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

The UCLPartners Size of the Prize resources show that the NHS could prevent thousands of heart attacks and strokes by optimising the treatment of common risk factors like blood pressure and cholesterol.

High blood pressure and cholesterol are leading causes of heart attack and stroke (cardiovascular disease – CVD) in England, 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 and social care 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.

UCLPartners Size of the Prize shows how many patients with high blood pressure or high cholesterol are on the right levels of treatment, and 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:

• The pre-pandemic position: even before COVID struck, only around 70% of patients with high blood pressure were treated to the recommended target.
• The disruption to treatment caused by COVID: in all local systems and across the country, optimisation rates fell to around 50%, substantially increasing the risk of heart attack and stroke for many people.
• Progress: three and a half years after the start of the pandemic, most systems have still not recovered blood pressure treatment to pre-pandemic levels with almost one in three people not treated to target.

The opportunity: Size of the Prize sets reasonable levels of ambition that go beyond the historical status quo of suboptimal treatment – showing how many additional heart attacks and strokes will be prevented in three years and the savings generated if more people have their treatment optimised.

The numbers are huge. Across England if just 80% of people with diagnosed high blood pressure were on optimal treatment, around 16,000 heart attacks and strokes would be prevented in just three years with savings to the NHS of £180 million. In every ICB area, hundreds of these lifechanging events would be prevented.

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. The Size of the Prize shows that across England, almost one in five 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, 13,000 heart attacks, strokes and deaths would be prevented in three years. If treatment rates were increased to 95%, around 22,000 events would be prevented. This translates into hundreds of prevented cardiovascular events in every ICB area. For cholesterol, it is important to recognise that this is but the tip of the iceberg. In addition to the one in five patients with CVD not taking any lipid lowering therapy, large numbers of people are on insufficient treatment to lower their cholesterol. Optimising treatment in these patients will prevent many more cardiovascular events.

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

The UCLPartners Size of the Prize for Blood Pressure and Cholesterol shows the huge opportunity every ICB has to achieve a major impact on population health in a short timeframe and substantially reduce demand on health and social care resources at a time when the NHS and social care are under immense strain.

As a starting point for each ICB, Size of the Prize estimates the number of heart attacks and strokes that would be prevented if all PCNs were to match the achievement of the top quartile or top decile of PCNs. Exploring variation between PCNs enables ICBs to understand how best practice is achieved and where support is needed to bring all PCN’s up to that level.

But we need a systematic approach to translate ambition into outcomes.

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. CVDACTION is now being piloted in ICBs in London and elsewhere to evaluate the impact of case finding and to understand the implementation support needed by clinical teams on the ground.

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.