CARDIOLOGY
around 7.4 billion a year; in terms of the wider non-healthcare system, the cost is roughly double,” commented Thompson. She acknowledged that to achieve change it is necessary to influence behaviour at individual, community and population level. “We have seen initiatives such as the Behaviour Change Wheel, published by the University College London, which help us to understand the different types of policy actions and interventions likely to influence behaviour, and help us achieve progress across a range of risk factors. Coupling this with NICE guidance, we have a good insight into the clinical interventions required to deliver reductions in cardiovascular disease,” Thompson continued.
“In terms of some of the extra actions
that Public Health England has been taking forward, we’ve worked with partners from the British Heart Foundation, the Joint British Societies, University College London and NHS Digital to look at new ways of communicating around cardiovascular disease risk. In 2018, we had a Heart Aid campaign launch, and that has demonstrated there is a real interest and appetite among the public for easy to understand risk communication tools. “We had two million people use the tool on one day, and four million people used it over the month-long campaign period. I’m sure many of you are aware there have been significant benefits from the regulation introduced around smoking, and also, more recently, the sugar levy that has come into play. We are currently also working with industry on voluntary targets for salt, as well as working with a whole range of partners on national ambitions for cardiovascular disease.” She explained that three areas are being targeted – including the diagnosis and management of atrial fibrillation, high blood
pressure and high cholesterol. Modelling shows that, by optimising the detection and management of these three areas, 150,000 heart attacks and strokes could be prevented and savings of around £2.30 for every £1 spent could be achieved.
She went on to highlight the NHS Health Check programme –15 million people are eligible for a check every five years. This addresses the top seven risk factors driving the burden of disease and is a key mechanism for identifying people who would benefit from other local services like the Diabetes Prevention programme. “We have also seen from the evidence and research that it can tackle health inequality. But there is more work to do. We know that half of those invited do not take up the NHS Health Check, so there is an opportunity to improve its impact,” Thompson concluded.
Improving care delivery The Westminster Health Forum also featured sessions on ‘Improving the delivery of care: personalisation, integrating services and developing multidisciplinary teams’. Dr. Rani Khatib, a consultant pharmacist in cardiology and cardiovascular clinical research, at Leeds Teaching Hospitals NHS Trust offered an insight into the innovation taking place in Leeds in relation to the national cardiovascular disease agenda. He pointed out that there are currently “many missed opportunities”. “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…In addition, despite NICE guidelines supporting the use of innovative drugs, we are not making
them accessible to patients,” Dr. Khatib commented. So, how should the NHS reduce these missed opportunities? Dr. Khatib believes a person-centred approach is vital. “It is about understanding and listening to the needs of the patient and delivering a service that meets their needs. Multi- disciplinary team (MDT) working is central for this, but we also need to spread good practice,” Dr. Khatib continued. He explained that cardiovascular clinics in Leeds have been successfully ‘re-engineered’ to ensure they are more person centred and this approach has proven popular with patients, as well as improving performance in a number of key areas.
“Nearly 44% of patients with ischaemic
heart disease in West Yorkshire were not taking their medicines. So, we thought: how about ensuring that patients are seen by a variety of healthcare professionals, such as a consultant pharmacist alongside a cardiologist? We can triage patients to see the healthcare professional that they need most and tailor the service that we’re delivering to their needs,” he explained. New tools such MYMEDS were developed
to support patients in sharing their personal experiences of medications, to provide a better understanding of how to support them. Patients completed a questionnaire to establish their barriers to adherence. They then attended a clinic with the consultant pharmacist or cardiologist (or both). Barriers to adherence were identified and discussed, and an action plan developed.
Results
Overall, the project produced excellent results, and over 500 patients were seen in the clinic in the first year2
: l The patient’s experience improved
AUGUST 2020
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