Preventing Heart Attacks and Strokes The Size of the Prize Dr Matt Kearney General Practitioner and National Clinical Director for CVD Prevention NHS England and Public Health England
The NHS needs a radical upgrade in prevention if it is to be sustainable 5 year Forward View 2014
NHS Prevention Board The NHS Prevention Board endorses CVD prevention as a priority for the Health and Social Care systems January 2017
CVD Prevention a must do for NHS sustainability 4 NHS RightCare will work with CCGs and STPs to improve detection and management in the High Risk Conditions for CVD Public Health England will work with STPs and NHS RightCare to support the implementation of identified preventative interventions at scale. www.england.nhs.uk
Presentation title - edit in Header and Footer The growing burden of CVD
CVD dramatic fall in premature mortality Total CVD mortality declined by 68% between 1980 and 2013 in the UK Ref: Bhatnagar et al, Heart Online, 2016
CVD parallel rise in morbidity From 1981 to 2014 7-fold increase in CVD prescriptions in England Ref: British Heart Foundation, 2015
A population getting older
A population getting bigger www.england.nhs.uk 9
Getting serious about prevention What can the NHS do? 1. Population level interventions, eg: National policy and strategy Local action through STP partnerships 2. Support for individual behaviour change, eg: NHS Health Check Diabetes Prevention Programme Social prescribing 3. Early diagnosis and optimal treatment of the high risk conditions NHS RightCare Programme NHS Health Check
Diabetes Prevention Programme Early indicators 1. Coverage 75% England 2. On target to enrol 100,000 by 2020 3. Take up 48% Half male 80% under 75 More from deprived and BAME communities 4. Retention TBC 13 Presentation title - edit in Header and Footer
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Secondary Prevention The High Risk conditions for CVD But late diagnosis and suboptimal treatment are common 15
High Risk Conditions: opportunity for improvement High Blood Pressure Diagnosed Controlled to 140/90 6 in 10* 6 in 10* Atrial Fibrillation Known AF and on anticoagulant at time of stroke 1 in 2* High Cholesterol 10 year CVD risk above 20% and on statins 1 in 2* Type 2 Diabetes All 8 care processes All 3 treatment targets 1 in 2* 4 in 10* (*with wide geographical variation)
BUT what about the real (clinical) world? o GPs are overworked and have NO capacity o Pulse and blood pressure checking and counselling about statins is important but is often trumped by other priorities o Patients often bring multiple priorities of their own to consultations o Improvement in secondary prevention will not come from working harder or reading guidelines more often o It will only come from doing things differently. and by making the system work better for clinicians and their patients
High Impact Interventions Resources: Atrial Fibrillation High Blood Pressure 23
Improving detection and management of the high risk conditions for CVD: the key local ingredients 1. Doing things differently high impact interventions Mobilising the wider system to support general practice Expanded role for pharmacists in diagnosis, management & adherence Self testing and self monitoring Shared decision making eg anticoags and statins New technologies eg AliveCor, WatchBP Boosting NHS Health Check uptake 2. Local clinical leadership GP, nurse, consultant, pharmacist, public health, commissioner, patient 3. Local intelligence how many local people have high risk conditions that are undiagnosed or under-treated? 4. Clarity of vision - relentless local focus on the size of the prize - how many strokes and heart attacks could we prevent by doing better?
Stow Health Self testing blood pressure New diagnoses Optimising treatment Released 15 hours/month clinician time
Dudley Practice pharmacists managing blood pressure
Lambeth & Southwark Pharmacists manage blood pressure and AF Community pharmacist interventions Results: Improved BP control 1300 new patients anticoagulated Estimated 45 strokes averted in 15 months
West Hampshire Systematic support to improve management of AF CCG wide programme: Leadership and education Screening and audit tools Pharmacist interventions Results: Estimated 52 strokes averted in 20 months
Bradford Systematic improvement at scale and pace Multiple interventions Shared approach across practices Results 21,000 Rx optimisations (BP, AF, Cholesterol) 200 strokes and heart attacks averted in 18 months Presentation title - edit in Header and Footer
30 Presentation title - edit in Header and Footer National Cardiovascular Intelligence Network
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www.england.nhs.uk
www.england.nhs.uk
www.england.nhs.uk
What can STPs do to improve 2 o prevention? 1. Awareness raising 2. Making it easy to get your pulse and BP tested, making it normal to know your heart numbers, eg Mobile units in shops and community centres Automatic machines in workplaces and leisure centres More people trained to measure BP in routine encounters o opticians, pharmacy technicians, community workers, firefighters etc Increasing uptake of NHS Health Check 3. Supporting maximal roll out of NHS RightCare CVD prevention programme 35 Presentation title - edit in Header and Footer
www.england.nhs.uk
Thank You Matt.Kearney@nhs.net @DrMattKearney www.england.nhs.uk