Reducing inequalities: CVD Cardiovascular disease isnt just an indicator of 1 health inequalities; it is a primary driver of them . Dr Pegah Salahshouri, Lead Cardiology Consultant at West Suffolk NHS Foundation Trust and Clinical Advisor to Eastern AHSNs CVD Programme, shares how we have been working with partners across the region to improve heart health. Cardiovascular disease (CVD) affects around seven million people and is responsible for one in four deaths in the UK; thats more than 160,000 deaths each year, with more than 40,000 of them in those aged under 752. Despite being largely preventable, CVD is a leading cause of morbidity, disability and mortality in England, and is among the largest contributors to health inequalities3. A report funded by Eastern AHSN, delivered in August 2022 in partnership with the University of Cambridge, found that more deprived areas tended to have a higher prevalence of all CVD conditions, reflecting the impact of the wider determinants of health on CVD outcomes. The exception was atrial fibrillation, which was found to be less prevalent in the most deprived areas, suggesting potential underdiagnosis of this condition. If we want to address health inequalities, then cardiovascular disease prevention is a great place to start. Thats why Eastern AHSN has been working to help improve the detection, management and optimisation of high-risk conditions related to CVD, optimising blood pressure and minimising the risk of myocardial infarction and stroke across the region. Ive been proud to support the team as a clinical advisor on this work and have been amazed by the expertise and passion the team has shown as they convene clinicians, and support the implementation of innovative interventions to improve the heart health of the population we serve. Some of the highlights include: Improving lipid management High blood cholesterol is a risk factor for developing heart and circulatory diseases and can be caused by lifestyle and genetic factors. The aim of lipid therapy is to decrease this by lowering harmful cholesterol levels. Healthy lifestyle changes, such as reducing smoking and alcohol intake, healthy diets and physical activity are imperative. However, when lifestyle changes alone do not optimise cholesterol levels, drug therapy can help. This year, more than 200 healthcare professionals have attended our lipid management training events and, according to prescribing data of lipid-lowering therapies, 89% of GP practices are now adopting the new NICE-endorsed lipid management pathway. Additionally, 19,689 extra patients in the region have been prescribed with a lipid-lowering therapy to optimise their cholesterol levels, which is estimated to prevent almost 2,000 cardiovascular events over the next five years5. Learn more about our cardiovascular disease (CVD) prevention programme on our website. Identifying familial hypercholesterolaemia (FH) Familial hypercholesterolaemia (FH) is a genetic condition that causes extremely high cholesterol levels and is estimated to affect around 1 in 250 of the UK population6. Without treatment, FH can lead to heart disease at a very young age and people with undetected FH are four times more likely to have a heart attack or stroke than the general population6. However, once its been diagnosed, it can be treated with medicines and a healthy lifestyle. This year, we have supported eight GP practices to take part in the FH ChildParent Screening pilot and 51 children have been screened during their immunisation appointments. So far, two children have been referred for genetic testing and are awaiting results. We have been part of a collaboration, working with Eclipse Live, East Genomics Medicine Service Alliance (GMSA), East Genomics, Norfolk & Norwich University Hospitals, Norfolk & Waveney ICB and PRIMIS, to develop the Eclipse Live FH Hub. The Hub identifies the highest-risk FH patients and offers 12 virtual clinical assessments per week. It also reduces waiting list times for assessments by approximately 12 months through proactive triage. Our work with the East GMSA and the East Genomics team has also resulted in Understanding familial hypercholesterolaemia (FH): Marks story: developing an East of England FH Info Zone for healthcare professionals, expanding access to FH genetic testing as outlined in the NHS Long Term Plan the first region in the country to achieve this. Through designing programmes with equity in mind, and monitoring results by disadvantaged groups to inform continual improvement, quality improvement programmes can reduce inequalities across the East of England and ensure their benefits favour those who are most disadvantaged Dr John Ford, clinical lecturer in public health at the University of Cambridge4 Detecting irregular heart rhythms to reduce strokes Atrial fibrillation (AF) is one of the most common forms of abnormal heart rhythm (arrhythmia) and a major cause of stroke. Around 1.5 million people in the UK have been diagnosed with the condition and it is estimated that there are at least 270,000 people aged over 65 with undiagnosed (or silent) atrial fibrillation in the UK6. This year, Eastern AHSN brokered a pilot of a new remote AF detection pathway across West Suffolk and Ipswich hospital sites. The pilot used a population health-management approach to identify individuals at higher risk of AF to offer heart-rhythm monitoring for seven days using FibriCheck. FibriCheck is an innovative, hardware-free smartphone and smartwatch application that detects cardiac arrhythmias using the phones camera. Where screening suggests the potential presence of AF, patients are offered further diagnostic assessment for 14 days via ZioXT Patch, a wire-free remote ECG monitor, which collects data that is then analysed by AI technology. This AI technology is validated by cardiac physiologists and is recommended by NICE. This is followed by a remote consultation and initiation of treatment to prevent avoidable strokes where appropriate. Over the course of the pilot, 1,192 people at higher risk of AF used the FibriCheck app, with 36 going on for further monitoring with the ZioXT Patch and 10 being diagnosed and treated for AF. Two of these patients had no noticeable symptoms of AF, so would not have been identified via the traditional routes. Relieving the pressure The Blood Pressure Optimisation programme, delivered by Eastern AHSN in partnership with NHSX, and commissioned by NHS England, aims to prevent heart attacks, strokes and dementia in patients with hypertension through the adoption of a standard framework for hypertension in primary care. We have been prioritising GP practices in the highest index of multiple deprivation areas across our region to maximise our impact. This year, we have supported 178 GP practices to adopt a proactive approach to hypertension optimisation, including 34 in particularly deprived areas. To help us understand hypertension management from a patients perspective, we surveyed more than 700 members of the public to gain insight into their understanding of high blood pressure and how to best access and use services. On average, respondents reported being extremely confident about taking their own blood pressure, and 89% of people prefer to monitor their own blood pressure at home. We are now working with local commissioners and providers to embed the learnings from the survey into their practice. Are you interested in joining our Stroke Forum? Visit our website to find out more Creating a network for healthcare professionals in stroke services Eastern AHSN proudly hosts the East of England Stroke Forum, which was relaunched this year. The aim of the forum is to nurture, develop and sustain a community of knowledgeable professionals, competent in meeting the needs of individuals affected by stroke in the East of England. To this end, we have created an online repository with resources related to stroke research and care to support clinicians continuous professional development. In November, we ran the first in a series of more than 20 interactive online learning events with expert speakers and clearly defined learning objectives. The session recordings are available on our website and will run until 2025. We are currently planning the first annual face-to-face conference for the forum in September 2023. The Stroke Forum has helped convene the healthcare community to discuss this vital work, network and keep abreast of best practice, to the huge benefit of our patients Lynda Sibson, telemedicine manager for the East of England Stroke Telemedicine Partnership Share this article Return to About Us If you want to find out more about our work to improve the detection and management of CVD, visit our website or contact nick.pringle@eahsn.org. Up next: Read about the work we are doing to support mental health. References Ford, J. (2022). Cardiovascular disease inequalities in the East of England. [Online]. Eastern AHSN. Last Updated: August 2022. Available at: https://www.easternahsn.org/ wp-content/uploads/2022/08/CVD-Evidence-Briefing-Aug-2022.pdf [Accessed 20 December 2022]. 2 British Heart Foundation. (2023). UK Factsheet. [Online]. British Heart Foundation. Last Updated: April 2023. Available at: https://www.bhf.org.uk/-/media/files/forprofessionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf/ [Accessed 20 April 2023]. 3 The Kings Fund. (2022). Cardiovascular disease in England. [Online]. The Kings Fund. Last Updated: November 2022. Available at: https://www.kingsfund.org.uk/sites/ default/files/2022-11/CVD_Report_Web.pdf [Accessed 10 December 2023]. 4 Ford, J. (2022). Cardiovascular disease inequalities in the East of England. [Online]. University of Cambridge Department of Public Health and Primary Care. Last Updated: August 2022. Available at: https://www.phpc.cam.ac.uk/pcu/files/2022/08/Cardiovascular-Disease-Inequalities-in-the-East-of-Engl [Accessed 20 November 2022]. 5 Armitage, J. Baigent, C. L, Blackwell. Collins, R. Emberson, J. Reith, C .Collins, R. (2016). Interpretation of the evidence for the efficacy and safety of statin therapy. [Online]. The Lancet. Last Updated: 8 September 2016. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31357-5/fulltext [Accessed 20 November 2022]. 6 British Heart Foundation. (2023). UK Factsheet. [Online]. British Heart Foundation. Last Updated: April 2023. Available at: https://www.bhf.org.uk/-/media/files/forprofessionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf/ Accessed 20 April 2023.