The National Service Framework (NSF) for Coronary Heart Disease has confirmed the need for a significant increase in the amount of coronary artery surgery and interventional cardiology performed in the UK.

• More than 1.4 million people suffer from angina in the UK.

• Three hundred thousand people have heart attacks every year in the UK. One third of men and a quarter of women below the age of 65 will die within one hour of the onset of symptoms. Of those admitted to hospital most will make an uneventful recovery, but despite hospital treatment 20-25% will die within a month. Overall, about 50% of all victims die within 30 days. The most important predictor of a heart attack is a previous heart attack.

• The burden of CHD is higher in the UK than many other countries and it accounts for approximately 3% of all hospital admission

The NSF sets 12 standards for improving inequity of access and quality of care for patients with coronary heart disease over a ten year time frame.  Standards 9 and 10 apply specifically to coronary revascularisation and are described in Chapter 5 of the NSF document. The standards are supported by defined deliverables in the form of Milestones which define the rate of progress towards the standards over the next few years. As a result of the devolved nature of healthcare administration the NSF applies only to England and Wales.

The 10 year goal is that patients satisfying the NSF criteria for angiography and revascularisation will be identified and treated within agreed specified waiting times. The waiting time goal for referral by GP to specialist assessment/consultant appointment is 2 weeks maximum followed by prompt investigation and for those for whom it is indicated, revascularisation with 3 months of a decision to operate.  Current estimates are that this will equate to a national rate equivalent to at least 750 coronary artery bypass operations per million population (PMP) and at least 750 PMP for percutaneous coronary interventions depending on the local standardised mortality ratio (SMR) for coronary heart disease. 

The aim of this document is to explore the options available for increasing the number of coronary bypass operations while maintaining and improving standards of care.