NHS Stroke action will save hundreds of lives

A new £9 million programme to spot heart conditions earlier will save at least 200 lives and offer protection to thousands more, NHS England announced today.

The scheme, which will run until next March, will see almost 20,000 people at higher risk of experiencing a stroke receive targeted checks and treatment as part of the NHS Long Term Plan’s renewed focus on preventing and tackling killer conditions.

Patients will be identified by specialist nurses and clinical pharmacists across the country who are trained to treat a heart condition – called atrial fibrillation – which increases the chance of having a stroke.

Specialist clinicians will identify patients in each surgery who have been diagnosed with atrial fibrillation but are not receiving treatment. Anyone identified as being at risk will be offered a personalised treatment plan developed with their GP.

The new scheme will treat more than 18,000 people, preventing around 700 strokes, saving an estimated 200 lives and stopping long-term health problems among thousands more, including disability.

The programme will run across 23 areas of the country with the highest rates of the condition receiving funding for specialist clinical pharmacists to help identify people who could benefit from medication.

NHS medical director, Professor Stephen Powis, said: “Tackling heart disease and stroke is a top priority in the NHS Long Term Plan, which will save thousands of lives by better diagnosis and treatment for people with killer conditions.

“By targeting help at those people most at risk of illness, and training up specialist clinicians, the NHS in England will help families across the country avoid the pain and loss associated with stroke.

“Not only is stroke one of the biggest killers in our country, but it leads to life-changing and often devastating long-term harm for many others, so by spotting the risks early, the NHS will not only prevent serious harm to the people affected, but avoid the need for aftercare which puts additional pressure on the health service.”

Treating people who have atrial fibrillation with anticoagulation drugs, reduces the risk of stroke by two-thirds yet only half of those with the condition who go on to suffer a stroke had been prescribed them.

People who are poorer, from black or ethnic minority backgrounds or other disadvantaged groups are more likely to be among those who go undiagnosed and untreated.

Juliet Bouverie, Chief Executive of the Stroke Association said: “This is a great step in the right direction. We’re pleased that pharmacists now have the tools to spot people most likely to have a stroke, so that they can be supported and spared the devastation stroke brings. Most people don’t know if they have atrial fibrillation and we’d like to see more speaking with a pharmacist or visiting their GPs to get checked.”

As well as being devastating for patients and their families, strokes are estimated to cost the NHS around £3 billion per year, with additional costs to the economy of a further £4 billion in lost productivity, disability and informal care.

Treating someone for five years after they have a stroke can cost as much as £45,000.

The scheme is one of the first steps delivered from the NHS Long Term Plan, published last month, which sets out a blueprint for new treatments to save half a million more lives over the next ten years by diagnosing quickly and tackling major killers including heart disease, cancer and diabetes.

The new programme builds on a successful pilot scheme in south London and will see Clinical Commissioning Groups in selected parts of the country give extra training to health professionals, including specialist anticoagulation pharmacists, who will be expected to identify people more likely to experience a stroke, and offer preventive treatment.

Atrial fibrillation is a heart problem which causes an irregular or excessively fast heartbeat, and anyone with the condition is more likely to suffer stroke.

Stroke incidence is higher in some ethnic minority groups and in lower socioeconomic groups, and – along with heart disease – is the biggest cause of premature death in poorer parts of the country. On average, strokes occur ten years earlier in people from Afro-Caribbean backgrounds than the rest of the population.

Dr Matt Kearney, GP and National Clinical Director for Cardiovascular Disease Prevention said: “People living with atrial fibrillation may not be aware of the serious health risks they face, which is why targeting help at those groups most at risk, will be a lifesaver. Making effective treatment available and expanding access to care across England will mean GPs and pharmacists can offer support and prevent death and long-lasting harm.”

In south London, Lambeth and Southwark Clinical Commissioning Groups ran a successful pilot scheme between 2015 and 2016, where the GP and specialist anticoagulation pharmacist discussed patients with atrial fibrillation using a virtual clinic model – which can be carried out remotely via skype or telephone, or face to face.

The GP and pharmacist discuss treatment options with the patient to ensure that their atrial fibrillation is being managed as effectively as possible.

1340 patients were reviewed across 92 practices, 947 of whom were identified as not currently receiving anticoagulants. In total, 1292 of those patients are now anticoagulated, preventing an estimated 45 strokes a year.

Helen Williams, Consultant Pharmacist for Cardiovascular Disease, Lambeth and Southwark CCGs, said: “As a result of the virtual clinics delivered across Lambeth and Southwark CCGs, we have seen a substantial increase in the number of patients with Atrial Fibrillation who are prescribed anticoagulant therapy, and an associated reduction in AF-related strokes.  We are delighted that NHS England is investing in rolling out this model to a further 23 CCGs so that more patients across the country can benefit.”

Cardiovascular disease accounts for one in four deaths in England and can lead to lifetime disability for survivors of stroke and heart failure, with stroke being the largest cause of disability in England.

Simon Gillespie, Chief Executive of the British Heart Foundation said:
Diagnosing and treating more people with atrial fibrillation is vital in preventing thousands of strokes every year. Around a third of people with the condition are currently undiagnosed, which makes them 5 times more likely to suffer a stroke. The condition is, however, easy to diagnose and treat.  Designing innovative programmes to diagnose people with AF in the community has the potential to rapidly increase the number of people who are given potentially life-saving anti-coagulants.

“This important and innovative programme will ensure that some of the country’s most at-risk groups get diagnosed and treated at an earlier stage, in the process preventing hundreds of people from experiencing the often devastating impact of a stroke.”

As well as causing significant harm to health, treating all cardiovascular problems costs the NHS £9 billion each year.