avoidable delay in the referral to treatment 26-week target a system review.

The NHS Wales Performance and Improvement will develop service specifications or pathways to support health board and trust planning.

Acute Heart Failure Pathway (currently being finalised)

British Association for Cardiovascular Prevention and Rehabilitation Standards and Core Components 2023

Cardiac-Rehabilitation-Consensus-of-Key-Terminology