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What is changing in cardiovascular disease care?

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Paul Midgley explores the NHS Long-term Plan’s strategy for tackling cardiovascular disease and what it means for pharma.

Cardiovascular disease (CVD), which covers a wide range of conditions, such as coronary heart disease, heart valve disease (HVD) and strokes, is responsible for a quarter of all deaths in the UK.

The Long-term Plan, which identifies CVD as the single biggest area where the NHS can save lives over the next 10 years, highlights the importance of tackling lifestyle-related risks such as obesity, smoking and poor diet.

Improving the detection and management of high-risk conditions, such as high blood pressure, high cholesterol and Atrial Fibrillation (AF) that can cause CVD, as well as many cases of dementia, is also a key part of the strategy.

Identifying people at risk
The Long-term Plan says the NHS aims to help to prevent up to 150,000 heart attacks, strokes and dementia cases over the next 10 years. It pledges to take further action on problems such as obesity, alcohol and smoking.

It also highlights the progress that other countries have made in ensuring that people routinely know their ‘ABC’ – AF, blood pressure and cholesterol – and the possibility of replicating this approach.

In line with this, NHS England has recently announced that as part of a new £13 billion five-year contract, from October 31, community pharmacists will start to develop and test an early detection service to identify people who may have undiagnosed high-risk conditions like high blood pressure for referral for further testing and treatment. If successful it could be rolled out to all community pharmacies by 2021-22.

Another area of focus in identifying people at risk is genome mapping, particularly around rarer conditions. The Long-term Plan says that expanding access to genetic testing for Familial Hypercholesterolaemia (FH), which causes early heart attacks and affects at least 150,000 people in England, will enable it to diagnose and treat those at genetic risk of sudden cardiac death.

Technology
Technology is key to enabling improvements across the NHS particularly in early diagnosis and disease prevention. Improving the effectiveness of approaches, such as the NHS Health Check, which is currently offered to everyone aged between 40 and 74 to spot the early signs of major conditions that cause premature death, is a CVD-related objective in the Long-term Plan.

Following on from this, the Government has recently announced a review of the NHS Health Check service to explore how analytics and data-driven technologies can deliver personalised health advice to patients. The idea is that new intelligent, predictive checks could enable the NHS to take issues such age, risk factors and lifestyle into account when offering tests.

Integrated care organisations
Many CVD services will be delivered in Primary Care Networks (PCNs) by community teams that are likely to include physician associates, clinical pharmacists, specialist heart failure nurses and possibly consultants.

There will be a big focus on identifying relevant cohorts of patients and offering timely interventions. This work will be supported by a new national CVD prevention audit which will extract routinely recorded but anonymised GP data, making it easier for PCNs and other NHS organisations to determine what needs to be done to improve outcomes for their patients and populations.

Integrated Care Systems (ICSs) will look at the whole CVD strategy to ensure a co-ordinated approach at each level of integrated care. This will cover everything from identifying the right patients to target, to providing proactive screening and treatment for lipid lowering.

Implications for pharma
As the NHS continues to embrace ICSs, reducing costs across the whole system is expected to become increasingly important. In line with this, annual contracts are likely to move to multi-year contracts of between five and 15 years.

This will help ICSs to consider technologies and drugs that support service transformation and improve outcomes over time without increasing overall costs in the entire patient journey

Key players in the anticoagulant market have already managed to successfully engage with the NHS on the long-term cost-saving benefits of these products for stroke prevention.

Given the current focus on ABC, industry needs to do the same for lipid-lowering drugs, paying particular attention to how cost-efficiency messages for these products translate over a long period of time.

As the NHS focuses on place-based care, pharma also needs to gather other supporting population health data relevant to specific areas, such as the number of previous hospital admissions for stroke in a given region, or the cost of managing comorbidity issues in a relevant cohort of patients.

Conclusion
Prevention and early intervention are key to tackling CVD, and the Long-term Plan makes it clear that the NHS must take a multi-faceted approach from addressing lifestyle-related issues to identifying high-risk conditions.

Pharma needs to keep abreast of local plans for CVD prevention and management. Industry also needs to ensure that its propositions are built on a solid understanding of the NHS’s goals for CVD and the integrated, population-based approach that underpins it.