The Healthy Heart Trust

Our response to the consultation by the Department of Health and Social Care on the ‘Major Disorders Strategy’, June 2023

Our priorities:

1. Preventing the onset of CVD through population-wide action on risk factors and wider influences on health (sometimes referred to as primary prevention)
2. Stopping or delaying the progression of CVD through clinical interventions for individuals at high risk (sometimes referred to as secondary prevention)
3. Getting more people diagnosed quicker

Identify those at high risk – This is an important priority for research in the NHS, examining data related to symptoms and when and how advice or treatment is sought. The UK is in a unique position in that the NHS holds one of the richest datasets in the world on individuals, which can be utilised to build models that can more accurately and effectively identify high risk people. We feel it is likely that diagnosis and treatment are coming too late in some cases, particularly within certain socioeconomic groups. If this information can be gleaned and explored appropriately, this should then lead into a core area of activity related to targeted awareness and behaviour change. 

Engagement – We feel this is perhaps the most significant area of opportunity. Engagement leading to prevention or early treatment is key, but this engagement might also assist in the identification of late presenting symptoms, so that appropriate urgent treatment may be sought. Engagement should be centred solely on those at high risk, but rather should consider those who may become high risk in the future but may avert this by making changes to their lifestyle. Such engagement should commence at a young age, ideally starting in schools. 

Reaching certain socioeconomic groups who are at particular risk, including those who may currently be less engaged with cardiovascular prevention initiatives, is important. Within the UK, we have diverse groups of citizens, some of whom do not have English as a first language, and some whose religion or economic circumstances mean that they do not have ready access to dietary and exercise options. The engagement piece needs to break down barriers and find the means to reach these areas of the population – and we believe that there is a place for young people to relay important cardiovascular health messages to their parents or community. Additionally, evidence from community development and public health in recent years has pointed to good practice in engaging of high risk groups. For example, people who hold influence within local communities (such as faith leaders, local GPs) should be engaged to support uptake of interventions. Also important is the education of those who work in a variety of frontline health settings (e.g. research, commercial testing companies) to provide appropriate signposting to early intervention on the basis of clinical risk factors.

Treatment – There is an important piece around signposting to support and intervention at an early stage, when symptoms present, to identify early onset symptoms and seek support at this stage – many may put off seeing a GP for a variety of reasons, including lack of access. Support could be in the form of a medical intervention, but perhaps here further guidance is needed to support decisions related to diet and exercise – for many a change of lifestyle needs to be phased in for it to be effective. Similarly, perhaps mental health support for those managing a new condition could supplement other services.