06.06.18
The impact of NICE on cardiovascular disease prevention
Professor Gillian Leng, deputy chief executive and director Health and Social Care at NICE, looks into what can be done to decrease cardiovascular disease nationally and how to prevent missed opportunities in the future.
Cardiovascular disease (CVD) accounts for just over a quarter of deaths and affects around 7 million people in the UK. Risk factors for CVD include smoking, obesity, mental illness, physical inactivity, and long-term factors like diabetes, high cholesterol and high blood pressure. These can all be addressed with the right care and support.
The new NICE impact report on CVD prevention explores how our guidance helps to tackle these risks. While the data suggests NICE is having a positive impact in key areas, it presents a clear case for wider implementation of our recommendations, which offer effective, evidence-based advice to prevent CVD and reduce mortality.
For example, data from the Public Health Outcomes Framework (PHOF) shows smoking levels in 2016 fell to 15.5% of the adult population. To encourage this, we recommend offering patients in hospitals, mental health, and maternity services advice on quitting. But despite an audit of 15,000 patients finding that of the 73% that had their smoking status recorded, only 28% were asked if they would like to quit. This suggests key opportunities are being missed to further tackle smoking rates. On early prevention, data shows that more could be done to implement NICE’s recommendations in schools— with some 40% of pupils not receiving the right level of education on the risks of tobacco use, as advised by NICE.
The impact report also looks at six conditions that are major causes of CVD including high blood pressure, high cholesterol, atrial fibrillation, chronic kidney disease, high blood sugar and diabetes. Diagnosing and managing these conditions is vital to preventing CVD events such as heart attacks and strokes. NICE is working with Public Health England and NHS RightCare to embed our guidance in the CVD Prevention Pathway, which aims to give CCGs the tools and resources to detect and treat these conditions at a local level.
For high blood pressure, data shows that just 60% of people under 80 achieved the NICE recommended target blood pressure. Our guidance on high blood pressure aims to highlight the importance of physical activity, and encourages people to increase levels of activity to manage their condition. However, data shows only 9% of people with high blood pressure aged 16-74 had their physical activity assessed in the last 12 months. This indicates that we are not doing enough to encourage people to exercise more, and thus to reduce risk of CVD.
Atrial fibrillation (AF) is associated with a higher risk of stroke, and the CVD Prevention Pathway highlights that 30% of people with the condition are undiagnosed. Of those diagnosed, over half are not getting the right care and treatment. NICE recommends offering anticoagulants for AF to prevent blood clotting and reduce stroke risk. The National Stroke Audit has shown steady increases over the years of prescribing these medicines but the most recent figures show only 53% of patients had received anticoagulants before they had a stroke, highlighting that people at high risk of stroke may not be getting the care they need. The national audit says anticoagulants could prevent around 6,000 strokes each year in patients with AF, so there are clear benefits of prescribing them.
Our latest impact report offers useful insight into the positive effect NICE is having on CVD prevention across the health and care system. But there is a familiar pattern of potential missed opportunities to improve patient care and save lives. We know only too well the challenges the system faces to deliver high quality care. When the evidence shows that using NICE guidance works, we need to make sure it is at the heart of local strategies to reduce premature deaths from CVD and preventable illness.