Cardiovascular Disease Prevention and its impact across the system

Cardiovascular Disease Prevention and its
impact across the system
Martin Cassidy
Senior Quality Improvement Lead
East Midlands Cardiovascular CN
15 April 2016
Premature Deaths due to cardiovascular disease in 2014
8 people per day
High risk AF patients NOT on anticoagulation
Undiagnosed Hypertension
3,216
The Why, The How & The What
WHY cardiovascular disease prevention?
Cardiovascular Disease is a major causes of premature mortality:
 In 2010-12, 3136 premature deaths (23%) were due to
CVD
 of which
– 2,151 (69%) were male, and
– 985 (31%) were female
Ischaemic heart disease and cerebrovascular disease are leading
causes of years of life lost (YLLs) and disability-adjusted life
years (DALYs) in England
Cancer and CVD premature mortality
by East Midlands LAs
6
Communicating the Why?
• Communicating a compelling case for action to CCGs
(clinicians and commissioners) – slide sets and infographics
• Highlight
– gaps in care against evidence
– areas of unwarranted variation
– raw number of patients impacted
• CCG and practice comparative data
• Evidence of impact from improved prevention focus
ATRIAL FIBRILLATION
West Leicestershire CCG
77
1,541
25
1,191
20
(35.0%)
60
£709,000
ATRIAL FIBRILLATION
West Leicestershire CCG
5,878
3,402
1.58%
57.9%
2,211
65.0%
60
20
£711,000
159
7,419
6,900
5,865
52
£1,886,000
2014
CVD prevention
• Evidence Review
• Top Tips Document – broad prevention strategy
• Report on comparative QOF performance on CVD areas for
CCGs
• Clinical leadership and advice through CVD Prevention Group –
excellent CCG engagement
• Contribution to CCG 5 year strategy development
• Using data to make compelling case for CCGs for action on
cardiovascular disease
HOW we have supported improvements?
AF
• Presentations to CCG Clinical Cabinets
• Clinical champion
• Grasp-AF
• Algorithm and evidence based clinical template to encourage
diagnosis and management in line with NICE Guidelines
19 CCGs
• GP up-skilling
7 CCGs
• Cardiology USP Programme implemented
HOW we have supported improvements?
HF
• Clinical Champion
• GP up-skilling
• Grasp-HF
8 CCGs
CKD & AKI
•
•
•
•
•
•
•
Clinical Champion
IMPAKT CKD audit tool
CKD Nurse Facilitator
Up-skilling
Sick Day Rules
AKI innovation in Acute Trusts
eGFR surveillance programme
8 CCGs
18 CCGs
HOW we have supported improvements?
Diabetes Prevention
• Prevention Pathway
• EMAHSN Innovation Bid
• Led an East Midlands successful bid with PHE and 13 CCGs to
Healthier You: NHS Diabetes Prevention Programme (NDPP) –
1st wave
• Funding to all CCGs to support development of robust registers
of high risk patients and implementation of prevention pathway
WHAT has been the impact?
Cardiovascular Disease Prevention has developed or been
maintained as a major focus for CCGs
CCGs are starting to adopt a broader prevention strategy which is
being reflected in Operational Plans and should focus highly in
STPs
WHAT has been the impact in AF between
March 2013 & March 2015?
• 7,017 additional patients have been diagnosed with AF (+9.7%)
• 5,898 additional high risk AF patients have been anticoagulated
(+22.4%).
• This will prevent an estimated 159 strokes and 53 deaths per
year
• Estimated £1.89m admission costs avoided
• The anticoagulation uptake across CCGs in East Midlands has
increased from 64.3% in March 2013 to 74.1% in March 2015
• A further 10% increase in patients on anticoagulation in East
Midlands in 2015-16 could prevent a further:
87 strokes and 29 deaths per year
.
WHAT has been the impact?
CKD – West Leicestershire CCG
• 618 additional patients diagnosed with CKD (+4.7%)
• 241 fewer patients have blood pressure above 140/85 (-6.5%)
• 63 fewer hypertensive CKD patients with proteinurea NOT on
ACEI/ARB (-38.7%)
Good impact to date
but
still so much more to do
Young people
0
NHS NOTTINGHAM NORTH AND EAST CCG
NHS NOTTINGHAM CITY CCG
NHS NOTTINGHAM WEST CCG
NHS SOUTHERN DERBYSHIRE CCG
NHS RUSHCLIFFE CCG
NHS EREWASH CCG
NHS MANSFIELD AND ASHFIELD CCG
NHS NORTH DERBYSHIRE CCG
NHS WEST LEICESTERSHIRE CCG
NHS NEWARK & SHERWOOD CCG
NHS EAST LEICESTERSHIRE AND RUTLAND CCG
NHS SOUTH LINCOLNSHIRE CCG
NHS LINCOLNSHIRE EAST CCG
NHS NENE CCG
NHS HARDWICK CCG
NHS LEICESTER CITY CCG
NHS LINCOLNSHIRE WEST CCG
NHS SOUTH WEST LINCOLNSHIRE CCG
NHS CORBY CCG
High risk AF patients on anticoagulation
Comparison of CCGs in East Midlands with all CCGs in England
100
90
80
England average 74.3%
70
60
50
40
30
20
10
Lincolnshire East CCG - Clinical champion drive for further improvement
75.8% anticoagulation
67 years
GP Practice in Nottingham City CCG
Summary
• Significant missed opportunities for cardiovascular disease
prevention within primary care
• Need for CCGs to adopt a broad cardiovascular prevention
strategy
• CCGs & GP practices through focused work on priority areas
are deliver significant improvements - motivating
• Using data in the right way, engaging and developing clinical
champions and providing support to CCGs and GP practices
helps to deliver improvement
• What could we achieve if we were really radical about
cardiovascular disease prevention?