Cardiovascular disease: The scale of the challenge

While COVID-19 continues to dominate the news and policy agenda, we recently saw an important milestone in our understanding of a more long-standing health challenge of our time: cardiovascular disease (CVD). As part of efforts set out in NHS England’s Long Term Plan to prevent 150,000 deaths over the next decade from the likes of heart attacks and strokes, the first CVDPREVENT audit has been published. Its findings around the scale of the challenge, as well as the opportunities for improvement it identifies, are stark.

It’s important to remind ourselves why taking action on CVD matters. CVD contributes to disability, death and hardship on a huge scale. Stroke alone is the single biggest cause of adult disability in the UK and not only devastates the lives of those affected but is associated with enormous cost to the health, social care and welfare system.

Thousands of cases of stroke, diabetes, heart failure and kidney disease could and should be prevented every year yet currently are not. As the audit reveals, too many people with high risk conditions such as atrial fibrillation – a type of irregular heartbeat associated with the most serious strokes and heart attacks – are either not being diagnosed or being poorly managed. Only two thirds of those with high blood pressure are being treated in line with clinical guidance, and how people are monitored and treated varies depending on sex, age and ethnicity. And when it comes to dealing with cholesterol, black people are the least likely to have been prescribed medication, despite what is known about the link between high cholesterol and heart attacks, for example.

It’s also clear that the range of conditions which fall under the CVD banner should not be viewed in isolation because chances are that if someone has one high risk condition for CVD, they will also be living with multiple other long-term conditions.

COVID-19 has shone a spotlight on how the burden of ill health is spread far from equally. This report – bringing together patient data from before the pandemic – reminds us yet again that we cannot make serious progress against the big killer diseases without recognising the role inequalities play in access to treatment and outcomes and CVD and its associated risk factors is no different.

But as the report makes clear, there are opportunities to change things, not least because CVD and its associated high risk conditions can be – in many cases – very effectively diagnosed and managed. Such are the numbers of people affected by CVD – 6.5 million have diagnosed hypertension in England alone – that even incremental improvements can make a world of difference. And just imagine the impact if we could find, diagnose and effectively manage the five million or so with undiagnosed hypertension, or the 85% of those who don’t know they have familial hypercholesterolaemia, a type of high cholesterol.

Encouragingly, the audit comes with new resources for local health systems to support their own quality improvement programmes, and there are real opportunities for ICSs, CCGs and others to work collaboratively – including with charities and industry – to make these a success and to share what works with others. Great work is already happening but it needs to be scaled up urgently.

This first CVDPREVENT audit is a significant milestone in supporting national and local systems assess and prioritise their work around these killer diseases. And while the data cover only England, decision-makers elsewhere in the UK should consider how doing something similar in their areas could help them too address one of the biggest health challenges of our time.

Building a clear picture of the scale of the challenge, as well as the opportunity to do better, is something which should continue to be a priority for policymakers, not least because CVD is such a key battleground in the fight against health inequalities and supporting those living with multiple long term conditions.