Secondary prevention: reducing disparities and improving life expectancy

High impact interventions for the prevention and treatment of cardiovascular disease, diabetes and respiratory disease

There is a strong rationale for Integrated Care Systems (ICSs) and their partners to prioritise prevention.  Over the last century we have seen significant improvements in healthy life expectancy driven, in part, by improvements in secondary prevention.  Since, 2010 however, these improvements have stalled; particularly amongst more deprived communities, further exacerbating health inequalities, which are driven by a higher prevalence of modifiable risk factors within certain population groups, particularly the Core20PLUS5 population.

The DHSC has reported non-Covid excess mortality since July 2021, primarily driven by cardiovascular disease (CVD), liver disease, and diabetes.  In addition, the NHS is experiencing a sustained period of high demand for urgent and emergency care, with analysis showing respiratory disease and CVD (for which diabetes is a major risk factor), amongst the leading drivers of A&E admissions.

There is extensive evidence on prevention interventions which work and deliver rapid improvements. For example, regular diagnosis and treatment of high blood pressure, atrial fibrillation or abnormal heart rate and high cholesterol to prevent progression of CVD has a significant, rapid and tangible impact on the health of the population (alongside population-level preventative interventions, such as cancer screening programmes).

A return to delivery at pre-pandemic levels, whilst extending the reach of existing services to address health inequalities, is crucial.  We must ensure effective interventions reach populations which don’t traditionally engage with these services. It’s in these groups where the greatest impact can be made with ICSs providing an excellent opportunity to rethink how prevention interventions are systematically delivered, to achieve a real shift in outcomes across the population.

To support the development of prevention strategies by ICSs, NHS England in partnership with NICE, have developed the resource below: setting out advice on the most impactful interventions relating to the prevention and management of CVD, diabetes and respiratory disease.  There is a robust evidence base for them, which should deliver benefits at an individual patient level, based on a summary of the existing evidence and resources available.

Modifiable Risk Factors

  • Tobacco dependence identification and treatment in secondary care
  • Weight management services for people with diabetes and/or hypertension
  • Alcohol care teams.

View as a pdf or view as accessible web pages


  • Spirometry in diagnosis of asthma and chronic obstructive pulmonary disease (COPD)
  • Inhaler and medicines optimisation
  • Pulmonary rehabilitation for COPD
  • Personalised asthma action plan for all children and young people with asthma.

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  • Structured education
  • NHS Diabetes Prevention programme
  • Delivery of 9 diabetes care processes.

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  • Community pharmacy hypertension case finding
  • Cholesterol search and risk stratification
  • NHS health check
  • Case finding and direct-acting oral anticoagulation to prevent atrial fibrillation related strokes
  • Cardiac rehabilitation for patients post-ACS and diagnosis of heart failure
  • Optimisation of hypertension treatment
  • Optimisation of heart failure treatment through annual reviews
  • Optimising management post ACS, including lipid management.

View as a pdf or view as accessible web pages