CARDIOLOGY
these ambitions? The National Defibrillator Network has now gone live in the West Midlands, with 1200+ defibrillators registered, and this is now being rolled out across the rest of the country. The Getting It Right First Time (GIRFT) programme has also seen cardiologists go into individual hospitals to examine their services, as well as identify unwarranted variation between hospitals and within hospitals. Recommendations on improvement are subsequently being delivered – including on how variation can be reduced. Pilot studies are also underway to understand the barriers as to why patients do not attend rehabilitation, as well as to seek ways to improve the time to treatment for patients with ST elevation myocardial infarctions. The Quality and Outcomes Framework (QOF) measure for heart failure, in particular, is being adjusted, so there is now a shorter target for GPs in terms of the diagnosis and initial management of heart failure. This will ensure that patients are diagnosed and treated sooner. “This is a really exciting time; we have the investment to deliver on these ambitions,” concluded Dr. Linker.
Key risk factors Katherine Thompson, head of cardiovascular disease prevention for Public Health England, continued the discussion on opportunities for prevention. She highlighted the fact that there have been dramatic reductions in cardiovascular disease
mortality, over the past 40 years, but warned against complacency. “This is credit to the public health and healthcare systems working together to innovate – new technology and pharmaceutical interventions have helped to save lives. In fact, you would be forgiven for thinking that there is nothing left to do on cardiovascular disease. However, reductions in cardiovascular disease mortality are actually starting to slow down,” she warned. “It is still one of our biggest causes of deaths, with one in four deaths every minute caused by cardiovascular disease.” She pointed out that it is not just mortality that is a concern – morbidity is a key factor too; cardiovascular disease is still the second greatest contributor to disability adjusted life years, slightly behind cancer. “While people are living longer, a lot of people are living out these extra years in poor health. We have over six million people who are living with cardiovascular disease. It is not the only contributor to those years of extra life in poor health, but it has a significant role to play. “People who live in our poorest communities are also four times more likely to be affected by cardiovascular disease than those in our most affluent communities. There is a great opportunity to make a difference to people’s lives – by reducing mortality and morbidity and getting to the heart of health inequalities,” Thompson commented.
The INTERHEART study reveals that
We know that 50% of patients do not take their medicines. In fact, by year two of being on a statin, up to 75% of patients are no longer taking them. There is a real issue here – there is a need to make better use of what we already know, even before we invent newer interventions.
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nine factors account for 90% of myocardial infarctions in men and 94% in women. These include six risk factors (dyslipidaemia characterised by high apoB/apoA1 ratio, smoking, hypertension, diabetes mellitus, abdominal obesity and stressful psychosocial factors) and three protective factors (daily consumption of fruits and vegetables, moderate alcohol consumption, and regular physical activity). These findings suggest that interventions targeting these nine factors have the potential to prevent most premature cases of myocardial infarction and that these strategies should be implemented worldwide.1 “Over the last few decades there has been a huge amount of activity across the system, both in healthcare and public health to tackle these factors. We have seen significant improvements in smoking rates, but they still remain stubbornly high – particularly in areas where there are health inequalities. “In addition, 3 in 5 adults are overweight and obese – and this trend appears to be going in the wrong direction. We know that about 2 in 5 people are not hitting their five portions of fruit and veg – and, despite increases, only 1 in 4 people are currently achieving national physical activity guidelines. Again, in terms of alcohol consumption, 1 in 4 people still continue to drink above the low risk levels. It is a mixed picture in terms of underlying behavioural risk factors,” Thompson continued. The physiological risk factors are also modifiable, she pointed out. In fact, 4 in 10 people have undiagnosed hypertension and, for those who are diagnosed, the data shows that 4 in 10 are sub-optimally managed. “Two in 10 people have undiagnosed atrial fibrillation and around half of those with AF are not treated before they go on to have a stroke. In terms of cardiovascular disease risk, we know about 1 in 10 people are likely to be at high risk of having a heart attack or stroke in the next 10 years. However, only 3 in 10 of those people are prescribed statins. “We certainly have some unfinished business here – and that business is costly. Cardiovascular disease costs the NHS
AUGUST 2020
© Damian Hora iu Sult noiu
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