Risk Assessment and Management of Cardiovascular Diseases - an English Approach. Lynam E. Conference on Cardiovascular Diseases (Madrid: Ministry of Health and Social Policy; 2010).

1. Risk Assessment and Management in
CVD: An English Approach
Elizabeth Lynam
Branch Head, Vascular Programme
Department of Health

2. • Established in 1948, the NHS celebrated its 60th anniversary in 2008
• Provides high-quality healthcare, free at the point of need, according
to clinical need
• taxpayer-funded healthcare accounted for 7.8% of UK GDP in
2007/8
• Provides healthcare in a variety of settings and at various stages in
the care pathway of patients:
– primary care: through pharmacists, General Practitioners,
dentists,
– opticians and walk in centres
– community care: through health visitors, district nurses,
community hospitals
– secondary care: through ambulance services, acute hospitals,
mental health services, and social care services

3. Structure of the NHS in England
• England is organised into 10
SHAs
• A network of 152 Primary Care
Trusts holds the NHS budget
and commissions services on
behalf of local populations
• NHS annual budget is £103
billion for 2009 - 10

4. Lifestyle Risk Factors
• lifestyle challenges such as smoking, obesity and alcohol
misuse, cost the NHS approx € 10bn annually, society
approx € 40bn annually and cause 140,000 preventable
deaths each year.
• though rates are dropping, 10million (21%) of the general
population smoke; half of these are routine and manual
workers
• 62% of the adult population are overweight or obese
• only 39% of men and 29% of women meet the
recommended daily amount of physical activity

5. Our Approach
1. Informing and supporting people to make healthier and more
responsible choices
2. Creating an environment in which the healthier and more
responsible choice is the easier choice
3. Identifying, advising and treating those at risk

6. Impact of Cardiovascular
Disease in England
• Second biggest area of spend for the NHS by disease programme
• CVD is the leading cause of premature mortality
• Stroke is the leading cause of adult disability
• Diabetes is the leading cause of adult blindness and lower limb
amputations

7. Health Inequalities
In England, people who live in least affluent areas have worse health
outcomes, including higher rates of premature death.
• CVD is leading cause of premature death
Also, certain groups in English society experience higher rates of
CHD:
• mortality rates from CHD is 46% higher for men and 51% higher for
women of South Asian origin than in the non-Asian population
• occurrence of diabetes in individuals of South Asian origin is twice
that of the general population

8. Vascular diseases:
the strategic approach
Good progress tackling vascular
conditions so far:
• 40% fewer cardiovascular deaths
• planned reduction achieved early
Existing policies:
• Coronary Heart Disease NSF (2000)
• Diabetes NSF (2001)
• Renal Services NSF (2004)
• National Stroke Strategy (2007)
All highlight the need for prevention
but set out individual approaches

9. CVD and Diabetes Prevention –
the Case for Risk Assessment
UK National Screening Committee – proposed diabetes
screening for targeted groups within the context of
broader CVD risk assessment
Department of Health’s Vascular Programme Board –
with major Screening Committee input developed an
outline proposal for a vascular risk assessment and
management programme

10. ‘
Vascular disease risk factors
Same risk factors:
‘Fixed factors’
• age
• gender
• ethnicity
‘Modifiable factors’
• smoking
• physical inactivity
• obesity
• blood pressure
• blood fats
Having one disease increases the risk of
developing another

11. Vascular Risk Assessment
and Management Programme

12. Role of the National Programme
• A population-based approach based on public health principles
• About risk assessment (and management) – not principally a
disease finding programme
• Systematic and universal (for populations within specified age
bands)
• Will standardise the approach to vascular risk assessment and
management already being undertaken piecemeal across the
country – ensuring that diabetes and kidney disease are included

13. The National Offer
• NHS Health Check detailed in
Best Practice Guidance (April,
2009)
• Everyone aged between 40 – 74
not on an existing disease
register
• Call and recall every 5 years

14. Clinically and cost effective
DH economic modelling showed that, each year the NHS Health
Check programme could prevent at least:
• 1,600 heart attacks and strokes
• 650 cardiovascular deaths
• 4000 people developing diabetes
Prevention figures are cautious estimates based only on known
effective management applied to those at high risk.

16. The check
• Face to face check
• Assess risk of:
• heart disease
• stroke
• diabetes
• kidney disease
• Explanation of vascular risk
• Tailored lifestyle advice
• Referral to other investigations and interventions as appropriate

17. Strategic Fit with National
Health Policy
Primary Care Led NHS �
Prevention �
Tackling Health Inequalities �
Greater Role for Pharmacy �
Health Promotion Strategies �

18. Reaching those at highest
risk
• Check suitable for a variety of settings
• Some PCTs using outreach services
– examples on the NHS Improvement website
• Targeting those with greatest risk/need first
• National communications materials tested with those at highest risk.
• Tailored and translated of the leaflet being made available – plus
DVD

19. Early Challenges Encountered
• Rolling out a standardised programme in a devolved healthcare
system
• Will take several years to reach full coverage
• Overcoming scepticism from some of the people who will need to
provide this
• Achieving good rates of take up
• Having enough services to support lifestyle interventions

20. Further information
www.improvement.nhs.uk/nhs
healthcheck
www.dh.gov.uk/nhshealthcheck
e-mail:
nhshealthcheck@dh.gsi.gov.uk