3.66. Heart and circulatory disease, also known as cardiovascular disease (CVD), causes a quarter of all deaths in the UK  and is the largest cause of premature mortality in deprived areas. This is the single biggest area where the NHS can save lives over the next 10 years. CVD is largely preventable, through lifestyle changes and a combination of public health and NHS action on smoking and tobacco addiction, obesity, tackling alcohol misuse and food reformulation. Chapter Two sets out more detail. Eating too much salt remains a leading cause of raised blood pressure, leading to thousands of heart attacks, strokes and early deaths. Reducing salt in foods by 1 gram/day, for example, could prevent 1,500 premature deaths each year and save the NHS over £140 million The government has been clear that salt intake needs to reduce. Some – but insufficient – progress has been made with the voluntary salt reduction programme. The government has agreed to set out by Easter 2019 the details of how the programme’s targets will be met.
3.67. Early detection and treatment of CVD can help patients live longer, healthier lives. Too many people are still living with undetected, high-risk conditions such as high blood pressure, raised cholesterol, and atrial fibrillation (AF). Other countries have made more progress on identification and diagnosis working towards people routinely knowing their ‘ABC’ (AF, Blood pressure and Cholesterol). Replicating this approach will be increasingly possible with digital technology, and major progress could be achieved working with the voluntary sector, employers, the public sector and NHS staff themselves.
3.68. Working with local authorities and PHE, we will improve the effectiveness of approaches such as the NHS Health Check, rapidly treating those identified with high-risk conditions. Working with voluntary sector partners, community pharmacists and GP practices will also provide opportunities for the public to check on their health, through tests for high blood pressure and other high-risk conditions. Expanding access to genetic testing for Familial Hypercholesterolaemia (FH), which causes early heart attacks and affects at least 150,000 people in England , will enable us to diagnose and treat those at genetic risk of sudden cardiac death. Currently only 7% of those with FH have been identified , but we will aim to improve that to at least 25% in the next five years through the NHS genomics programme.
3.69. Where individuals are identified with high risk conditions, appropriate preventative treatments will be offered in a timely way. We will support pharmacists and nurses in primary care networks (see Chapter One) to case find and treat people with high-risk conditions. Where 100 people with AF are identified and receive anticoagulation medication, an average of four strokes are averted, preventing serious disability or even death. The creation of a national CVD prevention audit for primary care will also support continuous clinical improvement.
3.70. People with heart failure and heart valve disease will be better supported by multi-disciplinary teams as part of primary care networks. 80% of heart failure is currently diagnosed in hospital, despite 40% of patients having symptoms that should have triggered an earlier assessment . When admitted to hospital, we will improve rapid access to heart failure nurses so that more patients with heart failure, who are not on a cardiology ward, will receive specialist care and advice . Better, personalised planning for patients will reduce nights spent in hospital and reduce drug spend. Greater access to echocardiography in primary care will improve the investigation of those with breathlessness, and the early detection of heart failure and valve disease.
3.71. Fast and effective action will help save lives of people suffering a cardiac arrest. The chance of survival from a cardiac arrest that occurs out of hospital doubles if someone receives immediate resuscitation (CPR) or a high energy electric shock to the heart (defibrillation) . A national network of community first responders and defibrillators will help save up to 4,000 lives each year by 2028. This will be supported by educating the general public, including young people of school age, about how to recognise and respond to out-of-hospital cardiac arrest. We also will work with partners such as the British Heart Foundation to harness new technology and ensure the public and emergency services are able to rapidly locate this life saving equipment in an emergency. More effective mapping of data on incidence will help direct community initiatives to areas where they are most needed, with the British Heart Foundation’s national Outcomes Registry allowing us to track survival rates and target unwarranted variation.
Case study: CPR and GoodSAM
Apps and mobile technology are increasingly helping people to play a role in their own care and that of others. The GoodSAM app platform allows members of the public who can deliver basic life support (CPR) and use a defibrillator to receive alerts from anyone in their local area who needs urgent assistance. It integrates with ambulance dispatch systems and also features a crowdsourced map of defibrillators – including those in vehicles. The platform now has over 19,000 volunteers and partnerships with 80 organisations, including many NHS ambulance trusts. This is being supported to scale nationwide.
3.72. Cardiac rehabilitation is an intervention recommended by NICE which can save lives, improve quality of life and reduce hospital readmissions . Access to and uptake of cardiac rehabilitation services varies across England, and only 62,822 patients (52%) of the 121,500 eligible patients per year take up offers of cardiac rehabilitation . Scaling up and improving marketing of cardiac rehabilitation to be amongst the best in Europe will prevent up to 23,000 premature deaths and 50,000 acute admissions over 10 years.
Milestones for cardiovascular disease
- The NHS will help prevent up to 150,000 heart attacks, strokes and dementia cases over the next 10 years.
- We will work with our partners to improve community first response and build defibrillator networks to improve survival from out of hospital cardiac arrest.
- By 2028 the proportion of patients accessing cardiac rehabilitation will be amongst the best in Europe, with up to 85% of those eligible accessing care.
115. British Heart Foundation (2018) UK Factsheet November 2018. Available from:
116. Public Health England (2018) Familial Hypercholesterolaemia Implementing a systems approach to detection and management. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/731873/familial_hypercholesterolaemia_implementation_guide.pdf
117. Public Health England (2018) Familial Hypercholesterolaemia Implementing a systems approach to detection and management. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/731873/familial_hypercholesterolaemia_implementation_guide.pdf
118. Bottle, A., Kim, D., Aylin, P., Cowie, M., Majeed, A. & Hayhoe, B. (2018) Routes to diagnosis of heart failure: observational study using linked data in England. Heart. 104 (7), 600-605. Available from: https://doi.org/10.1136/heartjnl-2017-312183
119. Cleland, J., McDonagh, T., Rigby, A., Yassin, A., Whittaker, T & Dargie, H. (2011) The national heart failure audit for England and Wales 2008–2009. Heart. 97 (11), 876-886. Available from:
120. Perkins, G., Lockey, A., de Belder, M., Moore, F., Weissberg, P. & Gray, H. (2016) National initiatives to improve outcomes from out-of-hospital cardiac arrest in England. Emergency Medical Journal. 33 (7), 448-451. Available from: http://dx.doi.org/10.1136/emermed-2015-204847
121. National Institute for Health and Care Excellence (2013) Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease. Available at: https://www.nice.org.uk/guidance/cg172
122. British Heart Foundation (2018) The National Audit of Cardiac Rehabilitation (NACR) Annual Statistical Report 2017. Available from: https://www.bhf.org.uk/informationsupport/publications/statistics/national-audit-of-cardiac-rehabilitation-annual-statistical-report-2017