Imperial College Health Partners (ICHP)

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To make the clinical and financial case for an ICS CVD programme that improves the management and prevention of CVD in NWL, in line with the ICS Long Term Conditions Plan, the national AHSN CVD programme targets, NHS Long Term Plan and CVD DES.

To make the clinical and financial case for an ICS CVD programme that improves the management and prevention of CVD in NWL, in line with the ICS Long Term Conditions Plan, the national AHSN CVD programme targets, NHS Long Term Plan and CVD DES. i.e. utilising CVD Baseline Data to quantify the ‘NWL size of the prize’ (potential opportunity for CVD improvement) and re-measuring at 6 monthly intervals. It is proposed that the following data is obtained from WISC, (given QoF, HES and e-PACT data is not as current as WISC to meet clinician/ICS needs) to establish; 1. Non-elective admission rates for stroke and heart attacks - annual figures for past 5 years per NWL CCG Identifies strokes and heart attacks prevented if reach target of; • AF - 90% anticoagulated • BP - 80% treated to 140/90 (150/90 > 80 yrs) and the associated cost savings i.e. 5 - 10% reduction in total bed days, reduced length of stay (LoS)…. 2. Prevalence rates for Atrial Fibrillation (AF) and Hypertension Detection & Protection a. AF Detection: • Quarterly prevalence rates for each CCG over the last 3-5 years (AF001), including Covid and reset period. i.e. produce similar trajectory to https://www.gov.uk/government/publications/atrial-fibrillation-prevalence-estimates-for-local-populations) • Include no. of pulse checks performed in NWL GP practices over past year compared to previous year to determine impact of Covid-19. b. AF Protection: • Number of AF patients who require anticoagulants (AF006) in NWL CCGs • Proportion of patients on the NWL AF register with CHA2DS2VASc ≥2 who are on anticoagulants (AF007) for past year • Further split to patients on warfarin vs DOAC for past year (identifies Strokes prevented cost saving for 1 in 25 treated). (Compare current AF prevalence data obtained against AF Rightcare dashboard, updated with QoF 18/19, and 19/20 (when available) here c. Hypertension Detection Produce similar trajectory to https://www.gov.uk/government/publications/hypertension-prevalence-estimates-for-local-populations) • Estimated NWL adult population with hypertension (HYP001) • No. NWL adults with undiagnosed hypertension. Include no. of Practice Blood Pressure checks versus Home BP checks performed in past year compared to previous year to determine impact of Covid-19. d. Hypertension Protection (QoF) • The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 150/90 mmHg or less (HYP002), filtered for >80 years old • The percentage of patients aged 79 and under with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 140/90 mmHg or less (HYP003) Cost savings for NEL Stroke & Heart Attack admissions (reduction in MI at 10%), anti-hypertensive medicines for five years to prevent death, heart attacks, and strokes: 1 in 100 for heart attack, 1 in 67 for stroke. 3. Hypercholesterolemia including Familial hypercholesterolemia (Up to 5 years of data per NWL CCG, if required) • Estimated NWL adult population 30 to 85 years with 10 year CVD risk (QRisk) >20% • Estimated percentage of people with CVD risk ≥20% treated with statins • Estimated NWL adult population 30 to 85 years with 10 year CVD risk (QRisk) >10% with CVD co-morbidities • % people with existing CHD or stroke on lipid lowering therapy/ on statins who are on maximum dose of high intensity statin • % people with CVD risk above 10% (and 20%) who are on lipid lowering therapy for 5 years (given absolute benefit in 10,000 people taking statin for 5 years). • % of patients with Total cholesterol (> 7.5 mmol/L) with/without diagnosis of FH • % people with FH on lipid lowering therapy Note: A further combination of lipid parameters to stratify patients in searches for 1. Secondary prevention, lipid optimisation/PCSK9 eligibility 2. FH 3. Other co-morbidities may be required

18/03/2021

TRE