CVD Prevention

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“Heart and circulatory diseases cause a quarter of all deaths in the UK and are the largest cause of premature mortality in deprived areas. This is the single biggest area where the NHS can save lives over the next 10 years” NICE Long term Plan 2020. At least half of all heart attacks and strokes are attributed to sub-optimum blood pressure control. Cardiovascular disease (CVD) is also one of the most significant risk-factors for Covid-related severity and morbidity. 

Smoking, weight, diet, physical activity and the treatment of high blood pressure (including medication adherence) are key drivers of risk. Sustained lifestyle changes can both lower blood pressure and slow (and potentially even reverse) the progression of early-stage coronary heart disease to a serious cardiac event, such as a heart attack.

However, most patients diagnosed with CVD in primary or secondary care (specifically high blood pressure or following a CT scan confirming early-stage coronary artery disease) receive only relatively brief information, advice and guidance, which is widely acknowledged to be insufficient to engender sustainable behaviour change. 

Our CVD Prevention programme supports people to understand high blood pressure and CVD and reduce their risk of progression by making sustainable improvements to their diet, activity and weight. Its design combines CVD-specific guidance and evidence with relevant elements of the more mature evidence-base for Diabetes Prevention Programmes (DPPs). Specifically, it builds on Momenta’s DPP which achieves the best health outcomes across all rigorously selected programmes on NHS England’s national Healthier You programme* and was Commended as offering ‘Scalable, flexible and cost-effective diabetes prevention’ in the Quality in Care Programme Diabetes Awards 2020. 

We developed the CVD Prevention programme in a cross-sector collaboration with:

• South Eastern Health & Social Care Trust (SET) in Northern Ireland’s cardiology, cardiac rehab, psychology, primary care, public health and research teams 
• British Heart Foundation’s (BHF) senior dietitian reviewed all nutrition content and BHF NI facilitated patient involvement in the co-design process
• A leading academic and past president of the BACPR advised on physical activity.

The programme comprises 18 structured sessions delivered virtually or in-person over nine months to groups of up to 20 participants. It can be delivered by trained and assessed non-specialists from a range of relevant backgrounds in order to maximise accessibility and cost-effectiveness. We have developed two variants around a common core programme for different referral criteria and care pathways:

• Primary care: GP practice referral for patients diagnosed with high blood pressure (e.g. at NHS Health Checks)
• Secondary care: Cardiologist referral for patients diagnosed with early-stage coronary artery disease after a CT scan (narrowing of the arteries of 30-70%).

We believe that it is the first scalable and replicable programme of its kind and will help fulfil a pressing need to offer a cost-effective way to empower participants with the knowledge, skills and support that they need to improve their health sustainably. 

The CVD Prevention programme complies with relevant NICE and SIGN Guidance, including relating to behaviour change (NICE PH6, PH49), cardiovascular disease (NICE CG181), physical activity and obesity (NICE PH53, PH42, CG43), as well as other pertinent research (e.g. SCOT-HEART, INTERHEART). 

Coaches attend four days of training (in-person or equivalent on-line blended training) and receive extensive supporting resources, including comprehensive distance learning, a 260 page manual and supporting off or on-line ‘kitbag’ of resources. Participants receive a 250-page workbook (including a lifestyle logbook), My heart health logbook and a pedometer. 

Early retention, feedback and outcomes from the Ulster Hospital and SET pilot are positive.

* Valabhji et al, 2019