Set up
During set up we will support to make sure you have everything in place needed for successful implementation. Key steps include identifying clinical and operational leads for your project and confirming what technical approach to CVDACTION will work best locally.
Communication & engagement
CVDACTION is all about enabling primary care to do things differently. This has to be locally owned and locally led. Our learning to date has shown that leads and team members need time to explore CVDACTION and the linked resources, to understand how it can help them and their patients and consider how best to adapt for local use.
We have a range of resources to support staff engagement including: 
- UCLPartners’ Size of the Prize: for every Integrated Care Board in England you can see how many heart attacks and strokes could be prevented in three years by optimising blood pressure and cholesterol management to reasonable levels of ambition. Data can be viewed for ICBs and PCNs.
Top tip: you cannot engage enough!
Spend time ensuring all staff understand CVDACTION, their roles and how doing things differently in this way benefits them and their patients. Regularly brief and engage them on the programme and available resources, explore any questions or concerns that they have, help them to adapt pathways to minimise duplication and release capacity, and feed back data so that they can see the impact they are having on their patients’ care. A lot of great resources for clinical and non-clinical staff are embedded in the CVDACTION dashboard – make sure you share them with the staff who do not access the dashboards directly.
Technical implementation
CVDACTION searches have been developed for SystmOne and EMIS. They are also available in Structured Query Language (SQL). The dashboards are built in Tableau and Power BI, using the templates that we provide. The CVDACTION team will help you to work through the most appropriate approach in your area.
Below are some examples of how CVDACTION has been configured in different local systems:
Mid and South Essex – Integrated Care System approach
In Mid and South Essex, they are using their central data analytics platform provided by Agem CSU to host CVDACTION. Agem used the SQL search queries to populate the CVDACTION dashboard in Athena using their primary care data sets. Primary care teams then use their Athena accounts to access the CVDACTION dashboard and view their patients’ data. 
North West London ICB –  Whole System Integrated Care Dashboards (WSIC) Â
In North West London, they used their population health management platform (WSIC) to host CVDACTION centrally. They used the SQL search queries to populate the Tableau dashboard template. Users access their own patients’ data by logging into the secure WSIC servers.  
Sutton Primary Care Networks (SPCN) CiC – EMIS Enterprise
SPCN ran the CVDACTION search queries in EMIS Enterprise which was in place for all practices in the borough with appropriate date sharing agreements. Data was then extracted and fed into the CVDACTION dashboard in PowerBI located on a central server.
Wandsworth Federation – EMIS Â
Wandsworth Federation ran the EMIS search queries on each participating practice’s clinical system, before combining the outputs using a python script, and then populating to populate the CVDACTION dashboard in PowerBI located on a central server. 
Information Governance:
All patient level data extracted for CVDACTION is held locally. Practices will need to have shared data agreements in place to be able to run CVDACTION across multiple practices. The dashboards are designed so that data is only viewed by staff who have the appropriate permissions. CVDACTION relies on existing governance infrastructures to access sensitive information, mirroring any permissions that are in place.  
Digital Governance:
CVDACTION is compliant with DB0129. Please contact the CVDACTION team for the documentation relating to this standard.
How to add local resources to the CVDACTION help bar
You can add local resources to CVDACTION. 
The CVDACTION help bar sits on the right-hand side of every page in the dashboard and includes useful links to a user guide, clinical next steps for each condition, relevant NICE guidance and the wider Proactive Care Framework resources. The help bar can be adapted to include locally agreed pathways, protocols and other local guidance. 
To do this you simply edit the table in the dashboard template, extend the rows and then add the relevant links to external resources, before refreshing the dashboard. Find a quick guide on how to do this here.
Prioritisation
CVDACTION identifies patients whose risk of heart attack and stroke can be substantially reduced by optimising the use of high impact, NICE recommended treatments.  
A core aim of CVDACTION is to help teams manage their capacity and workflows. There are likely to be a lot of patients whose blood pressure is not controlled to target or whose cholesterol is sub-optimally managed for example. CVDACTION breaks this large workload into manageable chunks by stratifying into small cohorts and making it easy to prioritise safely.
For example, for patients whose blood pressure is not treated to target, CVDACTION shows you who is at highest risk – for example those whose BP is above180/120 followed by those whose BP is above 160/100.
Similarly, patients who have pre-existing cardiovascular disease are stratified into three groups to aid prioritisation:
- People with CVD on no lipid lowering therapy – they are at very high risk of a premature cardiovascular event
- People with CVD on a statin but at suboptimal dose or intensity
- People with CVD who are on maximal statin but with non-HDLc not treated to target – these patients may be eligible for second line therapies
This simple stratification helps to decide what to prioritise and what to safely phase over time, and it creates manageable chunks of work for time pressured clinicians.
When deciding where to start, it may make sense to begin with a single condition where several indicators can be addressed in individual patients. This will increase the impact on the patients’ health and save time for clinicians – by efficiently treating multiple risk factors in single consultations rather than single risk factors in multiple consultations.
Top tip: how to start
Consider starting with:
- Patients who have both hypertension and CVD: focus on optimising both blood pressure and cholesterol management at the same time; or
- Patients with chronic kidney disease or diabetes: focus on optimising the use of four high impact treatments: blood pressure treatment, lipid lowering therapy, renal angiotensin antagonists and SGLT2 inhibitors.
This multi risk factor approach will reduce the number of consultations needed, save time for the clinician and have much bigger health impact for the patient and local population.
Find out more about how the tool can be used to aid prioritisation in the video below.
Learn how the ‘Demonstrator sites’ prioritised their high-risk cohorts to align with local priorities in the case study section.
Tackling health inequalities
CVD is a major contributor to health inequalities, accounting for a fifth of the life expectancy gap between most and least deprived communities. CVDACTION can help you to target health inequalities – even in a single practice.
On each dashboard, clicking on the ‘Demographics’ button allows you to filter any indicator or group of indicators by factors such as deprivation, ethnicity or severe mental illness. The dashboard will then provide you with lists of patients in already vulnerable communities (e.g. most deprived quintile or those with severe mental illness) who are at increased risk of CVD because their blood pressure, cholesterol, CKD or diabetes is not optimally managed.