CARDIOLOGY
conscience with this amazing heart centre just waiting for our population to come through the door?” commented Dr. Patel. “We had a duty, if only a moral duty, to
try and do something about this. The Trust’s hierarchy were really supportive, and we set up the East London Prevention Group (ELoPE), focusing on three core aims.” The first of these was to develop and coordinate strategies of prevention across the Trust, which included four large hospitals. The second aim was to support and provide leadership for primary prevention in the community and the third aim was to partner with key stakeholders – including the British Heart Foundation – to maximise the value of existing projects and to align priorities with national and region objectives. This has seen the breaking down of traditional healthcare boundaries. “We are trying to change the culture; we
want everyone in the Trust to think about cardiovascular disease prevention. Every contact with a healthcare professional is valuable. When patients come in for a gastroenterology appointment, they usually have their blood pressure checked, but no-one pays attention. Even in cardiology clinics, patients may have their blood pressure checked and it may be a little bit high, but no-one pays attention. What we are trying to do with various campaigns is to change that culture – to make it a responsibility for everyone to do something. Not doing anything is not an option – even if it is simply to ask about smoking. We are also integrating a lot of our cardiovascular disease risk services with a multidisciplinary approach to familial hypercholesterolemia and use of novel medicines.
“In addition, we are targeting those ‘hiding in plain sight’ – i.e. our staff. Bart’s Health has 24,000 staff on its books. Statistics show that 4 in 10 people will have undiagnosed hypertension; we have a huge population within our Trust staff – many of these will have underlying cardiovascular conditions, which we can help with. Then, of course, we are working with public health to make sure that we have healthy food in vending machines,” Dr. Patel explained. Outside of the Trust, an equally ambitious campaign has been developed to engage with the community: “We want to get out of our ivory tower and engage with the people we serve. We have an exciting programme to target almost 175 primary schools in our three boroughs to talk about heart health and deliver heart health assemblies, using our 24,000-volunteer workforce. In secondary schools, we are also facilitating CPR and resuscitation training. This is a major component and will be integrated into the school curriculum
AUGUST 2020
from next year,” Dr. Patel continued. The British Heart Foundation is currently distributing resus training kits and dummies to all schools. However, teachers have reported they are not confident in their ability to deliver the training. To address this issue, the Trust resuscitation training teams are offering mentoring for schoolteachers across the borough. “The key thing we have discovered is the
importance of working in partnership – even secondary care can play in important role in cardiovascular disease prevention, working not in isolation, but in absolute partnership with primary care community organisations and key stakeholders. It is a multidisciplinary, multi- organisational effort,” Dr. Patel concluded. CSJ
References 1 Scheen, AJ, and Kulbertus, H, Interheart: Nine Risk Factors Predict Nine Out of Ten Myocardial
Infarctions, Rev Med Liege, 2004 Nov;59 11:676- 9. Accessed at:
https://pubmed.ncbi.nlm.nih. gov/15646744/
2 NICE shared learning, Re-engineering the Post- Myocardial Infarction Medicines Optimisation Pathway, February 2018. Accessed at: https://www.
nice.org.uk/sharedlearning/re-engineering-the- post-myocardial-infarction-medicines-optimisation- pathway
3 Nice shared learning, Innovative Medicines Optimisation Clinic for PCSK9 inhibitors & Statin Intolerance, October 2019. Accessed at https://
www.nice.org.uk/sharedlearning/innovative- medicines-optimisation-clinic-for-pcsk9-inhibitors- statin-intolerance
4 Abraham, WT, et al, Sustained Efficacy of Pulmonary Artery Pressure to Guide Adjustment of Chronic Heart Failure Therapy: Complete Follow-Up Results From the CHAMPION Randomised Trial, The Lancet. Accessed at:
https://pubmed.ncbi.nlm.nih. gov/26560249/
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