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?

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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

www.england.nhs.uk

Thank You

Matt.Kearney@nhs.net

@DrMattKearney