Dr Sunil Gupta is a GP in Benfleet, and the System clinical lead for cardiovascular disease. In this blog, Dr Gupta casts some light on why disadvantaged people are at greater risk of developing heart attacks and strokes at a younger age. He will also explore what we’re doing in Thurrock to improve the management of Type 2 diabetes and high blood pressure and how in mid and south Essex we’ve supported over 62,000 people to monitor their blood pressure at home. Finally, Dr Gupta has some top tips on reducing your risk of heart attacks, strokes and beating cardiovascular disease.
Tackling cardiovascular disease in our communities
Cardiovascular Disease affects around seven million people in the UK and is a significant cause of disability and death. It’s responsible for one in four premature deaths in the UK and accounts for the largest gap in health life expectancy.
It’s among the largest contributors to health inequalities with those in the most disadvantaged 10% of the population almost twice as likely to die as a result of cardiovascular disease than those in the least disadvantaged 10% of the population. It also accounts for one-fifth of the life expectancy gap between most and least disadvantaged communities.
Who is at most risk?
Cardiovascular disease is a general term for conditions affecting the heart or blood vessels and includes all heart and circulatory diseases, including coronary heart disease, angina, heart attack congenital heart disease, high blood pressure (hypertension), stroke and vascular dementia. You’re more at risk of cardiovascular disease if you have, high blood pressure, high cholesterol (hyperlipidemia), smoke, have diabetes or a family history of heart disease, or are from a black, Asian or minority ethnic background. The Global Burden of Disease study identified that in 2019, tobacco use, high blood pressure and a variety of dietary risks that together increase the risk of cardiovascular disease.
Social determinates, or wider determinates, mean that where someone lives or the communities they are a part of, may impact their health and wellbeing. We also know that people living in the most disadvantaged areas of England are known to be 30% more likely to have high blood pressure, and four times more likely to die prematurely from cardiovascular disease than those in the least disadvantaged areas.
There’s are also significant health inequalities for people living with severe mental illness, having a 53% higher risk of having cardiovascular disease and 85% higher risk of death from cardiovascular disease, as well as having a life expectancy 15-20 years lower than the general population. This is because they are potentially more likely to lead a sedentary lifestyle with limited physical activity, as well as lack awareness of the impact of certain risk factors that contribute to cardiovascular disease. As a group they experience higher rates of obesity, diabetes, high blood sugar (hyperglycemia), and high cholesterol. In addition, they also experience social exclusion, lower income, and limited access to healthcare and leisure facilities, predisposing them to a higher risk of developing heart disease.
Prevention and intervention
Tackling cardiovascular disease will need action that focuses on what causes disadvantages and deprivation and investing in narrowing the gaps on the wider determinants of health, ensuring health and care pathways are designed to begin with prevention and early intervention.
As part of the Mid and South Essex Integrated Care Strategy 2023, the vision of reducing inequalities is at the heart of the Mid and South Integrated Care System’s common endeavour. Through partnerships with individuals, communities and organisations we can focus on prevention, early intervention and providing high-quality, joined-up health and social care services, when and where people need them.
Cardiovascular disease is a priority as hypertension is one of the five clinical conditions in the Core20Plus5 framework that provides a focus for Integrated Care System’s on which priority groups are most impacted by poorer health outcome and preventable long-term health conditions.
Through using the framework and population health management tools to look for high risk factors such as medical conditions, where they live, family history and lifestyle factors, we can develop services and programmes and target these groups with a personalised and holistic approach to improve their long-term health.
A significant majority of mid and south Essex’s most economically disadvantaged population live in Basildon where 17% are part of the 20% most disadvantaged nationally, and Southend (15%) and Thurrock (11%), with smoking prevalence amongst adults being particularly high in Basildon and Thurrock.
To address this disparity, the Mid and South Essex Integrated Care System has developed a number of projects that focus on prevention, targeting specific communities.
CVD (Cardiovascular Disease) Improvement in Thurrock
Following focused work by GP Practices and the Public Health team in Thurrock, the borough now has the best-managed hypertension in England, as shown by recently released data .
In the 2016 Annual Public Health Report for Thurrock Council set out a vision and plans for a sustainable adult Health and social care system in the borough. The extensive report highlighted a number of issues including:
- Variable access to primary care across the borough;
- differences in the quality of care between practices (affecting both the detection and management of long-term conditions);
- Impact on patients of having different quality of care with subsequent changes in their health status and consequent hospital admissions.
As a result, they put in place a successful enhanced quality standards programme, with the public health team in Thurrock working with clinical leads and partners in developing a Cardiovascular Disease Management specification for Primary Care Network. It aims at improving the health and wellbeing of patients with a long-term condition, reduce the non-elective hospital admissions, as well as reduce the number of major health events that can result in a new or increased need of adult social care packages.
The Primary Care Networks chosen to take part included:
The service they created aimed at increasing the involvement and collaboration within Primary Care Networks (PCNs), using a holistic individualised approach to care and using clinics designed to support the management of their existing conditions including lifestyle support. Creating their own clinics has also given them the flexibility and freedom to design services to suit their local residents.
They selected residents most at risk, but where a preventative approach could be taken. They were chosen as they had two or more long-term conditions related to cardiovascular disease, including high blood pressure or cholesterol and Type 2 diabetes. This represented 25% of people in Thurrock with two or more long-term conditions, equating to a total of 2.42% of the18+ years registered population in Thurrock.
Outcomes so far
It’s expected that by the end of 2023/24 there’ll be improvements for the group in terms of better blood pressure management and control, stroke risk assessment and anticoagulation treatments increase in flu vaccination, referral to stop smoking and weight management services, as well as increase in mental health assessment and treatment.
So far, the clinics have reviewed 10% of the total group and have seen improvements in the majority of clinical areas, as well as identified future focus and development in the roll out of the approach with all PCNs in 2023/24.
You can read the full report on cardiovascular disease from Thurrock Council here.
BP at Home was launched in April 2021 to enable people to measure their blood pressure where they live.
- Over 72,000k people have monitored their blood pressure at home,
- Over 3300 people have gone on to have their medication reviewed,
- Over 2000 people have discussed how changing certain behaviours can improve their health,
- 1500 people have also been diagnosed with diabetes,
- Plus over 270 people have been referred to hospital for specialist care.
You can more about the BP@home project here:BP@Home – Blood Pressure
Improve your heart health and beat cardiovascular disease
If you develop cardiovascular disease you will suffer from poor health and be unable to get the most out of every day with friends and family.
Through improving your heart health and reducing the disease that affects the vessels that carry blood around your body, you can beat cardiovascular disease.
There are so many great reasons to start making little changes to your lifestyle to help you feel better and live longer in better health.
Whether you just want to keep up with your kids or your grandchildren or be able to spend more time doing things that you want to do, feel happier and get to really enjoy and get the most out of your time.
Five reasons to make changes to your lifestyle
- Any existing conditions will improve
- Reduce joint problems – you will be able to play with your kid or grandchildren or just be able to get around without pain and discomfort
- You will live longer and in better health
- It will make you feel more positive and motivated
- It can reduce your use of medication and the need to access NHS services.
What you can do about it
There are six ways to avoid cardiovascular disease, so click on the links to start making a change. Just by making a few changes and can make a huge difference. Read about you can do to start beating cardiovascular disease by following a few top tips:
- Eat a balanced diet and manage your weight
- Get active and raise your heart rate
- Stop Smoking
- Cut down on alcohol
- Manage your blood pressure
- Support your mental health and wellbeing
A range of services are available locally to help you improve your health and wellbeing. Click on the link below to find out more and access your local service.Lifestyle Services