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Clinical Effectiveness Group

Optimising treatments for high blood pressure and cardiovascular disease is life-saving and cost effective

A recent study shows that optimising medicines for high blood pressure and cardiovascular disease patients living in East London could reduce lifetime hospital costs and prevent cardiovascular events such as heart attacks and strokes.

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CEG provided East London data for the study, which was led by Queen Mary health economists Runguo Wu and Professor Boby Mihaylova and funded by Barts Charity. The research estimates the lives and costs saved by optimising medications for blood pressure control (hypertension) and cardiovascular disease (CVD). It examines both a modest 10% improvement in prescribing and full optimisation of prescribing of antihypertensives and statins.

Key findings

In the three inner east London boroughs of City and Hackney, Tower Hamlets and Newham (population ~1 million) there were 91,828 adults with hypertension and 23,723 people who had CVD (heart attack/angina, stroke or peripheral arterial disease).

  • 24% (21,954 of 91,828) with hypertension had BP above target.
  • 38% (9,062 of 23,723) with CVD were not optimally treated with statins.

The evaluation found that over five years, full optimisation of related medications would save an estimated:

  • 678 heart attacks, strokes or related deaths from hypertension
  • 308 heart attacks, strokes or related deaths from CVD

Over the patients’ lifetimes, full optimisation would save:

  • 22,228 years of life and £41 million in hospital costs (Hypertension treated)
  • 4,034 years of life and £11 million in hospital costs (CVD treated with statins)

Even a modest 10% improvement would have a major impact over the patients' lifetimes and reduce inequities:

  • 1,994 fewer heart attacks, strokes or related deaths with 10% improvement in hypertension treatment.
  • 398 fewer heart attacks, strokes or related deaths with 10% improvement in statin treatment for people with CVD.

Covid-19 impact

Outside of the evaluation, primary care data analysed by CEG shows the pandemic has had a major impact on blood pressure recording and CVD management in general. In 2019, before the pandemic, the North East London region was performing better than London and England for blood pressure control. In 2020-21, most North East London areas have fallen below the London average.

Graph showing the percentage of people with hypertension under 79 years old whose blood pressure is lower than 140/90, comparing 2019-20 with 2020-21

 

With practice investment and support, a 10% improvement in existing management is achievable

A key element is training and assistance for in-practice pharmacists and practice teams. CEG is supporting this in North East London via several initiatives, including REAL-HEALTH Cardiovascular and the Redbridge CVD statin initiative. CEG’s tools and resources are available to NHS GP practices across North East London Clinical Commissioning Group with support from a dedicated primary care support team:

  • APL-CVD: An in-practice software tool for all-round management of patients with cardiovascular disease. It enables easy review of relevant information from the patient record, risk stratification, auditing and medicines optimisation.
  • Search and risk stratification tool: A simpler tool that groups patients into five risk categories. This is supported by project partner UCLP through their Proactive Care Programme.
  • CEG dashboards: Available to NHS practices and commissioners in the North East London Clinical Commissioning Group (access enquiries to ihse-ceg-admin@qmul.ac.uk).
  • STOP-BP: As part of a pan-London ‘pathfinder’ collaboration to support the London Health Data Strategy, CEG will develop a hypertension and CVD dashboard for the North East London Integrated Care System. This will include equity indicators by ethnic group and vulnerable groups, such as people with a learning disability or who are housebound.

More information

 

 

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