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Charting the Cardiovascular Atlas: A Q&A with Sally Cox

Sally Cox collects data - data that can be used to improve lives and strengthen patient care.

Recently, as NWIS Lead Publishing Specialist, Sally played a key role in the preparation of the data for an NHS Wales Cardiovascular Atlas of Variation - a Public Health Wales and NHS Wales Health Collaborative publication spotlighting cardiac issues across Wales with the aim to improve cardiovascular care. 

The atlas was produced at the request of the Welsh Government and hopes to raise questions about equity of access, effectiveness and value of the services provided by NHS Wales and act as a stimulus for transformation, innovation and delivery of evidence-based high-value cardiac services.

The document is available at  Interactive maps and charts to support the release are available on Health Maps Wales .

Q: This seems to be quite a big deal. Can you tell me a bit about what this atlas is hoping to achieve?

A: What the Health Collaborative, Public Health Wales and the cardiovascular experts wanted to do is start a conversation into why there are differences - why there might be different severities of cardiovascular illness across Wales, different rates, different treatments. What they are really looking for is the presence of unwarranted variation which maybe due to the underuse of high value interventions or the overuse of low value ones and then once highlighted, discover the reasons why those variations exist.

Q: High and low value interventions?

Intervention basically means "treatment". High value treatments are those that provide the most benefit to the patient and these should be being used across Wales instead of treatments with limited or low value. This atlas hopes to spotlight if that's the case. The aim is for the Health Collaborative  and the experts to work with the health boards and Welsh Government to improve cardiac services based on the conclusions they make. It's very much a collaboration.

Q: And how do you fit in?

A: I'm part of the atlas technical working group and we received guidance from the expert reference group - the cardiologists and clinicians from across NHS Wales. They would decide what indicators they wanted to look at. They wanted to focus on three main areas: Acute Coronary Syndrome, Heart Failure and Atrial Fibrillation. As part of my role as an analyst, I have access to NHS data sets, and so my job was to collate the data, create the indicators and to do the visualisation - display it in an easily understood way.

Most of the data that was used is held in our national data warehouse, for example, the secondary care data that is collected monthly from health boards. There was also primary care data, cardiac audit data from the health boards and mortality data from the Office of National Statistics.

Q: Let me ask you more about the NWIS Publishing Team. Besides Welsh Government, who asks for information? What do they use it for?

People are always asking for information - researchers looking for statistics, clinicians for figures. And a lot of requests come from our own health boards. They can query their own data, but sometimes they need to see data from other health boards so they can compare their services or maybe where they are nationally.

Our publishing team tries to take that information, compile it and present it in a clear way - whether its text, a graph, a map, or interactive applications. There's a lot of crossover with our publishing team that visualises and displays this information and our NWIS Analysis Team. They deal with tons of ad hoc requests - emails and phone calls from Welsh Government, health boards, GP surgeries, everyone.

Q: Will there be more variation atlases, perhaps for other topics?

A: Well, Welsh Government's plan was to develop a series of variation atlases. This was the first one they wanted to do. But right now, we don't know. Let's see how this does and if it can start the conversations needed to better understand the variation across Wales and work to make a real difference in trying to drive improvement and value-based healthcare.