Update

Five ways the NHS Long Term Plan can turn back the tide on cardiovascular disease

With the launch of the NHS Long Term Plan just around the corner, we examine what the BHF is calling for and the impact these actions could have on cardiovascular care.


19 November 2018, by Siobhan Chan

What does success look like for cardiovascular disease (CVD) care over the next decade?

It’s a question – along with many others – that the health service will seek to solve when it sets out its Long Term Plan next month. 

It follows the announcement in June of a 3.4% per-year real-terms budget increase over five years in England starting in April 2019.

Cardiovascular and respiratory health is listed among the plan’s four clinical priorities. Meanwhile, Public Health England (PHE) has called for the NHS to prioritise the prevention of CVD in the plan, as well as smoking and obesity.

The BHF has now added its voice. We’ve recommended five core actions for the NHS and Government that we believe will make the biggest impact for people with or at risk of CVD.

1. Tackle the big population health problems

View of smog over London

Millions of people are at greater risk of CVD because of air pollution, smoking, obesity, and poor diet.

Air pollution can worsen cardiovascular conditions. By 2035, major air pollutants will account for 2.5 million extra cases of disease including CVD in England according to PHE estimates.1

We want to see the legal limits on air pollution lowered to match those suggested by the World Health Organization, mandatory charging ‘Clean Air Zones’ in areas with the worst air quality and a national reporting scheme so that people can protect themselves when air quality is poor.

The Government must also work with industry to significantly reduce salt content in food, helping to lower cases of uncontrolled high blood pressure (BP). It must also encourage greater physical activity and move towards a target for a ‘smoke-free country’ by 2030.

2. Earlier detection of the major risk factors

Man having blood pressure taken

Detecting and managing risk factors for heart attack and stroke should be a priority for the NHS.

We currently rely on overstretched primary care services for detection, but the NHS should explore innovative ways of reaching those most at risk. We need coordinated, national action – including testing services in community pharmacies, football stadiums, train stations and workplaces – as well as better support for self-management.

Countries such as Canada, which has increased hypertension diagnosis and treatment rates from 13% to 57% in three decades, show us that community-based health promotion, and partnering with healthcare professionals to improve long term disease management can have a dramatic impact.

If we matched Canada’s levels of early detection and treatment for high blood pressure, we could prevent an estimated 115,000 heart attacks, strokes and other cardiovascular events in England over the next decade.2

In addition, nearly 1 in 100 people (525,000) in England are estimated to have undiagnosed inherited heart conditions, including familial hypercholesterolaemia. To improve detection, the NHS must increase access to cascade testing and invest in a heart disease genetic testing programme.

3. Improve timely access to the best treatments

Ambulance driving

We must reduce variation in the care received by people who have had a cardiovascular event.

We can improve outcomes for heart attack patients by ensuring they are treated at specialist cardiac centres, and that all cardiac arrest services are commissioned to a standard specification.

For people who have had a stroke, mechanical thrombectomy – where the blood clot is removed from the blood vessel – is highly effective, but only 5% of eligible patients actually receive it. By extending treatment access, we could help up to 2,000 people every year in the UK avoid a life-changing disability.3

Urgent improvements in the diagnosis and management of heart failure and heart valve disease are also needed.

And patients suspected of heart failure should have access to brain natriuretic peptide (BNP) testing and easier access to hand-held echocardiography; timely access to specialist assessment; and end-of-life support if necessary. Taking this approach to the treatment of heart failure could prevent up to 230,000 hospital admissions and 30,000 deaths in England over the next decade.4

4. Reimagine rehabilitation services

Group of people at an exercise session

People recovering from a cardiovascular event should be offered the support to help them recover and live healthier, more active lifestyles.

Cardiac rehabilitation is proven to reduce hospital readmissions and improve patients’ quality of life, but only half of those eligible take up these services. Achieving uptake of 85% in England would lead to nearly 20,000 fewer deaths and avoid nearly 50,000 hospital admissions over the next ten years, as well as saving tens of millions of pounds.5

Most cardiac rehabilitation is group-based and undertaken in a hospital setting. We know that certain groups – women, people from more deprived areas, people from black and minority ethnic communities and people with heart failure – are less likely to attend.

Innovative ways of delivering these services could help tackle this problem – for example, digitally supported, home-based and more personalised ‘menu-based’ approaches.

5. Exploit the potential of technology and data science

Genome sequencing

New technologies and data science offer opportunities to address the challenges of CVD.

We’ve seen advances already, such as using wearables to detect and manage risk factors; avoiding hospital visits through at-home monitoring; and employing artificial intelligence to aid our understanding of diseases.

Big data will drive this transformation but for this potential to be realised, we need to overcome a number of barriers currently limiting progress.

We must promote effective data-sharing to ensure that patients receive greater continuity of care, and healthcare professionals and researchers have access to real-world evidence.

We need the NHS to be working in partnership with others to develop, test and roll-out innovative solutions to cardiovascular problems, including investment in health technology and digital tools that facilitate remote-monitoring and self-management.

And we must create the right environment to ensure data scientists, whose expertise underpins all of this work, are incentivised to work within healthcare.

The public must also be involved in the use of data science in healthcare delivery, if new technology is to achieve the greatest benefit.

 

Read the full report

References

  1. PHE, Estimation of costs to the NHS and social care due to the health impacts of air pollution, 22 May 2018
  2. Imperial College Health Partners analysis for the BHF using Sheffield/Public Health England CVD Return on Investment tool
  3. McMeekin, P et al (2017) Estimating the number of UK stroke patients eligible for endovascular thrombectomy. European Stroke Journal, Vol 2(4) 319-326
  4. Mortality and hospital admissions estimates based on Bottle A et al (2018) Routes to diagnosis of heart failure: observational data using linked data in England. Heart 2018; 104: 600-605.
  5. Hinde, S et al (2018) Improving Cardiac Rehabilitation Uptake: Potential health gains by socioeconomic status. Submitted for publication.