The power of working together to optimise cardiovascular management

Jessamy Baird, General Manager, General Medicines Sanofi UK & Ireland, sets out why working together across the Life Sciences industry, government, regulators, the NHS, social care and the third sector is so important

Cardiovascular disease (CVD), despite progress in science and innovation, remains a real challenge to health systems across the world today, leading to high levels of healthcare demand, and spiralling costs of chronic ill-health management.  More importantly CVD still negatively impacts many people and their families every day. In the UK alone, the management and treatment of CVD costs the NHS around £7 billion a year1 and CVD is responsible for one in four premature deaths in the UK2.  It is critical that at risk patients are identified early, monitored and that management is optimised.

Cardiovascular disease is known as “the silent killer” for good reason. Not visible or detectable to the naked eye, it can strike seemingly healthy people at any moment. It also places a spotlight on health inequalities: people in the most deprived communities in England may be four times more likely to die prematurely from cardiovascular disease3

The impact of Covid-19 
The crisis triggered by Covid-19 has only served to exacerbate CVD health inequalities. The number of people arriving at hospital with a heart attack fell sharply during the first lockdown, with some units seeing around the 50% of the expected number of cases4.  The number of patients referred from primary care to cardiology outpatient clinics also dropped by 80%.4 The provision of cardiac services was severely restricted partly due to the focus on patients with Covid-19, and patients’ reluctance to seek medical help during lockdown.4

The significant reduction across cardiology referrals, investigations, diagnoses and management is likely to have created a considerable surge in demand for cardiology services in the coming months.4 To avoid an increase in excess deaths in the next 12 to 18 months, we need to rethink how we can identify and treat these patients as a matter of urgency. Cardiology services need to prepare for a significant increase in workload and develop new pathways to urgently help those adversely affected by the changes in service provision.4,6

We now see that we are joining up the dots between the various services to make sure that people are followed up and optimally managed.  Following an acute event, where someone has had to go into hospital, it is vital that we continue monitoring them as they are at very high risk of another acute cardiac event. There is NICE guidance to support the active management of CVD and by working together with key stakeholders across primary and secondary care that we are driving up CV outcomes and minimising the risk of further CVD events.


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Helping people live longer, healthier lives
For us as an organisation, the prevention of long-term conditions is at the heart of our mission to help people live longer, healthier lives. For the NHS, the NHS Long Term Plan has a pledge to prevent 150,000 strokes and heart attacks over the next ten years by improving the treatment of the high-risk conditions – hypertension (high blood pressure), high cholesterol and atrial fibrillation (AF).2

The pandemic has shown how effective it is when the government, the NHS, the Life Science Industry alongside Universities, Public Health England, and the MHRA work together. As a combined force, the UK has worked to fight one of the biggest public health challenges the NHS and our country has ever faced; this collaborative approach has led to the creation of a vaccine, the procurement and manufacture of multiple others and started an effective vaccination programme, with a roll out now reaching over half of the adult population.

I think the situation we face now has taught us that the challenges faced by the NHS cannot be solved by the health and social care system alone and we are determined to play our part as a Life Science organisation in helping to create a health system that is sustainable for future generations. Our mission is to protect, enable and support people so they can live life to the full. At the heart of this mission is the prevention of ill-health, extending the number of years people enjoy in good health; and relieving the capacity, financial and workforce pressures facing the NHS.

Working with key stakeholders to drive change in lipid management
The Accelerated Access Collaborative (AAC) has been established to drive change in the health system and to increase uptake of innovation. Sanofi is proud to be working with the AAC as part of the Rapid Uptake Products (RUP) Working Group which supports improvements in Lipid Management services and includes a novel, NICE-approved clinical pathway. The RUP programme has been designed to support stronger adoption and spread of proven innovations. It identifies and supports products with NICE approval that support the NHS Long Term Plan’s key clinical priorities5, but have lower than expected uptake to date.

The Lipid Management workstream has recommended a series of initiatives that aim to tackle the barriers at each step of the patient pathway.

Dyslipidaemia can have severe consequences for individuals and the NHS, which may lead to increased unnecessary cardiac events, hospitalisations, surgeries and unplanned admissions which may have been avoided with joined-up, optimal care.

We’ve been working closely with our industry partner Amgen, as well as NHS England, NHS RightCare, Public Health England (PHE), the Academic Health Science Networks (AHSNs), the National Institute for Health and Care Excellence (NICE), the Regional Medicines Optimisation Committees and Heart UK to identify where the gaps exist in the treatment of dyslipidaemia and how we can help bridge those gaps.

At a national level, the AAC has written to NICE to draw attention to key topics to support patient management, including the use of absolute lipid level targets and percentage reduction targets to help identify patients that require further management. A clinical sub-group has been created to support the development of a NICE approved guideline on lipid management for primary and secondary prevention of CVD.

Change may be required to create an integrated care system across both primary and secondary care to include routine monitoring and treatment of CVD as part of everyday practice. By working alongside NHS England through the AAC and the Pathway Transformation Fund, we hope to establish effective management of dyslipidaemia.

We, as part of RUP Working Group, are also engaged with selected NHS trusts via the AHSNs to increase the identification and treatment of individuals at high risk of CVD and heart attacks. At secondary care level, this includes the funding for the recruitment of specialist staff and accredited training.

On a primary care level, the Clinical Practice Research Network is collating data via a new national primary care clinical audit programme which will help us understand how many patients with high-risk conditions may be underdiagnosed, or under or over-treated. As a group we are also working closely with CVD Prevent to develop cholesterol metrics to help identify patients that will need careful monitoring in an effort to avoid a second event. In addition, the working group has written to NHS England to request two new cholesterol-related Quality and Outcomes Framework (QOF) measures.

We are optimistic that the work we are undertaking together will drive meaningful change and help improve outcomes. If patients at high risk of CV events are optimally managed and routinely monitored, our collaborative approach will be a success. The ultimate measure will be fewer CV events and improved outcomes for patients. This is particularly relevant at this critical time given the additional pressures placed on the system by underdiagnosis and undertreatment during the pandemic. 

Leading by example
Preventing ill health begins at home and we take our responsibility as an employer seriously. Maintaining the health and wellbeing of colleagues is of the utmost importance, not just for the individuals and their families, but also for the company and our commitment to improving health outcomes, as well as for society as a whole by reducing the burden on the healthcare system.

This year Sanofi was the first biopharmaceutical company to receive a national award recognising our commitment to employee health and wellbeing. The Workplace Wellbeing Charter accreditation recognises our commitment to improving the health and wellbeing of the 1,000 people who work with us in the UK.

By becoming active participants in our own health, we can all ‘do our bit’. We support everyone working with us to lead healthier, happier lives by encouraging them to make healthier lifestyle choices, having regular health check-ups and looking out for potential symptoms that may indicate an underlying health condition.

Together as a strong, healthy team, we are committed to uncovering and realising new possibilities in disease management. We are combining our experience and portfolio of trusted brands with the power of technology, digital innovation and collaboration to help develop solutions that may transform the management of cardiovascular disease now and for generations to come.

This article is organised and funded by Sanofi which was originally published with Pharmafile Spring 2021

References

  1. The NHS, The Long Term Plan is a game changer https://www.england.nhs.uk/blog/the-long-term-plan-is-a-game-changer/ [last accessed March 2021]
  2. NHS. Cardiovascular disease. https://www.england.nhs.uk/ourwork/clinical-policy/cvd/ [last accessed March 2021]
  3. Public Health England (2019), Health Matters: Ambitions to tackle persisting inequalities in cardiovascular disease,  https://publichealthmatters.blog.gov.uk/2019/03/04/health-matters-ambitions-to-tackle-persisting-inequalities-in-cardiovascular-disease/ [last accessed March 2021]
  4. Fersia O, Bryant S, Nicholson R, et al. The impact of the COVID-19 pandemic on cardiology services. Open Heart 2020;7:e001359. doi: 10.1136/openhrt-2020-001359
  5. NHS Long Term Plan NHS Long Term Plan’s key clinical priorities
  6. The Kings Fund. Covid care one year on: how can the health and care system recover? Covid-19 one year on | The King's Fund [last accessed March 2021]