SIGN 97: Risk estimation and the prevention of cardiovascular disease

Guideline Index Page | SIGN Methodology

13 Implementation and audit

13.1 Local implementation

Implementation of national clinical guidelines is the responsibility of each NHS Board and is an essential part of clinical governance. It is acknowledged that every Board cannot implement every guideline immediately on publication, but mechanisms should be in place to ensure that the care provided is reviewed against the guideline recommendations and the reasons for any differences assessed and, where appropriate, addressed. These discussions should involve both clinical staff and management. Local arrangements may then be made to implement the national guideline in individual hospitals, units and practices, and to monitor compliance. This may be done by a variety of means including patient-specific reminders, continuing education and training, and clinical audit.

13.1 SMC and NICE guidance

The Scottish Medicines Consortium has issued advice on the use of nicotinic acid (February 2006).295 Assessments on a number of statins, angiotensin receptor blockers, beta blockers and direct thrombin inhibitors are also published. Further details are available from www.

The following reports have been approved by NHS Quality Improvement Scotland:

NICE Technology Appraisal Guidance - No. 39 Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation.300

NICE Technology Appraisal Guidance No 51 - The use of computerised cognitive behaviour therapy for anxiety and depression.301

NICE Technology Appraisal Guidance No 52 - The use of drugs for early thrombolysis in the treatment of acute myocardial infarction.302

NICE Technology Appraisal Guidance No 80 - Acute coronary syndromes ? clopidogrel.303

NICE Technology Appraisal Guidance 90 - Clopidogrel and modified-release dipyridamole in the prevention of occlusive vascular events.304

NICE Technology Appraisal Guidance No. 94 - Statins for the prevention of cardiovascular events.305

13.3 Key points for audit

The National Clinical Datasets Development Programme and ISD Scotland are working to develop national standard datasets for implementation in IT systems supporting patient care. The following clinical datasets have been developed and are available at

The CHD and Stroke Programme is setting up working groups to develop methods and coding definitions to support the monitoring of the new SIGN guidelines from new datasets and existing data collections. Where there are gaps in the data ISD Scotland will work to support the necessary information collection.

13.4 Recommendations for research

Risk estimation

Physical activity and exercise

The dose response of exercise for reducing CVD risk is well recognised. Further questions following from this are:



Pharmacological intervention



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Guideline Index Page | SIGN Methodology

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