Heart Disease Action Plan 2021

Objectives

The Heart Disease Action Plan 2021 sets a Scotland-wide framework to minimise preventable heart disease and ensure that people with suspected or established heart disease receive timely, equitable, evidence-based diagnosis, treatment, care and support to live well.[1][2]It applies National Clinical Strategy principles including quality, evidence-guided change, self-management, community-based provision, equitable access, collaboration and Realistic Medicine.[3]

• Prevent cardiovascular disease by improving detection, diagnosis and management of high blood pressure, high cholesterol, familial hypercholesterolaemia and atrial fibrillation, while supporting risk reduction across the women’s lifespan and managing hypertensive disorders in pregnancy.[4][5][6]
• Improve access to nationally consistent pathways spanning primary, community, secondary, specialist, rehabilitation and palliative care, guided by a ‘Once for Scotland’ vision.[7][8]
• Reduce inequities by designing services with and for under-represented groups, including people experiencing deprivation or homelessness, Gypsy/Traveller communities, women, older and younger people, people with learning disabilities, and LGBTI people.[4]
• Enable people to live well with heart disease through self-management, cardiac rehabilitation, psychological and emotional support, anticipatory care planning and palliative care where needed.[7][9][10]
• Build a supported, sustainable and innovative workforce, particularly in cardiac physiology, with nationally agreed competencies, education, training and advanced-practice opportunities.[11][12]
• Use high-quality, standardised and linked data to support clinical decisions, assess patient outcomes, guide service planning, reduce unwarranted variation and strengthen research and quality improvement.[2][12][13]

Implementation

Implementation uses a whole-system, person-centred model integrating primary, community, acute and specialist services with third-sector organisations, digital technology and people with lived experience.[1][3][6]The National Heart Disease Task Force, supported by the Scottish Government Clinical Priorities team, oversees delivery, while a lived-experience structure feeds directly into Task Force decision-making.[2]A Task Force Executive Group advances actions between meetings, and identified groups must prepare annual implementation plans for Task Force agreement and oversight.[4]

• Co-produce awareness, prevention and detection programmes with clinical partners, primary care, community pharmacists, third-sector organisations, community groups and locally trained volunteers.[5][6]
• Expand technology-enabled care, including ScaleUp BP home blood-pressure monitoring, text messaging and clinical advice, and develop remote monitoring pathways for heart failure and other cardiovascular conditions while addressing digital exclusion.[14][6]
• Develop nationally agreed referral and care pathways for presentations such as palpitations, breathlessness, chest pain and syncope, alongside pathways for specialist care, rehabilitation, long-term management and palliative care.[8]
• Test and scale effective diagnostic innovations, including hand-held echocardiography, one-stop diagnostic clinics, community electrocardiograms and blood testing, and improve capacity for computed tomography coronary angiography, electrocardiography and echocardiography.[15][9]
• Strengthen rehabilitation through face-to-face and digital provision, multidisciplinary biopsychosocial assessment, informal and self-directed support, and broader access beyond people who have had heart attacks or cardiac surgery.[7][9][16]
• Provide stepped psychological care by making computerised cognitive behavioural therapy available through cardiac rehabilitation and specialist cardiac nursing services, developing psychology liaison roles, and working with mental-health and education partners.[10][8]
• Extend palliative and anticipatory care beyond heart-failure nursing services to people with coronary, valvular and congenital heart disease, including appropriate discussions about cardiac-device deactivation.[10]
• Coordinate workforce planning through a cardiac physiology workforce model, cardiology and cardiac-surgery gap analyses, sustainable education pathways, and competency frameworks for cardiologists, trainees, specialist nurses, pharmacists and cardiac physiologists.[12]
• Provide national leadership for quality indicators, standardised datasets and a Scottish Cardiac Audit Programme with Public Health Scotland, including patient-reported outcome measures and improved data linkage across care settings.[13][17]
• Develop specialised regional and national services, including pathways for Transcatheter Aortic Valve Replacement and ST-elevation myocardial infarction reperfusion, and national commissioning of MitraClip and Left Atrial Appendage Closure through the National Services Division.[18]
• Monitor implementation through annual progress reporting, agreed indicators, audit governance and data platforms that can assess access, diagnosis times, admissions, readmissions, mortality, length of stay, coding quality and geographical variation.[4][9][17][19]

Monitoring & Evaluation

The plan establishes a national improvement and accountability approach centred on high-quality, standardised data, quality indicators, audit, service intelligence and lived-experience input. It aims to measure outcomes, identify unwarranted variation and inequalities, improve clinical decision-making, and direct improvement activity across the full heart disease pathway.[1][2][12][13]

• Develop quality indicators covering key timescales, interventions and outcomes, aligned with relevant National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network guidance.[13]
• Co-produce indicators with healthcare professionals and people with lived experience, including patient-reported outcome measures to test whether service improvements reflect patient needs.[13][17]
• Map, standardise and improve the interoperability of datasets across primary, community, secondary and tertiary care, incorporating patient experience where appropriate.[13][17]
• Use data to identify gaps, assess variation in access and outcomes, monitor health inequalities, and target resources towards interventions with greatest potential benefit for patient outcomes.[1][2][11]
• Collect and report real-time service-activity and outcome data to support quality improvement and assess meaningful progress.[1][3]
• Establish national information on time to diagnosis as a core measure for data collection and quality-improvement work, supporting identification of unwarranted variation in diagnostic access.[15][9]
• Improve indicators and data collection for high blood pressure, high cholesterol, familial hypercholesterolaemia and atrial fibrillation, with data available locally, regionally and nationally.[6]
• Use Scottish Primary Care Information Resource reports to assess whether people recorded with atrial fibrillation receive treatment appropriate to their risk score, establish a national baseline for anticoagulation and set a Scotland-wide improvement target.[14][6]
• Include access to palliative care, where appropriate, within wider data collection and quality-improvement activity.[10]
• Evaluate innovative diagnostic-care pilots to understand resource requirements before wider implementation.[8]
• Contribute to the National Audit of Cardiac Rehabilitation, collate service information centrally, and link rehabilitation, acute-service and outcome data to assess access, models of care and outcomes.[16]
• Work with Public Health Scotland to deliver a Scottish Cardiac Audit Programme with governance for audit and service improvement.[17]
• Establish a data and intelligence platform for healthcare professionals and researchers, informed by learning from the Scottish Cancer Registry and Intelligence Service model.[13][17]
• Operate an eRegistry across all NHS Scotland Boards, with data held in a local SafeHaven, and scope heart-failure data linkage across five Boards.[19]
• Monitor heart-failure admission rates, 30-day readmissions, 30-day and one-year mortality, length of stay and coding accuracy at national, Board and hospital levels through the NSS Discovery heart-failure platform.[19]
• Publish an annual progress report against the strategic priorities; require identified groups to prepare annual implementation plans; and have the National Heart Disease Task Force oversee progress, supported by its Executive Group and a Public Health Scotland audit lead.[4]

Baseline evidence identifies that up to 610,000 adults in Scotland may be unaware that they have high blood pressure, while 27% of adults with high blood pressure have it treated and controlled below 140/90 mmHg.[5]A Canadian community cardiovascular programme was associated with a 9% reduction in population-level admissions for stroke, heart attack and heart failure among working-age people compared with communities without the programme.[5]

The supplied material does not specify a complete numerical target set, a detailed reporting timetable, standard evaluation methodology, surveillance protocol or formal accountability framework beyond annual reporting, Task Force oversight, audit governance and the proposed data platform.[4][13][17]

Costing & Financing

Financing information is limited. The plan identifies workforce capacity, education, training, digital technology, data infrastructure, audit and quality improvement as resource requirements, but does not provide a costed implementation plan, overall budget, expenditure profile, quantified allocation, funding-gap estimate, resource-mobilisation target or economic assumptions.[11][12][13][17]

• Support and invest in proven technology for cardiovascular risk detection, telemonitoring and tailored support, without specifying a monetary allocation.[6]
• Fund ScaleUp BP through the Scottish Government's Technology Enabled Care programme, with no stated value, date-specific allocation or programme budget.[5]
• Assess resource requirements through pilots of innovative diagnostic-care models before considering wider national implementation.[8]
• Address limited psychological-support capacity, including a shortage of clinical psychologists with a specific remit for heart disease, although no workforce cost or funding requirement is quantified.[10][8]
• Meet workforce, diagnostic-capacity, training, education, data and quality-improvement requirements without stated budgets or financing mechanisms.[15][11][12]
• Use an HRUK grant awarded in October 2019 to test the REACH-HF cardiac rehabilitation programme across five NHS Scotland Boards; the grant value is not specified.[18]

No funding source, budget or cost estimate is specified for the Scottish Cardiac Audit Programme, indicator development, dataset standardisation, the data-access platform, nationally agreed pathways, rehabilitation expansion, palliative-care improvements or national cardiac services.[7][16][13][17][18]