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Why promote CVD prevention in your professional practice?
Over the last few decades, great strides have been taken in reducing premature deaths due to cardiovascular disease (CVD) in England. However, CVD still remains a significant cause of disability, death and health inequalities.
Nearly 7 million people are living with CVD in England, and it contributes to over a quarter of deaths each year. People from our most deprived populations are nearly 4 times more likely to die prematurely from CVD, compared to those from the most affluent populations.
Health and social care costs in England relating to CVD are estimated at £7.4 billion each year, with wider costs to the economy estimated at £15.8 billion annually.
Heart attacks and strokes are highly preventable through population level measures, and support for individual behaviour change. But the NHS also has a crucial role in identifying individuals who have developed high-risk CVD conditions. These include atrial fibrillation (AF), high blood pressure and raised cholesterol, which have been shown to significantly increase the risk of CVD events such as heart attack, stroke and dementia.
Optimal treatment of AF, high blood pressure and raised cholesterol is highly effective in preventing CVD events. However, a large proportion of those living with these conditions remain undiagnosed, and of those with a diagnosis, a large number are not receiving optimal treatment. For instance, over 40% of people with high blood pressure remain undiagnosed. Of those people diagnosed with high blood pressure, only 67% are optimally managed.
Access the cardiovascular disease prevention e-learning session
An interactive e-learning version of this topic is now available to use.
Public Health England (PHE) and Health Education England’s ‘e-Learning for Healthcare’ have developed this content to increase the confidence and skills of health and care professionals, to embed prevention in their day-to-day practice.
If you’re a front-line health professional:
There are several opportunities to identify CVD risk factors:
- access training to become more confident in identifying and managing high risk conditions for CVD - especially high blood pressure and atrial fibrillation
- support patients with information to lower their risk of CVD
- check if patients have been offered an NHS Health Check, if aged between 40 to 74 years of age
- ask patients if they know their recent blood pressure reading, and offer a blood pressure check
- ask patients if they have recently had their cholesterol checked, and offer testing where appropriate
- discuss with patients the importance of knowing and understanding their CVD risk
Managing CVD high risk factors
Provide information to patients on the benefits of treating and managing CVD high-risk factors.
Familiarise yourself with the referral and management pathways for:
- Atrial Fibrillation
- high blood pressure
- high cholesterol
- High Qrisk2 score
It is also helpful to:
- discuss with patients the benefits of behaviour change in reducing CVD risk - this includes lifestyle factors such as smoking, physical activity, obesity and alcohol consumption
- provide support for behaviour change on the lifestyle factors identified above
- familiarise yourself with the Heart Age Test as a motivational tool and route to support behaviour change
If you’re a team leader or manager:
- ensure the teams you lead are aware of latest guidance and interventions on CVD prevention within your local area
- provide learning and development opportunities on CVD prevention for team members
- ensure there are clear local referral and management pathways for CVD conditions
If you’re a senior or strategic leader:
- it is important to know what success looks like within your organisation - and create opportunities to share learning
- ensure that your organisation is represented in the membership of relevant prevention, or CVD disease oversight boards
- seek opportunities to work collaboratively with local partners including sustainability and transformations partnerships (STPS) and integrated care systems (ICS) on CVD prevention initiatives
- ensure there is clarity on shared priorities with local partners
Understanding local needs
Public Health England (PHE) provides intelligence and data through the National Cardiovascular Intelligence Network (NCVIN). This information is useful to identify how well people are being diagnosed and treated for CVD.
It includes updates and additions to:
- cardiovascular disease primary care intelligence packs
- PHE Fingertips profiles for cardiovascular disease profiles
- a digital platform providing CVD data and analysis guidance for health professionals and commissioners
NHS RightCare focus packs (CCG level) provide data and intelligence to highlight variation in performance.
Other useful data and information sources include:
- NHS datasets
- Strategic Health Asset Planning and Evaluation (SHAPE), a web enabled, evidence based application that informs and supports the strategic planning of services and assets across a whole health economy
As a health professional, there is a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution. This could be about sharing what has worked well in order to benefit your colleagues and local people or to support your professional development.
The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. It is not about performance management but resourcing and then rewarding good practice.
The Public Health Outcomes Framework examines indicators that help us understand trends in public health such as premature mortality in individuals with CVD.
Further reading, resources and good practice
Advice for patients and the public
- NHS.UK topic on cardiovascular disease
- the Heart Age Test tells you your heart age in comparison to your real age and explains why it is important to know your blood pressure and cholesterol
- One you contains information and applications to support healthy lifestyle choices on diet, exercise and alcohol consumption
- find out what your blood pressure reading means with the NHS high blood pressure tool
- the blood pressure quiz helps you to find out how much you know about blood pressure
Professional resources and tools
The NHS Long Term Plan sets out clear milestones for CVD prevention in ‘Chapter 3: Further progress on care quality and outcomes’ (pages 63 and 64).
To complement the NHS Long Term Plan, PHE and over 40 partners launched new CVD ambitions for England to improve the detection and management of AF, high blood pressure and cholesterol, and reduce health inequalities. The CVD ambitions for England publication is available at ‘Preventing cardiovascular disease: saving hearts and minds together’
The National Institute for Health and Care Excellence website has a range of tools and resources covering guidance and quality standards, high blood pressure, cholesterol and atrial fibrillation.
The NHS provides a RightCare Cardiovascular disease prevention pathway resource.
NHS RightCare toolkit: Physical ill-health and CVD prevention in people with severe mental Illness (SMI) is also available.
PHE produce a range of resources and tools to support the planning and delivery of CVD prevention - to improve outcomes and reduce variation and health inequalities.
- severe mental illness (SMI) and physical health inequalities guidance
- Familial Hypercholesterolemia: implementation guide
- the Size of the prize work shows the opportunity to prevent more than 9,000 heart attacks and at least 14,000 strokes over a 3 year period with better detection and management of high blood pressure, high cholesterol and atrial fibrillation
- an annual Action plan for CVD prevention 2019
- CVD prevention return on investment tool which helps commissioners to identify the benefits of interventions to local health economies
- Health matters - a collection of public health issues containing facts, resources and information on major public health issues including dementia, high blood pressure and smoking
- Public Health Matters - the official blog of PHE, providing expert insight on the organisation’s work including a regular topic on CVD prevention