Cardiology
by secondary care alone. As cases continue to rise, national policy must shift from a reactive model to a preventative, community-based approach that fully recognises and invests in the role of primary care. GPs, practice nurses, and community pharmacists are uniquely positioned to detect, diagnose, and manage heart failure earlier, prevent unnecessary hospitalisations, and support patients long after discharge. However, this potential will only be realised
through action by local leadership that integrates heart failure into care pathways, promotes training, and funds accessible diagnostic tools like NT-proBNP testing across GP practices, Community Diagnostic Centres, and through targeted population health initiatives. As our report will demonstrate, innovative local initiatives, from primary care-led medicine optimisation reviews to heart failure champions, are already demonstrating what can be achieved when primary care is empowered by supportive local leadership. However, without a national narrative
addressing the increasing burden of heart failure and emphasising the role of primary care, along with robust commissioning frameworks, these instances may stay isolated rather than becoming the norm. The silent epidemic of heart
failure will necessitate a transformative role for primary care. It’s time for policymakers to support a new model - one that brings diagnosis, medicine and device optimisation, and care to the heart of communities, and positions primary care teams as leaders in transforming heart failure outcomes.
CSJ
References 1.
https://www.cam.ac.uk/research/news/lack- of-understanding-of-common-heart-condition- leads-to-missed-treatment-opportunities- study?
2. Huntley AL, Johnson R, King A, Morris RW, Purdy S. Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis. BMJ Open. 2016 May 10;6(5):e010933. doi: 10.1136/ bmjopen-2015-010933. PMID: 27165648; PMCID: PMC4874181.
3. Kahn M, Grayson AD, Chaggar PS, Ng Kam Chuen MJ, Scott A, Hughes C, Campbell NG. Primary care heart failure service identifies a missed cohort of heart failure patients with reduced ejection fraction. Eur Heart J. 2022 Feb 3;43(5):405-412. doi: 10.1093/eurheartj/ehab629. PMID: 34508630; PMCID: PMC8825238.
About the author
Preeti Minhas is chair of the Alliance for Heart Failure, a coalition of charities, patient groups, professional bodies and healthcare companies working together to raise the profile of heart failure in Government, the NHS and media. She is a pharmacist and Independent Prescriber, a member of the Royal Pharmaceutical Society, and has completed her PG certificate in Learning & Teaching in Clinical Practice, and a PG certificate in Advanced Pharmacy.
Walking further and faster is linked to reduced heart risks
Analysis of over 36,000 people with high blood pressure has shown that taking more steps, even below the recommended daily target of 10,000 steps, and walking faster, is associated with a significant reduction in the risk of major problems of the heart and blood vessels. The study, published in the European Journal
of Preventive Cardiology, found that compared to a daily step count of 2,300 steps, every extra 1,000 steps was linked to a 17% reduction in the risk of developing a major adverse cardiovascular event (MACE), up to 10,000 steps. Additional steps above 10,000 were associated with a lower risk of stroke. Approximately 1.28 billion people worldwide
are living with high blood pressure, and it places them at increased risk of heart disease (49% increase), stroke (62% increase) and heart failure (77-89% increase). Until now, it has been unclear how much people with high blood pressure need to increase their physical activity in order to see a reduction in their risk of MACE. Professor Emmanuel Stamatakis, Director of
the Mackenzie Wearables Research Hub at the University of Sydney, Australia, who supervised the study, said: “This study is one of the first to demonstrate a dose-response relationship
between daily step count and major problems of the heart and blood vessels. In a nutshell, we found that, if you live with high blood pressure, the more you walk with greater intensity, the lower your risk for future serious cardiovascular events. “These findings support the message that any amount of physical activity is beneficial, even below the widely recommended daily target of 10,000 steps.” The study analysed data obtained from 32,192 people who had enrolled in a sub-study of the UK Biobank study. They had been diagnosed with high blood pressure and agreed to wear an accelerometer on their wrist for seven consecutive days to measure how far and how fast they walked. Data from the accelerometers was collected between 2013 and 2015. The average age was 64 and the participants were followed up for nearly eight years, providing the researchers with data for 283,001 person-years. During this time 1,935 cases of heart problems or stroke occurred. In addition to a 17% reduction in overall risk
for every extra 1,000 steps a day, the researchers found a 22% reduction in heart failure, 9% reduction in risk of heart attack, and 24%
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reduction in risk of stroke. This means that every increase of 1,000 steps a day was associated with an average reduction in the absolute risk of MACE of 31.5 events per 10,000 person-years; an average reduction in the absolute risk of 7.2 heart failure events per 10,000 person-years; an average reduction in the absolute risk of 9.9 myocardial infarctions (heart attacks) per 10,000 person-years; and an average reduction in the absolute risk of 10.4 strokes per 10,000 person-years. The average (mean) intensity of the 30
minutes of fastest walking per day was 80 steps a minute and this was associated with a 30% reduced risk of MACE. There was no evidence of harm in people whose 30 minutes of fastest walking or running was over 130 steps a minute. The researchers found similar results when
they looked at 37,350 people without high blood pressure. Every 1,000-step increase in daily step count led to an average lower risk of MACE, heart failure, myocardial infarctions and stroke of 20.2%, 23.2%, 17.9%, and 24.6%, respectively. The paper, announced by the European
Society of Cardiology (ESC), can be viewed in full at:
https://academic.oup.com/eurjpc/article- lookup/doi/10.1093/eurjpc/zwaf441.
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