The Scalpel's Blog

30.11.18

We’ll pay in the years to come if we fail to improve circulatory health today

The upcoming NHS long-term plan will provide a once-in-a-decade opportunity to improve our approach to heart and circulatory health – but only if we act now, writes Simon Gillespie, chief executive of the British Heart Foundation (BHF).

We’ve come a long way in improving heart and circulatory health since the 1960s. Advances in medical research and prevention mean death rates in the UK have more than halved. Pioneering BHF-funded research has played a pivotal role in this.

However, we can’t let this progress lead us to underestimate the grave challenge we still face. Each day in the UK around 420 people die of heart and circulatory diseases including coronary heart disease, stroke, and vascular dementia, accounting for one in four deaths across the country. And, sadly, living with often debilitating long-term conditions such as heart failure, along with many other conditions, is now the norm.

With the forthcoming publication of NHS England’s long-term plan, we have a once-in-a-decade opportunity to transform the way heart and circulatory diseases are detected and treated.

As the health secretary rightly pointed out in the recently-published strategy ‘Prevention is better than cure,’ prevention is essential to this agenda. Obesity rates across the UK are stubbornly high, and the number of younger people with type 2 diabetes is increasing, while too many people with high blood pressure and raised cholesterol go undetected. Worryingly, if nothing is done about these health concerns, we could experience a major resurgence of heart attacks and strokes.

To address this looming crisis, the NHS in England must ensure the success of strategies aimed at tackling risk factors. We need to see the actions within Chapter 2 of the Childhood Obesity Plan fully implemented, and new approaches to smoking cessation to ensure that we can actually reach the smoke-free target set out in the tobacco control plan for England.

More effective prevention must also work in tandem with improved detection and management.

By detecting and managing high blood pressure at an earlier stage, we could prevent around 115,000 cases of heart and circulatory disease over the next 10 years in England alone. But, unless we take radical action today, heart and circulatory diseases are likely to have a devastating impact in the years to come.

We must also learn from other countries, such as Canada, who have already demonstrated that community-based approaches can have a dramatic impact on detecting and managing silent risk factors such as high blood pressure.

Better prevention and early detection are just two areas we address in our new report, ‘Turning Back the Tide on Heart and Circulatory Diseases,’ which outlines key recommendations for the NHS as it plans for the next 10 years. The report focuses on five priority areas which, if tackled successfully, could help the NHS vastly improve diagnosis and treatment of heart and circulatory diseases.

Another key recommendation focuses on the need for the NHS to improve access to the best treatments, for all patients, as we still see a startling variation in treatment and survival rates across the UK. In fact, heart and circulatory diseases together present the biggest driver of health inequalities in the UK. For example, despite clear evidence and guidelines on the most effective treatment for people who have survived a heart attack or stroke, there remains unacceptable variation in the care people receive and thus the outcomes achieved.

If variation in care is to be reduced, we need the NHS to ensure heart patients have access to specialist cardiac centres, and we need to extend access to cutting-edge stroke treatment – which could prevent up to 2,000 people every year having to live with the disabling after-effects caused by stroke.

The needs of people with heart and circulatory disease do not stop after treatment ends, which is why it is so important for the NHS to reimagine the recovery process, especially rehabilitation.

At the moment, just over half of patients who have had a heart or circulatory event are taking up services that help them lead a more active lifestyle and protect them against further hospital readmissions. For certain groups, such as women and people from black and minority ethnic communities, uptake is much lower. This compares poorly to some other countries in Europe where figures are as high as 90%.

A cardiac rehabilitation uptake rate of 85% in England could result in 20,000 fewer deaths and nearly 50,000 fewer hospital admissions over the next 10 years. Personalised recovery services, such as digitally supported, home-based delivery, could also help to vary what’s on offer, leading to an increase in uptake amongst those not accessing traditional services.

Finally, we must also see the NHS exploit the huge potential provided by advances in technology and data science. Our increased understanding of genetics will play a huge role in years to come, helping us to identify people at risk years before they have a heart attack.

The need is urgent and our vision is clear. Without radical action now, too many will needlessly lose their lives from diseases that are often preventable and treatable. The NHS long-term plan provides a perfect opportunity to build on decades of research and huge advances in care, to tackle one of the UK’s biggest killers.

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