Size of the Prize – Helping the NHS to Prevent Heart Attacks and Strokes at Scale

Size of the Prize shows that the NHS could prevent thousands of heart attacks and strokes by optimising the treatment of common risk factors like blood pressure and cholesterol. This would deliver huge savings in health and social care and contribute significantly to UK economic growth.

• High blood pressure and cholesterol are leading causes of heart attack and stroke (cardiovascular disease – CVD), common conditions that account for a quarter of premature deaths. CVD is also a major driver of health inequalities, explaining around 20% of the life expectancy gap between most affluent and most deprived communities.
• Treatment to lower blood pressure and cholesterol is highly effective at preventing these serious events that are life changing for individuals and their families, and very expensive in terms of NHS, social care and broader economic costs.
• Despite this, large numbers of people with high blood pressure or high cholesterol do not receive the recommended levels of treatment, and as a result remain at high risk of having a heart attack or stroke.

Our Size of the Prize shows how many patients with high blood pressure or high cholesterol are on the right levels of treatment. It then models how many heart attacks and strokes would be prevented if more patients’ treatment was optimised. Size of the Prize is available for the whole of England, for each region and for every Integrated Care Board (ICB) geography. Within each ICB, it also provides achievement data for each Primary Care Network (PCN) and models the potential for improvement by tackling unwarranted variation.

Size of the Prize for High Blood Pressure

View the Size of the Prize for Blood Pressure below or access or download via this link: Size of the Prize for Blood Pressure

The Size of the Prize for Blood Pressure shows:

• Progress: In June 2024, treatment optimisation rates have fallen substantially below the March 2024 levels, and one in three people with hypertension are not treated to target.
• In-year variation: This same pattern was seen last year with optimisation rates across the country falling after the March peak and remaining lower until the following March. This reflects achievement and then decline after QOF measurement day each year.
• For the June CVDprevent data extraction, there has been a change to indicator definition with inclusion of home based and ambulatory blood pressure readings. This may explain some of the decline in optimisation rates.
• Geographical variation: there is substantial variation in optimisation rates between practices with achievement across England varying from under 40% to over 90%
• Opportunity: Size of the Prize sets reasonable levels of ambition that go beyond the historical status quo of suboptimal treatment. It shows how many additional heart attacks and strokes will be prevented in three years and the savings generated if more people have their treatment optimised.

And the numbers are huge. Across England if just 80% of people with diagnosed high blood pressure were on optimal treatment, over 17,000 heart attacks and strokes would be prevented in just three years with savings to the NHS of almost £200 million. This would have a major impact on population health and economy growth: recent modelling suggests that a 20% reduction in cardiovascular events would increase the UK’s GDP by £2.2 billion in 6 years.

Size of the Prize for High Cholesterol

View the Size of the Prize for High Cholesterol below or access or download via this link: Size of the Prize for High Cholesterol

For people with established CVD, cholesterol lowering treatment (such as statins) is essential to reduce the risk of further heart attack or stroke. Size of the Prize shows that across England, around one in six people with CVD are not taking this life saving medication. For each ICB, the Size of the Prize for Cholesterol models how many heart attacks, strokes and deaths would be prevented and how much NHS and social care spend would be saved if treatment rates were increased to reasonable ambition levels.

As with blood pressure, the numbers are huge. Across England, if just 90% of people with CVD were treated with statins, almost 9,000 heart attacks and strokes would be prevented in three years. If treatment rates were increased to 95%, over 17,000 events would be prevented. This translates into hundreds of prevented cardiovascular events in every ICB area.

And for cholesterol, this is just tip of the iceberg. In addition to the one in six patients with CVD not receiving lipid lowering therapy, large numbers of people are not taking the recommended dose or intensity statins. Optimising treatment in these patients will prevent many more heart attacks and strokes.

Using Size of the Prize to deliver a step change in CVD prevention

Size of the Prize gives us the ambition. But we will only achieve this ambition through at-scale targeted case finding and treatment optimisation. 

CVDACTION, developed by UCLPartners, is a smart data tool that identifies and stratifies patients with high-risk conditions (including blood pressure and cholesterol) that are sub optimally treated so that their preventive treatment can be rapidly optimised.

Further resources to support blood pressure and cholesterol optimisation

We have also developed a suite of proactive care resources to support primary care teams to optimise treatment for their patients at risk of CVD. These include:

• Slide decks, practical guides and digital resources to help clinicians manage conditions such as high blood pressure and cholesterol in real world primary care
• Guidance, protocols, support for training and implementation tools to assist the wider work force (e.g. Additional Roles Reimbursement Scheme roles) in providing structured support for education, self-management and behaviour change
• Digital resources for patients living with high risk conditions such as blood pressure and cholesterol

Find out more about the UCLPartners Proactive Care Frameworks.