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

Objectives

The Cardiovascular Disease Outcomes Strategy provides a whole-pathway framework to improve outcomes for people with, or at risk of, cardiovascular disease, treating cardiovascular conditions as an interconnected family rather than separate disease silos. Its overarching aims are to reduce mortality and morbidity, improve quality of life, patient experience and safety, reduce inequalities in access and outcomes, and improve cost effectiveness.[1][2]

• Prevent cardiovascular disease by addressing smoking, unhealthy diet, salt intake, harmful alcohol use, physical inactivity, obesity, diabetes, hypertension, raised cholesterol and other shared behavioural and bodily risk factors.[3][4][5]
• Identify risk earlier through the NHS Health Check programme for eligible people aged 40 to 74, primary-care case finding, and improved detection of hypertension, atrial fibrillation, diabetes, chronic kidney disease and peripheral arterial disease.[6][7][8]
• Identify people and families at very high inherited risk, particularly those affected by familial hypercholesterolaemia and inherited cardiac conditions associated with sudden cardiac death.[9]
• Improve emergency and acute care for cardiac arrest, heart attack, stroke, transient ischaemic attack, heart failure and vascular conditions by reducing variation and securing timely specialist assessment and evidence-based treatment.[10][11][12][13]
• Strengthen primary, community, hospital and social care management, including secondary prevention, rehabilitation, self-management, psychological support, personalised care planning, reablement and end-of-life care.[14][15][16][17]
• Support integrated assessment and management of co-morbidities, including coronary heart disease, stroke, peripheral arterial disease, chronic kidney disease, diabetes, arrhythmias, vascular dementia and heart failure.[3][18]
• Align cardiovascular action with the Public Health, National Health Service and Adult Social Care Outcomes Frameworks, while using National Institute for Health and Care Excellence guidance and quality standards to reduce unwarranted variation.[19][3][14]

Implementation

Implementation is based on coordinated, locally responsive action across public health, commissioning and care delivery, within the existing legislative framework and financial settlement. Local authorities lead public health improvement and the NHS Health Check programme, while the NHS Commissioning Board, clinical commissioning groups, providers and national improvement bodies commission, coordinate and improve services with patients, carers and communities.[3][20][9][21]

• Coordinate joint planning through health and wellbeing boards, linking local authorities, primary care, NHS services, schools, care homes and partners addressing wider determinants of health.[20]
• Commission services in accordance with National Institute for Health and Care Excellence guidelines and quality standards, using the NHS Standard Contract, Quality and Outcomes Framework indicators, commissioning support and comparative information to improve pathways and consistency.[14][7][22]
• Develop, test and evaluate integrated cardiovascular service models for hospital and community settings, including a standardised assessment template that supports identification of related cardiovascular conditions and risk factors. NHS Improving Quality leads this work with relevant stakeholders.[19][18]
• Support primary care to compare expected and reported cardiovascular prevalence, identify missing patients, improve risk-factor management and strengthen prevention and secondary prevention links with local authorities, Public Health England and voluntary organisations.[23][7][24]
• Improve follow-up after NHS Health Checks by connecting people with identified risks to medical treatment and lifestyle support, including physical activity and weight-management services.[23][9]
• Configure specialist networks and services to deliver timely emergency response, direct transfer where appropriate, seven-day assessment, imaging, angioplasty, thrombolysis, stroke-unit care, vascular intervention and specialist heart-failure support.[10][11][25][26][27]
• Expand public awareness, cardiopulmonary resuscitation training, automated external defibrillator mapping and registration, ambulance first-responder programmes, and campaigns such as Act FAST.[14][10][25]
• Provide person-centred long-term care through named coordination, written care plans, personal health budgets where appropriate, rehabilitation, early supported discharge, accessible information, peer support and psychological care.[28][15][16][29]
• Enable secure information sharing across primary, secondary and social care, give patients online access to records, and use electronic palliative care coordination systems to ensure care reflects patients’ wishes.[28][30]
• Strengthen end-of-life care by identifying people likely to be in their final year of life, assessing supportive-care needs, recording preferences, coordinating services and supporting rapid discharge where appropriate.[17]
• Build cardiovascular intelligence by linking clinical audits, registries, Hospital Episode Statistics, Office for National Statistics data and general-practice information; publish comparative data on risk factors, service quality and outcomes; and establish a cardiovascular intelligence network involving analysts, clinicians and patient representatives.[31][22]
• Use existing resources more efficiently because no new overall funding is assumed, while assessing intervention-level costs, benefits and potential longer-term savings where evidence is available.[32]

Monitoring & Evaluation

The strategy uses the Public Health, National Health Service and Adult Social Care Outcomes Frameworks to orientate cardiovascular disease outcome delivery, local priority-setting and accountability.[3][20][21]It seeks to monitor mortality, morbidity, quality of life, patient experience, safety and inequalities, supported by comparative information for commissioners, providers, clinicians and the public.[2][22]

• Monitor population risk and prevention through benchmarked information on risk-factor prevalence, National Health Service Health Check uptake, identified problems, interventions and outcomes.[23][7]
• Link cardiovascular audits and registries with Hospital Episode Statistics, Office for National Statistics data and, in due course, the General Practice Extraction Service; establish a cardiovascular intelligence network to integrate and interpret these data.[31][22]
• Publish comparative data on hospital cardiovascular teams, general-practice care, local-authority risk factors and outcomes to identify variation and support pathway redesign.[31][32][33]
• Track condition-specific indicators, including age-standardised cardiovascular mortality, practice-level expected versus reported prevalence, cardiac-arrest survival, emergency response times, treatment timeliness, stroke outcomes, amputation rates, rehabilitation access and end-of-life care quality.[34][7][10][12][35][36][37]
• Use established audits, including the Myocardial Ischaemia National Audit Project, national heart-failure audit, Stroke Sentinel National Audit Project and National Audit for Cardiac Rehabilitation, to support clinical performance assessment.[11][13][36]
• Evaluate integrated service models, standardised cardiovascular assessment, care planning, electronic palliative care coordination systems, personal health budgets and early supported discharge for clinical feasibility, outcomes and cost effectiveness.[18][28][16][17]

Reported performance examples include a 40% fall in under-75 cardiovascular mortality in England between 2001 and 2010, 92% of eligible primary angioplasty patients treated within 90 minutes in 2011/12, and rising stroke-unit admission within four hours from 17% in 2007/08 to 66% in 2012.[2][11][12]Reporting intervals, a consolidated indicator set, surveillance governance and formal sanctions are not comprehensively specified.[6][17]

Costing & Financing

The strategy assumes no new overall funding and emphasises efficient use of existing resources, while recognising that some interventions require upfront investment to deliver longer-term savings and health benefits.[32]It provides intervention-level economic evidence rather than a single programme budget, financing plan or quantified funding gap.[32][38]

• Fund local public-health action through a ring-fenced grant that can support weight-management services, while local authorities hold responsibility for National Health Service Health Checks from April 2013.[39][9]
• Use annual risk-adjusted capitation budgets in the Long-Term Conditions Year of Care Funding Model to replace episodic, activity-driven funding with person-centred financing.[16]
• Assess NHS Health Checks as an investment estimated to pay for itself after 20 years; modelling reports an average annual cost of £332 million and average annual net benefit of £2.765 billion, expressed as present values at a 2008 price base.[6][40]
• Prioritise interventions with stated savings or cost-effectiveness evidence, including early supported discharge, stroke-service reconfiguration, diabetic-foot multidisciplinary teams, familial hypercholesterolaemia management, atrial-fibrillation treatment and cardiac rehabilitation.[26][41][42][43][44]
• Recognise major cost burdens from circulatory problems, obesity and diabetic-foot care, while noting that several service areas have no quantified national resource impact or programme allocation.[35][32][45]

National Health Service expenditure on problems of circulation was £7.72 billion in 2010/11, from a total National Health Service budget of £107 billion.[32]The extracts do not specify a dedicated overall cardiovascular strategy budget, detailed financing mechanism, resource-mobilisation target or funding gap.[21][22]