Cardiovascular Disease Prevention

HI NENC is delivering a Cardiovascular Disease (CVD) Prevention programme, nationally mandated by NHS England. The programme supports CVD Prevention across the North East and North Cumbria with a particular focus on chronic kidney disease (CKD), disordered lipids, familial hypercholesterolaemia (FH) and hypertension. The other clinical area includes atrial fibrillation (AF) which is legacy work from a previous national programme.

Aims of the CVD Prevention Programme

By collaboratively working with partners, we aim to reduce cardiovascular events for patients as a result of their CVD risk factors, closing health inequality gaps, and improving their health by reducing morbidity and mortality.

Our mission is to ensure patients with CVD risk factors are detected and treated appropriately, and to ensure legacy work from the recent national CVD programmes are sustained.

This will be achieved through collaborative working with the regional health and social care system, to reduce inequalities within our population, providing capability and capacity to meet our objectives.

Benefits

• Prevention of future cardiovascular events, increasing years of wellness.
• Supporting PCNs to achieve their QOF 2024/25.
• Supporting ambitions laid out in the NHS Long Term Plan.
• Increase awareness of patients & clinicians of CKD as a risk factor for CVD.
• Increase awareness of patients & clinicians around the common genetic condition, FH.

Programme Delivery

The programme will be delivered in its constituent parts, but, as far as we are able, we will be taking a multi-morbid approach focusing on a cardio-renal-metabolic (CaReMe) ethos. For more information on the different elements please click on the appropriate topic in which you are interested.

The programme has a strategy group consisting of key stakeholders from across NENC, who provide support, insight and challenge to enable the programme to be responsive and accountable.

Metrics

Programme metrics have been developed for CKD, lipids, FH and hypertension. Success of the programme, however, will depend both on opportunistic and systematic case finding of eligible patients through innovative and validated CVD search tools such as CDRC, cascade testing, and robust primary and secondary CVD prevention pathway implementation, all seeking to optimise patients’ management of lipids, hypertension and CKD regardless of which setting their care is delivered in.

NEQOS lead on measurement support for HI NENC Population Health Improvement Programmes. This involves presenting data to the HI NENC strategy group. The latest presentation can be seen on the link below.

Download Metrics Presentation

Visual representation of the work can be seen below.

Feedback from local partners

Barry Todd is a North East Pharmacist Practitioner and the Pharmacy Lead at Wallsend Primary Care Network, who has working in partnership with HI NENC to deliver the programme. He said:

“In the 42 years I’ve been a Pharmacist, I’ve never been so excited at the opportunity of breaking down barriers and being able to work collaboratively across all sectors.

“Together we are making a real difference in tackling health care inequalities and driving down cardiovascular morbidity and mortality.”

Partnership working

New Focus of Lipid-lowering Therapy – A Pharmacist-led Clinic for Secondary Prevention Vascular and Diabetic Foot Patients 

Newcastle Hospitals NHS Foundation Trust and HI NENC have setup a new clinic to provide targeted treatment and support to vascular and diabetic foot patients, who have had a cardiovascular event such as a heart attack or stroke.

The pharmacist-led clinic, set up by Matthew Hart, Specialist Clinical Pharmacist, is thought to be the first of its kind in the UK.

HI NENC has funded Matthew to run the clinic two days a week and provided support with statistical analysis.

Read the case study

Joint working

HI NENC works collaboratively with a number of partners to enhance local services, please see details of our joint working agreements below.

Sanofi and HI NENC are working in partnership under a joint working agreement to facilitate better identification of patients within primary care who may be at risk of having Familial Hypercholesterolaemia (FH) or high cardiovascular risk. Read in full in this joint working agreement.