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Preventing Heart Attacks and Strokes
The Size of the Prize
Dr Matt Kearney General Practitioner and National Clinical Director for CVD Prevention
NHS England and Public Health England
“The NHS needs a radical
upgrade in prevention if it
is to be sustainable”
5 year Forward View 2014
NHS Prevention Board
“The NHS Prevention Board endorses
CVD prevention as a priority for the
Health and Social Care systems”
January 2017
www.england.nhs.uk
4
CVD Prevention – a must do for NHS sustainability
• NHS RightCare will work with CCGs and STPs to
improve detection and management in the High
Risk Conditions for CVD
• Public Health England will work with STPs and
NHS RightCare to support the implementation of
identified preventative interventions at scale.
The growing burden of CVD
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CVD dramatic fall in premature mortality
Total CVD mortality
declined by 68%
between 1980 and
2013 in the UK
Ref: Bhatnagar et al, Heart Online,
2016
CVD – parallel rise in morbidity
From 1981 to 2014
7-fold increase in
CVD prescriptions in
England
Ref: British Heart Foundation,
2015
A population getting older …
www.england.nhs.uk
A population getting bigger
9
Getting serious about prevention
What can the NHS do?
1. Population level interventions, eg:
• National policy and strategy
• Local action through STP partnerships
2. Support for individual behaviour change, eg:
• NHS Health Check
• Diabetes Prevention Programme
• Social prescribing
3. Early diagnosis and optimal treatment of the high risk conditions
• NHS RightCare Programme
• NHS Health Check
Diabetes Prevention Programme – Early indicators
1. Coverage 75% England
2. On target to enrol 100,000 by 2020
3. Take up 48%
• Half male
• 80% under 75
• More from deprived and BAME communities
4. Retention – TBC
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Secondary Prevention
The High Risk conditions for CVD
15 But late diagnosis and suboptimal treatment are common
High Blood Pressure
Diagnosed
Controlled to 140/90
Known AF and
on anticoagulant
at time of stroke Atrial Fibrillation
High Cholesterol
10 year CVD risk
above 20% and
on statins
6 in 10*
6 in 10*
1 in 2*
1 in 2*
High Risk Conditions: opportunity for improvement
Type 2 Diabetes
All 8 care processes
All 3 treatment targets
1 in 2*
4 in 10*
(*with wide geographical variation)
o GPs are overworked and have NO capacity
o Pulse and blood pressure checking and counselling about statins is
important but is often trumped by other priorities
o Patients often bring multiple priorities of their own to consultations
o Improvement in secondary prevention will not come from working
harder or reading guidelines more often
o It will only come from doing things differently …. and by making the
system work better for clinicians and their patients
BUT … what about the real (clinical) world?
23
High Impact Interventions
Resources:
• Atrial Fibrillation
• High Blood Pressure
1. Doing things differently – high impact interventions
• Mobilising the wider system to support general practice
• Expanded role for pharmacists in diagnosis, management & adherence
• Self testing and self monitoring
• Shared decision making – eg anticoags and statins
• New technologies eg AliveCor, WatchBP
• Boosting NHS Health Check uptake
2. Local clinical leadership – GP, nurse, consultant, pharmacist, public health,
commissioner, patient
3. Local intelligence – how many local people have high risk conditions that are
undiagnosed or under-treated?
4. Clarity of vision - relentless local focus on the size of the prize - how many
strokes and heart attacks could we prevent by doing better?
Improving detection and management of the high risk conditions for CVD: the key local ingredients
New diagnoses Optimising treatment Released 15 hours/month clinician time
Stow Health
Self testing blood pressure
Dudley
Practice pharmacists managing blood pressure
Lambeth & Southwark
Pharmacists manage blood pressure and AF
Community pharmacist interventions
Results:
• Improved BP control
• 1300 new patients anticoagulated
• Estimated 45 strokes averted in 15
months
West Hampshire
Systematic support to improve management of AF
CCG wide programme:
Leadership and education
Screening and audit tools
Pharmacist interventions
Results:
Estimated 52 strokes averted in 20
months
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Bradford
Systematic improvement at scale and pace
Multiple interventions
Shared approach across practices
Results
• 21,000 Rx optimisations
(BP, AF, Cholesterol)
• 200 strokes and heart attacks
averted in 18 months
National Cardiovascular Intelligence Network
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www.england.nhs.uk
www.england.nhs.uk
www.england.nhs.uk
What can STPs do to improve 2o prevention?
1. Awareness raising
2. Making it easy to get your pulse and BP tested, making it normal to know your
heart numbers, eg
• Mobile units in shops and community centres
• Automatic machines in workplaces and leisure centres
• More people trained to measure BP in routine encounters
o opticians, pharmacy technicians, community workers, firefighters etc
• Increasing uptake of NHS Health Check
3. Supporting maximal roll out of NHS RightCare CVD prevention programme
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www.england.nhs.uk
