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Healthy Hearts: a practical guide for CCGs

With the recent Public Health England and NHS England analysis spotlighting the opportunity to prevent many thousands of heart attacks and strokes, there has never been more impetus to improve the detection and management of high risk conditions such as high blood pressure, high cholesterol and atrial fibrillation (AF).

The Size of the Prize for Cardiovascular disease (CVD) prevention published in September 2017 provides an accessible one-page graphic for each STP showing how many people have undiagnosed or under-treated high blood pressure or AF. Using published evidence, it then calculates how many strokes and heart attacks could be averted if treatment were optimised in those who are under-treated.  And the numbers are not small.

For every STP, there are thousands of people with undetected or under treated high-risk conditions giving rise to the opportunity to avoid hundreds of life changing events.  It’s estimated that over three years, optimising blood pressure treatment could prevent up to 9,000 heart attacks and 14,000 strokes, saving £270 million, and optimising AF treatment could prevent 14,000 strokes and save £240 million.

AF and high blood pressure, along with cholesterol, diabetes and chronic kidney disease, are high-risk conditions that multiply the risk of cardiovascular events such as stroke, heart attack and dementia.  Preventative treatment in these conditions is highly effective and the success of primary care in providing secondary prevention has been one of the key reasons that early deaths from CVD have fallen so dramatically in recent years.

Despite this, late diagnosis and suboptimal treatment remain common, and there is substantial scope to improve care and outcomes for patients.

In response to this there are now some inspiring examples where clinicians and others have decided to do things differently to drive improvement. One such example is Bradford Districts CCG, who three years ago had the seventh worst CVD mortality rate in under 75s in England. But not any more.

Faced with the gaps highlighted in their NHS RightCare Where to Look pack, they saw a major opportunity to improve outcomes by transforming the treatment of the high-risk conditions for CVD. GPs with local clinical and public health professionals challenged themselves to improve.

The results of the Bradford’s Healthy Hearts programme, focusing on AF, high blood pressure and high cholesterol, are remarkable – over a very short period of time, 21,000 people had their treatment optimised and over 200 fewer people suffered heart attacks or strokes.

Colleagues from Bradford District CCG’s have kindly shared their experience and the NHS RightCare Healthy Hearts Resource Pack, launched yesterday, shows how this was achieved.

Dr Matt Kearney

Matt Kearney is NHS England’s National Clinical Director for Cardiovascular Disease Prevention and a GP in Runcorn. He has been working for both NHS England and Public Health England since 2013, supporting programmes to improve primary and secondary prevention of cardiovascular disease and diabetes.

In particular, he has focused on building primary care leadership to champion earlier detection and improved management of conditions such as hypertension, atrial fibrillation, type 2 diabetes and raised cholesterol, and in exploring ways in which the third sector, local authorities and other partners can help the NHS to get serious about prevention.

Previously Matt worked as clinical and public health advisor to the Department of Health respiratory programme, and was a member of the NICE Public Health Interventions Advisory Committee from 2005 to 2013

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