Cardiovascular disease (CVD) is now a priority for the NHS in England. The rationale is clear: CVD causes 1 in 4 premature deaths, it costs the NHS over £7 billion per year, and it is a major driver of health inequalities, accounting for a quarter of the life expectancy gap between rich and poor.
The NHS Long Term Plan announced a bold ambition to prevent 150,000 heart attacks, strokes and cases of dementia over the next ten years. The plan includes commitments on primary prevention, for example increasing smoking cessation support for people admitted to hospital and those in contact with maternity and mental health services; a doubling of capacity in the NHS Diabetes Prevention Programme; and more weight management support for people with both obesity and hypertension.
However, much of the reduction in cardiovascular events will be achieved by improving the detection and management of 3 high risk conditions - atrial fibrillation, high blood pressure and high cholesterol. Despite treatment of these conditions being highly effective at reducing the CVD risk they cause, many affected people remain undetected or under treated. For example, around 5 million people have undiagnosed high blood pressure, and of those who are diagnosed and on treatment, 4 in 10 are not treated to target.
Watch Dr Matt Kearney discussing high risk conditions for CVD and the importance of prevention.
Achieving these targets and the overall NHS Long Term Plan ambition will require real innovation in primary care data collection. Without real time data, GPs, practices and networks will have no indication of the scale of the problem or the opportunity for improvement for patients and populations. Audit is the only way to systematically identify individuals whose high-risk conditions are sub-optimally managed, either through non-diagnosis, under treatment or over treatment.
This blog provides an overview of the importance of data in improving cardiovascular outcomes, and a new national audit programme that will generate the data needed to address the issues around diagnosis and treatment.
Good quality data and health intelligence are essential
Improving outcomes for our patients and communities will only come from doing things differently. The Long-Term Plan and the new GP contract set out how this will be achieved: GP practices working together across primary care networks, developing new models of care and pathways, and mobilising pharmacists, nurses and the wider primary care workforce to find the undiagnosed and treat the under treated.
Focusing our attention on the high-risk conditions, maximising uptake of proven treatments, will help us reach this ambitious target of preventing heart attacks, strokes and cases of dementia at scale.
Good quality data is the essential first step in delivering this improvement, and it is generally acknowledged that providing comprehensive health intelligence is a very effective way of driving up improvements in services and outcomes. Public Health England (PHE) has provided strategic leadership through the National Cardiovascular Intelligence Network (NCVIN) in providing reliable, benchmarked and accessible tools and products that help commissioners, providers, local authorities and individual clinicians to understand where the gaps lie, and where the biggest opportunities for improvement are to be found.
A new national audit programme
CVDprevent, a new national audit programme, will provide a foundation for professionally led quality improvement in individual GP practices and across Primary Care Networks (PCNs). It will show for every practice how many patients with the high-risk conditions are potentially undiagnosed, under treated or over treated.
The audit will generate practice level (patient identifiable) data, as well as PCN, clinical commissioning group, regional and national level (anonymised) data across a broad range of metrics derived from NICE guidance, with no additional burden on general practice.
The audit, together with a range of existing health intelligence resources, will provide opportunities for transformational improvement in cardiovascular outcomes. These resources include:
- NCVIN’s primary care intelligence packs; CCG level CVD profiles; estimates of CVD prevalence
- PHE’s CVD Return on Investment tool
- NCVIN and Stroke Association’s Atrial Fibrillation: How can we do better?
- NCVIN and British Heart Foundation (BHF)’s Blood Pressure: How can we do better?
Collaboration across the system is essential
To support delivery of the NHS Long Term Plan, NCVIN will be working with health intelligence partners across the system such as NHS Right Care, NHS England and others. This collaboration will be important in ensuring all opportunities are explored for aligning existing and new health intelligence tools and resources, thereby assisting local leaders to navigate to the material that will serve them best.
However, it is appreciated that data alone is of little value unless used to inform and drive quality improvement. PHE, NHS Right Care, NHS England, the BHF and wider partners are working together to ensure we build strong partnerships to drive professionally-led quality improvement that will deliver the ambitions announced within the NHS Long Term Plan over the next ten years.
Further information on CVDPREVENT is available by emailing firstname.lastname@example.org
The full list of National Cardiovascular Intelligence Network (NCVIN) resources are available here:
You can read more about the new national CVD prevention ambitions and targets set out in the NHS Long Term Plan in PHE’s CVD prevention edition of Health Matters. This edition also includes case studies of best practice.