Blair Elliott, Innovation Project Manager at Health Innovation West Midlands

Cardiovascular disease (CVD) is one of the leading causes of death and disability in the UK. The implications for the NHS are profound, as increasing hospital admissions strain resources and escalate wait times.

Currently, people with one or more long-term conditions utilise 50% of all GP appointments, 64% of all outpatient appointments, and 70% of hospital beds. With CVD now the cause of 1 in 4 premature deaths in the UK, transforming the way we prevent and provide care is becoming increasingly crucial.

To address this challenge, a transformative approach to CVD prevention and management is essential, one that highlights early diagnosis, effective management and comprehensive education.

What are some of the things we can do to aid CVD prevention and empower patients and providers? Through my work within the CVD programme team at Health Innovation West Midlands (HIWM) I have seen how projects and interventions are contributing to the transformation of CVD care.

The urgency of early diagnosis

CVD accounts for 27% of all deaths in the UK and heart failure is also becoming increasingly prevalent, with over 780,000 people on their GP’s heart failure register. The earlier a patient begins treatment for CVD or heart failure, the better their chances of reducing hospitalisation and improving outcomes. Each admission not only adds to the strain on the NHS, but also significantly increases the risk of mortality.

Timely recognition of acute symptoms and expedited diagnosis must be at the forefront of our efforts. Initiatives such as the Pumping Marvellous charity’s B.E.A.T methodology, provides a simple and understandable acronym for patients and health care professionals to recognise the symptoms of heart failure (Breathlessness, Exhaustion, Ankle swelling, Time for a simple blood test, or Time to tell your GP).

Other cardiovascular conditions, such as high blood pressure and high cholesterol, can be more challenging to recognise as they often have no symptoms. Innovative approaches  like case-finding tools, enable patients with cardiovascular conditions to be identified and treated sooner. Supporting primary care with the adoption of such tools will help to establish a more timely diagnosis where appropriate, and provide better review and management of cardiovascular risk factors for patients.

In the hands of care providers in a community setting, innovative technologies and ways of working, including point of care blood tests and point of care ultrasound, can help to almost immediately identify whether heart failure is likely. When used alongside other point of care tests, and clinical assessment, a provisional diagnosis can be made quickly and allow treatment to begin while additional tests are   requested to be undertaken by a specialist team.

Approaches to CVD prevention

Managing cardiovascular risk factors in both primary and secondary prevention, is key to reducing the occurrence of CVD events. Upskilling of clinicians and sharing of good practice, are essential in supporting the management of cardiovascular risk factors and CVD prevention.

Something we have seen work well in the West Midlands, is embedding a clinical trainer to deliver education sessions to healthcare professionals on CVD prevention, ensuring that clinicians and their support teams are upskilled in the most up-to-date guidelines and treatment of these conditions.

HIWM created and launched a heart failure toolkit for primary care networks (PCNs), to give primary care teams the relevant information to support optimal care delivery of a heart failure patient. We also helped establish heart failure champions within our integrated care boards (ICBs) to allow for hands-on education, training and support.

This has meant healthcare professionals, such as PCN pharmacists, physician associates and advanced clinical practitioners have been upskilled in heart failure care, enabling more professionals to identify, diagnose and start treating patients with heart failure.

Around 80 per cent of heart failure diagnoses in England are made in hospital, despite 40 per cent of patients having symptoms that should have triggered an earlier assessment. By supporting primary care we can readdress this balance, more patients can be diagnosed locally to where they live avoiding the need to visit secondary care. This also frees up capacity within secondary care, enhancing the overall efficiency of the healthcare system.

Focusing on Familial Hypercholesterolemia

Not all causes of CVD are lifestyle related; Familial Hypercholesterolemia (FH) is a hereditary condition that significantly elevates the risk of heart disease. About 1:250 people have FH, which significantly increases the risk of a heart attack before the age of 50.

The West Midlands is fortunate to have the West Midlands Familial Hypercholesterolaemia service, which is a regional nurse led assessment and genetic testing service based out of University Hospitals Birmingham. HIWM has a strong relationship with the service and provides support in identifying areas where additional education and training may be required for primary care to improve the rate of appropriate referrals.

This has enabled us to undertake a child-parent screening (CPS) programme, which involves a heel prick blood test during a child’s routine one-year immunisation appointment, as a method of identifying children and their parents with FH. In turn this can support cascade testing to identify other relatives with FH and increase the detection rate for the condition.

HIWM were one of seven health innovation networks to invite PCN’s and practices to get involved with this pilot project, and we were the third highest screening area during its  lifetime. The goal is to achieve a 25% population prevalence of identified cases by 2025, contributing to the NHS’s long-term strategy for improved lipid management. It is unlikely that population screening of adults alone will help attain the target stipulated, so CPS work will be a crucial tool in order for us to help meet this ambition.

By identifying hereditary causes for CVD early, we can help more individuals to manage their cholesterol levels and reduce the risk of experiencing a cardiovascular event such as heart attack or stroke.

Implementing a population health management approach

Another way in which HIWM has been supporting CVD and heart failure treatment, is through adopting a population health management approach. This involves leveraging data to identify at-risk populations and ensuring that health interventions are tailored to meet individual patients’ needs.

Research tells us that those in the most deprived 10% of the population are almost twice as likely to die as a result of CVD, than those in the least deprived 10% of the population. Tailored outreach and education in these communities can bridge gaps in care and improve overall health outcomes.

With a population of over 6.2 million spanning six integrated care systems (ICS), the West Midlands region is home to a vastly diverse patient landscape; and is home to extensive rural populations as well as two of England’s most deprived ICSs. In fact, more than 65% of the population across the region, is considered to be living in the most deprived 20% of the national population.

There are noteworthy differences in the rates of circulatory disease, such as heart disease and stroke, between the most and least affluent, highlighting the need to improve access for under-served populations, particularly those in areas of deprivation.

HIWM’s Healthcare Inequalities Programme worked with four ICSs, to target cardiovascular disease management in underserved communities. The work engaged 2,200 individuals from seldom heard communities and resulted in 1,700 blood pressure checks and 650 cholesterol tests being undertaken.

By expanding interventions such as these into the broader health system, we can work to reduce health inequalities and ensure all individuals have access to the resources they need for effective heart disease prevention and management.

A collective responsibility

Improving CVD and heart failure management is a collective responsibility that requires the commitment of healthcare professionals, policymakers, and the public. By focusing on early diagnosis, integrated management, comprehensive education and new technologies, we can transform the landscape of CVD care.  The approach we have outlined supports the shifts required within the new 10 year Health Plan for England of moving care from hospital to communities, making better use of technology and focusing on preventing sickness.

Our overarching goal must be clear: to prevent heart attacks and strokes, ensure timely diagnosis of heart failure, and ultimately improve the quality of life for those affected. In doing so, we not only enhance health outcomes for the individual, but also alleviate pressure on our NHS, ensuring a sustainable future for CVD care.

For more information, please visit: https://www.healthinnovationwestmidlands.org/cardiovascular-disease-portfolio/