Scotland ‘underinvesting’ in heart disease


A leading heart disease charity is calling for urgent investment in clinical services for people with heart and circulatory conditions – and those at highest risk of developing them – amid evidence that as many as one in four patients in some parts of Scotland is having to wait more than six months for crucial diagnostic tests.


The British Heart Foundation (BHF) Scotland says the progress in reducing deaths that has been made in recent years could be put in jeopardy as government funding for fighting heart disease, they say, is slipping behind other killer conditions such as cancer and diabetes.


Heart and circulatory diseases cause around 50 deaths a day in Scotland – one in eight of them amongst people of working age – while an estimated 700,000 people are living with often life-limiting heart conditions.


BHF Scotland says, although there has been a significant reduction in deaths over the last 50 years, wider progress seems to be stalling.


The Scottish government published a Heart Disease Improvement Strategy in 2014, but BHF says that, since then, funding to support new strategies for cancer and Type II diabetes have left investment in heart disease trailing behind.


In a recent answer in the Scottish parliament, Cabinet Secretary for Health and Sport Jeane Freeman promised a refreshed improvement plan in spring this year. She pointed to a reduction in deaths from coronary heart disease of nearly a third from 2009 to 2018, and committed to continuing to implement the 2014 plan in the meantime.


BHF has meanwhile been working with clinicians and patients to draft a plan of their own, centred on three priority areas: tackling risk factors, including obesity, high blood pressure and high cholesterol; ensuring everybody has equal speedy access to diagnosis, treatment and care; and improving the use and access to data to understand the full scale of need and services across Scotland.


Freedom of Information requests by the charity have shown waiting times for diagnostic tests such as echocardiograms vary from one in 50 people waiting six months – to one in four.


David McColgan, Senior Policy and Public Affairs Manager at BHF Scotland, says the need for a new strategy is greater than ever:


“Heart disease is a major cause of ill health and death in Scotland and yet the Scottish Government’s plans to tackle heart disease haven’t been updated since 2014. During this time, there have been a lot of changes in the health care system, not least due to the Covid-19 pandemic.”


BHF points out that research suggests that people with underlying health conditions such as coronary heart disease and heart failure are at increased risk of severe complications from coronavirus and an increased risk of death.


“Health inequalities also remain,” says Mr McColgan.


“Rates of heart and circulatory diseases in the most deprived areas of Scotland are significantly higher than those in the least deprived areas. Dealing with these challenges and years of underinvestment means that new national priorities for addressing heart disease in Scotland are needed.


“That’s why BHF Scotland has been working with the clinical community and heart patients to identify them. As we look forward to the Scottish Elections at Holyrood in May, we are calling on all political parties to commit to work with us to tackle these issues.”


Consultant Physician and Cardiologist, Dr David Murdoch, is Chair of the National Advisory Committee for Heart Disease. He says it is important to ensure everyone has access to the best diagnosis and treatment wherever they are in Scotland:


“There’s no doubt there has been great success in improving survival rates from acute events like heart attacks in Scotland over recent decades. While this is hugely positive, it also means there are now more people living with heart conditions than ever before.


“We are working hard to improve access to prevention, efficient diagnosis with modern cardiac imaging and the latest treatments.”


The President of the Scottish Cardiac Society, Consultant Cardiologist Dr David Northridge, says planning is being made more difficult by gaps in information:


“We know that the earlier heart patients can be diagnosed and treated, the better the outcome for them and for the NHS as a whole. But the lack of consistent data on cardiac care means we don’t have a true picture of the scale of services and access to them across the country and that is a huge concern and one that we would like to see addressed in any future plan.”


BHF, which launches a manifesto for the Holyrood elections this week to coincide with the start of National Heart Month, says an ageing population and more people living longer with multiple health conditions, means there is a need to look at future care and treatments in the community to enable people to live well longer.


By John Magill


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Pharmacists central to £9 million investment to reduce strokes


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.


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 certain conditions. Patients will be identified by specialist nurses and clinical pharmacists across the country who are trained to treat atrial fibrillation.


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.


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.”


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.”


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.”


Helen Williams, a 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.”


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.”