Cardiovascular Disease Outcomes Strategy: Improving Outcomes for People With or at Risk of Cardiovascular Disease

Objectives

The cardiovascular disease strategy seeks to reduce premature mortality, morbidity, disability and inequalities, while improving quality of life, patient and carer experience, safety, independence and wellbeing. It frames cardiovascular disease as an interconnected family of conditions requiring prevention, early identification, timely treatment, long-term management and end-of-life care rather than separate disease-specific responses.[1][2][3][4]

• Reduce population and individual risk by addressing smoking, diet, physical inactivity, obesity, harmful alcohol use, hypertension, raised cholesterol, diabetes and chronic kidney disease.[5][6][7]
• Identify undiagnosed cardiovascular risk and disease through the NHS Health Check programme, primary-care case finding and tailored risk management, including five-yearly checks for eligible adults aged 40 to 74.[8][9][10]
• Improve identification and management of people at very high inherited risk, including familial hypercholesterolaemia and inherited cardiac conditions associated with sudden cardiac death.[11][12]
• Provide integrated assessment and management of coronary heart disease, stroke, hypertension, hypercholesterolaemia, diabetes, chronic kidney disease, peripheral arterial disease, heart failure, arrhythmias and vascular dementia, recognising co-morbidities and shared risk factors.[2][5][13]
• Strengthen primary and secondary prevention, reduce unwarranted variation, and ensure that poorer-performing services move towards the standards achieved by the best-performing services.[1][14][4]
• Improve acute responses to out-of-hospital cardiac arrest, heart attack, transient ischaemic attack and stroke through public awareness, rapid emergency response, specialist care and timely access to effective interventions.[15][16][17][18]
• Improve peripheral arterial disease, diabetic foot and vascular care to prevent avoidable complications, amputations and cardiovascular events.[19][20][21]
• Support people living with cardiovascular disease through personalised care planning, rehabilitation, self-management, psychological and practical support, and coordinated support for families and carers.[22][23][24][25]
• Improve end-of-life care so that people receive coordinated support and are more likely to be cared for, and die, in their preferred place where possible.[26][27]
• Improve children’s and young people’s health as a longer-term contribution to preventing adult cardiovascular disease and premature mortality.[28]

Implementation

Implementation is intended to operate within the existing legislative framework, systems architecture and financial settlement, through coordinated action by the Department of Health, Public Health England, the NHS Commissioning Board, clinical commissioning groups, local authorities, health and wellbeing boards, providers, professional bodies, charities, patients and carers.[5][4][29]The approach combines population-level prevention, locally commissioned public-health activity, integrated care pathways, specialist networks, evidence-based commissioning and transparent use of comparative data.[28][30][31]

• Assign local authorities responsibility for public-health improvement and NHS Health Checks, working with health and wellbeing boards, communities, primary care, schools, care homes and NHS services to address risk factors and wider determinants.[28][7][11][29]
• Commission healthcare through the NHS Commissioning Board and clinical commissioning groups, using National Institute for Health and Care Excellence guidelines and quality standards, local needs and outcomes frameworks to shape services.[28][16][29]
• Develop and evaluate integrated cardiovascular service models and a standardised assessment template across hospital and community settings, led through NHS Improving Quality with relevant stakeholders.[2][13][32]
• Coordinate care through named healthcare professionals, individual care plans, shared assessment, follow-up and secure information exchange across primary, secondary, community and social care.[30][33][22]
• Strengthen primary-care detection by comparing expected and recorded prevalence, identifying missing patients, supporting practices with low detection rates and reviewing relevant Quality and Outcomes Framework indicators.[9][12]
• Develop specialist and networked services, including vascular hubs, multidisciplinary diabetic foot teams, heart failure teams, rapid-access transient ischaemic attack services, stroke units and specialist acute cardiac services.[34][18][20][21]
• Use public campaigns, including Act FAST and Change4Life, alongside social marketing, industry engagement and voluntary Responsibility Deal activity to promote healthier lifestyles and symptom recognition.[7][34][17]
• Expand rehabilitation, early supported discharge, psychological care, personal health budgets, telemedicine and patient access to interoperable records to support recovery, choice and self-management.[33][23][35][36]
• Improve end-of-life coordination through advance care planning, staff training, care registers, the Transform programme, Electronic Palliative Care Coordination Systems and the Views of Informal Carers for the Evaluation of Services survey.[26][27]
• Use benchmarked data on risk factors, NHS Health Check uptake, interventions, outcomes and service quality to support local prioritisation, public comparison and improvement.[37][8][31]
• Link cardiovascular audits and registries with routine datasets, including Hospital Episode Statistics, Office for National Statistics data and, in due course, the General Practice Extraction Service; establish a cardiovascular intelligence network involving epidemiologists, analysts, clinicians and patient representatives.[38][31][39]
• Support pathway redesign through Commissioning Support Units, Strategic Clinical Networks and the NHS Standard Contract, while incorporating relevant NHS Commissioning Board and Public Health England actions into organisational work plans.[38][29][31]

Monitoring & Evaluation

Monitoring is anchored in the National Health Service, Public Health and Adult Social Care Outcomes Frameworks, the NHS Mandate and the Clinical Commissioning Group Outcomes Indicator Set. These mechanisms are intended to support local priority-setting, public comparison and accountability to communities, although no single consolidated reporting timetable or formal accountability framework is specified.[2][5][40]

• Monitor population outcomes including cardiovascular disease mortality, premature mortality, inequalities, risk factors, obesity, diabetes, smoking, diet, physical activity and undiagnosed disease. All-age cardiovascular mortality fell by 36% and under-75 mortality by 40% between 2001 and 2010; the absolute under-75 mortality gap between the most and least deprived areas narrowed from 103 to 75 deaths per 100,000, although the relative gap widened.[41][6][3]
• Publish benchmarked data on cardiovascular risk factors, NHS Health Check uptake, problems identified, interventions and outcomes, alongside comparative information on hospital cardiovascular services, general practice and local-authority outcomes.[37][9][31]
• Link cardiovascular audits and registries with routine datasets, including Hospital Episode Statistics and Office for National Statistics data, with future linkage to the General Practice Extraction Service.[38][31]
• Evaluate NHS Health Checks through nationally collected programme data, including reach, uptake, follow-up and access to risk-management services. The intended annual reach was one-fifth of the eligible population, approximately 3 million people; 2.2 million checks were offered and 1.1 million received in the preceding year.[8][11]
• Track acute-care performance through audit and service indicators, including survival after out-of-hospital cardiac arrest, bystander cardiopulmonary resuscitation, angioplasty timeliness, stroke-unit admission, brain imaging, thrombolysis, transient ischaemic attack assessment, carotid endarterectomy timing and heart-failure outcomes.[15][16][17][18]
• Assess rehabilitation, personalised care and psychological support using patient experience, self-management, quality of life, admissions, readmissions, mortality, disability and cost-effectiveness. Relevant audit findings include cardiac rehabilitation access for about 44% of patients and early supported discharge availability in 45% of stroke units.[23][35][24][25]
• Monitor end-of-life care through the Views of Informal Carers for the Evaluation of Services survey, the Death in Usual Place of Residence indicator, electronic palliative-care coordination records and locality intelligence.[26][27]
• Develop a cardiovascular intelligence network involving epidemiologists, analysts, clinicians, patient representatives and patient-safety experts to consolidate data, identify evidence gaps and improve use of information on quality, patient experience, costs and outcomes.[38][31][39]

Costing & Financing

The strategy assumes delivery within the existing financial settlement and no new overall funding. It emphasises more efficient use of existing resources, while recognising that some actions require up-front investment to secure longer-term savings and benefits.[5][40]

• Record NHS expenditure on problems of circulation at £7.72 billion in 2010/11, within a total NHS budget of £107 billion; the comparable 2003/04 figure was £5.72 billion, but methodological changes limit direct comparison.[40]
• Assess NHS Health Checks at an average annual cost of £332 million and average annual net benefit of £2.765 billion. The model uses 2008 prices, present values and a £50,000 valuation per quality-adjusted life year.[10]
• Identify service redesign savings, including an estimated £3.5 million annual reduction from the London hyper-acute stroke model and around £500 per patient from early supported discharge.[42][35]
• Recognise diabetic foot and amputation costs of £640 million to £660 million annually, including estimated hospital amputation costs of £25 million per year in England. Multidisciplinary diabetic-foot care has a reported trust case-study cost of £33,000 and associated annual savings of £250,000.[20][43]
• Estimate avoided leg amputation savings at around £32,000 per person in the first year; no national costing is available for peripheral arterial disease management.[44]
• Estimate an additional £8.6 million per annum for ST-elevation myocardial infarction reperfusion, with direct resource requirements expected to be offset by fewer adverse events.[45]
• Identify potential savings from specialist diabetes teams, rehabilitation and psychological care, but specify no dedicated national budgets, funding allocations, funding gaps or resource-mobilisation plan for most actions.[46][25][40]