Hypertension How can we do better at preventing strokes and heart attacks?

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1 Hypertension How can we do better at preventing strokes and heart attacks? Dr Matt Kearney GP and National Clinical Director for Cardiovascular Disease Prevention NHS England and Public Health England

2 CVD Prevention a must do for NHS sustainability NHS RightCare will work with CCGs and STPs: To implement optimal value solutions Deploying audit tools and new models of care To improve detection and management in the High Risk Conditions for CVD 2

3 Secondary Prevention The High Risk Conditions for CVD But late diagnosis and suboptimal treatment are common 3

4 High risk conditions Preventive Treatment is Highly Effective High Blood Pressure Contributes to half of all strokes and heart attacks Every 10mmHg BP reduction reduces risk of CV event by 20% Atrial Fibrillation 5-fold increase in stroke risk and more likely to kill & disable Anticoagulation reduces strokes by two thirds in high risk AF High Cholesterol Progressive increase in risk of heart attacks and strokes Every 1 unit reduction lowers risk of CV event by 25% each year Type 2 Diabetes Doubles risk of heart attacks and strokes Control BP, cholesterol and sugar substantially reduces risk

5 High Risk Conditions Opportunity for Improvement High Blood Pressure Diagnosed Controlled to 140/90 6 in 10* 6 in 10* Atrial Fibrillation Known AF and on anticoagulant at time of stroke 1 in 2* High Cholesterol 10 year CVD risk above 20% and on statins 1 in 2* Type 2 Diabetes All 8 care Processes All 3 treatment targets (*with wide geographical variation) 1 in 2* 4 in 10*

6 Rule of Halves Preventive treatment before a stroke THIN database 29,000 patients at first ever stroke/tia 17,700 had one or more preventive drugs indicated Clinically indicated prevention drugs not prescribed Statin 49% Anticoagulant 52% Anti-BP 25%

7 CVD: Primary Care Intelligence Packs NHS South Reading CCG May 2017 Version 1

8 Estimated diagnosed hypertension by CCG Comparison with demographically similar CCGs NHS Coventry and Rugby CCG 56.7% NHS Hillingdon CCG 56.3% NHS Greater Preston CCG 56.1% NHS Leeds North CCG 54.1% NHS South Reading CCG 52.9% NHS Portsmouth CCG 52.4% NHS South Manchester CCG 51.9% NHS Leeds West CCG 50.2% NHS Nottingham City CCG 50.2% NHS Bristol CCG 49.0% NHS Southampton CCG 48.8% 0% 10% 20% 30% 40% 50% 60% 8 CVD: Primary Care Intelligence Packs

9 Estimated diagnosed hypertension by GP Practice Substantial variation GP practice CCG KENNET SURGERY K RUSSELL STREET - DR SWAMI K81636 WESTWOOD ROAD SURGERY K81056 CHATHAM STREET SURGERY K81026 GROVELANDS MEDICAL CENTRE K81078 MILMAN ROAD SURGERY K81101 LONDON ROAD SURGERY K81072 ELDON ROAD SURGERY K81640 MILMAN ROAD SURGERY- DR MITTAL K81040 TILEHURST VILLAGE SURGERY K81644 LONDON STREET SURGERY K81007 ABBEY MEDICAL CENTRE K81081 MELROSE SURGERY DR DEAN K81651 LONG BARN LANE SURGERY K81048 WHITLEY VILLA SURGERY K81065 PEMBROKE SURGERY K81100 UNIVERSITY HEALTH CENTRE K81605 READING WALK-IN HEALTH CENTRE Y02476 SHINFIELD MEDICAL PRACTICE Y02128 SOUTH READING SURGERY K Est. 12,664 people with undiagnosed hypertension in NHS South Reading CCG Ratio 9 CVD: Primary Care Intelligence Packs

10 People with hypertension Last BP above 150/90 Comparison with demographically similar CCGs NHS Greater Preston CCG 80.5% NHS Leeds West CCG 80.4% NHS Coventry and Rugby CCG 80.1% NHS Nottingham City CCG 80.0% NHS Portsmouth CCG 80.0% NHS Hillingdon CCG 79.7% NHS South Reading CCG 78.8% NHS Leeds North CCG 78.4% NHS Bristol CCG 77.8% NHS Southampton CCG 76.8% NHS South Manchester CCG 75.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 10 CVD: Primary Care Intelligence Packs

11 People with hypertension Last BP above 150/90 GP practice variation No treatment Exceptions reported READING WALK-IN HEALTH CENTRE Y ELDON ROAD SURGERY K TILEHURST VILLAGE SURGERY K81644 CHATHAM STREET SURGERY K81026 PEMBROKE SURGERY K81100 LONG BARN LANE SURGERY K81048 KENNET SURGERY K81613 MILMAN ROAD SURGERY- DR MITTAL K81040 GROVELANDS MEDICAL CENTRE K81078 SOUTH READING SURGERY K81633 MILMAN ROAD SURGERY K81101 ABBEY MEDICAL CENTRE K81081 WHITLEY VILLA SURGERY K81065 WESTWOOD ROAD SURGERY K81056 MELROSE SURGERY DR DEAN K RUSSELL STREET - DR SWAMI K81636 UNIVERSITY HEALTH CENTRE K81605 LONDON ROAD SURGERY K81072 LONDON STREET SURGERY K81007 SHINFIELD MEDICAL PRACTICE Y Est. 3,014 people in CCG whose blood pressure is not controlled to 150/90 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 11 CVD: Primary Care Intelligence Packs

12 Secondary Prevention in CVD Size of the Prize for STPs

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14 Improving secondary prevention in CVD The key local ingredients 1. Local clinical leadership GP, nurse, consultant, pharmacist, public health, commissioner, patient 2. Local intelligence how many people have high risk conditions that are undiagnosed or under-treated? 3. Clarity of vision - relentless local focus on the size of the prize - how many strokes and heart attacks could we prevent by doing better? 4. Doing things differently high impact interventions Mobilising the wider system to support general practice Expanded role for pharmacists in diagnosis, management & adherence Self testing and self monitoring Shared decision making eg anticoags and statins New technologies eg AliveCor, WatchBP Boosting NHS Health Check uptake 14

15 Stow Health Self testing blood pressure New diagnoses Optimising treatment Released 15 hours/month clinician time

16 Dudley Practice pharmacists managing blood pressure 16

17 Lambeth & Southwark Pharmacists manage blood pressure and AF Community pharmacist interventions Results: Improved BP control 1300 new patients anticoagulated Estimated 45 strokes averted in 15 months

18 Bradford Systematic improvement at scale and pace Multiple interventions Shared approach across practices Results 21,000 Rx optimisations (BP, AF, Cholesterol) 200 strokes and heart attacks averted in 18 months

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20 Thank