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How can we shift from treatment to prevention in cardiovascular care?

21 March 2025 | Dr Matt Kearney OBE, GP and Senior Advisor to UCLPartners
We know what we need to do to treat the high-risk conditions that cause CVD. The challenge is how. Evaluation of the CVDACTION demonstrator programme provides insight into how we can support primary care to deliver the step change in prevention of heart attacks and strokes that is now a national priority. 

Cardiovascular disease (CVD) is a leading cause of premature death, health inequalities, emergency admissions, health and social care spend, and economic inactivity. It is also highly preventable, not just through lifestyle change, but through the treatment of high-risk conditions like blood pressure, cholesterol, diabetes, chronic kidney disease and atrial fibrillation.  

However, there is longstanding under-use of NICE recommended treatments in these conditions. For example, a third of people with hypertension are not treated to target, and one in six people with CVD are not on essential lipid lowering therapy.   

And yet… if we could do things differently and enable a step change in use of the high impact treatments, the effect on population health would be substantial and rapid. Size of the Prize shows that 6,000 heart attacks and strokes would be prevented in England every year by increasing blood pressure optimisation rates from 67% to 80% – not an unreasonable expectation from a patient perspective. Optimising treatment in the other high-risk conditions would have similarly dramatic impact.  

But this is hard to do in real world general practice where complexity, multimorbidity and time pressure are the norm. History shows that providing data, education and incentives is not enough. There has been little more than marginal improvement in the treatment of these conditions over many years despite NICE guidance, QOF and widespread quality improvement schemes. The real-world challenge for clinicians is having capacity, pathways and organisational infrastructure to respond to data.  

CVDACTION addresses this real-world challenge 

CVDACTION makes data easy-to-action in real world general practice, making it easy for clinicians to spot and manage high-risk patients who are on suboptimal treatment. This allows them to safely prioritise and stratify into manageable numbers that fit capacity and workflow. 

The CVDACTION Demonstrator Programme, funded by NHS England London, majored on the how-to of delivering a step change in treatment optimisation. Ten PCNs (600,000 population) took part. In each site, four essential pillars were put in place:  

  • Structured support to mobilise the wider workforce for rapid clinical optimisation and structured proactive care;  
  • Local system support to build transformation capacity including local leadership,  
  • Workforce training and tech support; and focused delivery support from the CVDACTION team. 

What does the evaluation show? 

Adapting pathways and workforce

CVDACTION was widely welcomed and was used by local teams to adapt pathways and workforce. Pharmacists working across PCNs and practices prioritised patients at highest risk for rapid treatment optimisation wider ARRS (Additional Roles Reimbursement Scheme) roles delivered structured proactive care consultations to support education, self-management and broader holistic care (using the UCLPartners Proactive Care Frameworks); admin staff, supported by training and scripts, managed patient calls and appointment scheduling. Patient engagement was used to inform pathways and development of education resources.  

Targeting health inequalities

Some sites also took targeted action on health inequalities – including using the inbuilt CVDACTION filters for deprivation and ethnicity, working with community champions to improve access and tailoring longer consultations. 

Step change in optimal treatment rates:

Quantitative data was available over a six month period. Despite the short time frame that also included programme set up, there is clear early evidence of a step change in optimal treatment rates with substantial numbers of patients with hypertension having their blood pressure treated to target, and of patients with CVD starting lipid lowering therapy.  

Expected impact

We know from long established evidence that increasing uptake of these high impact treatments will prevent heart attacks and strokes in the relatively short term, generating significant cost savings in health and social care and benefitting the wider economy through a reduction in economic inactivity.  

Delivering the national mission for CVD prevention 

The mission to reduce deaths from heart attack and stroke by a quarter in ten years will not be achieved without a step change in the management of the high-risk conditions that cause CVD. The challenge is not what to do – that is well established in NICE guidance. The challenge is how to do it in real world primary care. The key learning from the CVDACTION Demonstrator Programme is that with actionable data tailored to capacity and structured support for implementation, primary care can deliver the step change we need and patients deserve.  

Read the full CVDACTION evaluation report. 

You can also access helpful case studies and the CVDACTION Implementation Playbook.

For more information on CVDACTION and how to access it visit Into-Action.Health. Into-Action.Health is helping to scale CVDACTION beyond UCLPartner’s region.