Why is it a priority?
Coronary Heart Disease (CHD), which includes heart attacks and other heart problems or heart failure and stroke are two significant causes of premature death and disability in people. They are, however, often preventable, and can be reduced significantly by systematic evidence based management in primary care.
There are up to 600 admissions and around 120 deaths each year from strokes, and 430 hospital admissions and 185 deaths from heart disease in Greenwich. Whilst overall mortality from CHD is declining in all age groups, and has decreased in men by 44% since 2007, it has increased by 6.5% in women. Mortality rates from stroke in the under 75s are higher in Greenwich than for England, and the gap between Greenwich and England is widening.
People of African and Caribbean origin have double the incidence of stroke compared to others, whilst for CHD the highest death rates are in people from lower socio-economic groups. For both CHD and stroke there are gaps between likely prevalence and patients on risk registers, the “missing”.
What could make a difference at a local level?
- Raised cholesterol, high blood pressure, abdominal obesity and smoking are all key risk factors for CHD, so primary care has a key role in identifying (through NHS Health Checks PLUS), addressing risk factors (including atrial fibrillation) as well as maximising opportunities for secondary prevention through effective treatment and management of conditions
- Depression and high alcohol consumption are significant factors for stroke, so population level and primary care support to reduce unsafe drinking (licensing enforcement, restricting sales and promotions, alcohol brief interventions) and mental wellbeing promotion are required
- Finding the “missing” or undiagnosed people with CHD/stroke and those at risk and supporting them to self-manage their conditions, in particular finding those with atrial fibrillation who are undiagnosed and untreated (including roll out of GRASP-Heart Failure audit tool that identifies people with heart failure who are undiagnosed or under treated)
- Improving the clinical outcomes of those on CHD and stroke registers by managing the conditions proactively in the community
- Reducing unwarranted variations in care, especially referral into cardiac rehabilitation
- Access to rapid access diagnostic clinics and specialist support for management of angina and heart failure
- Education for health professionals to promote evidence based management of CHD & Stroke and high quality measurement of blood pressure including behaviour change interventions
What are the opportunities for improvement in Greenwich?
- Strengthening the prevention pathways from NHS Health Checks, to identify CVD risk, and reduce smoking, obesity, and alcohol misuse prevalence (and salt intake)
- Finding, and treating, the “missing” with CHD and stroke risk factors, such as hypertension, high cholesterol and atrial fibrillation, and addressing unwarranted variations in healthcare
- Systematic referral into smoking cessation services for CHD and stroke patients who smoke
- Cardiac rehabilitation – promoting timely referral into the service, reviewing referral rates, and acting on low referral rates post emergency admission
- Targeted interventions and behaviour change support with growing Black African populations in Greenwich to reduce their higher incidence of hypertension and stroke
- Developing and delivering new services and mechanisms to support carers and reduce depression in patients and carers