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EAPC Country of the month - United Kingdom

April 2015

Report prepared by Professor Gill Furze and Dr Joe Mills, with the kind assistance of Professor Robert Henderson, National CVD Prevention Coordinator for UK (-2017) and Honorary Secretary of the British Cardiac Society.

Gill Furze

President of the British Association for Cardiovascular Prevention and Rehabilitation

Professor of Cardiovascular Rehabilitation, Centre for Technology Enabled Health Research, Coventry University



Joe Mills

(Note: National CVD Prevention Coordinator for UK since 2017)

President-elect of the British Association for Cardiovascular Prevention and Rehabilitation

Consultant Interventional Cardiologist, Liverpool Heart and Chest National Health Service Foundation Trust

Documents to download

Health care

Health care in the United Kingdom (UK) is delivered by the National Health Service (NHS) run as four different, publically funded systems in the countries which make up the UK (England, Scotland, Wales and Northern Ireland). The NHS is funded through general taxation and covers hospital, community and primary care. Social care is delivered by local governmental authorities. Prevention programmes and the main cardiac rehabilitation services are covered within NHS funding – there are no age barriers to access of these services. Long-term cardiac rehabilitation (following the main programme) is often self-funded and delivered by community health or leisure services.

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Risk factors

Prevalence of principal CVD risk factors (2011-12 data) – UK figures unless otherwise stated.

  Men Women Comments
 Obesity  13.2 % in 1993 to 24.4% in 2012  16.4% in 1993 to 25.1% in 2012  18.9% of children aged 10-11 obese in 2012
 Physical activity 67% met recommendations  55% met recommendations  150 mins moderate intensity per week
 Cigarette smoking  51% in 1974 to
21% in 2011
 41% in 1974 to
19% in 2011
 Decline in children smoking
 Hypertension  31% (England)  27% (England)  Significant numbers undiagnosed
 Diabetes Mellitus  2.9% in 1994 to
6.7% in 2012 (England)
 1.9% in 1994 to
4.9% in 2012 (England)
 Approx 850,000 as yet undiagnosed in UK
 Total Cholesterol  14% below 4mmol/L (England)  12% below 4mmol/L (England)  England average of 5.1 mmol/L (men)

Source: Health & Social Care Information Centre: Statistics on Obesity, Physical Activity & Diet. 2014
British Heart Foundation Cardiovascular Disease Statistics 2014

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Main actors & prevention methods

Guidance on best methods for prevention (both primary and secondary) is given by the National Institute for Health and Care Excellence (NICE), as well as from the British Cardiovascular Society (BCS) and the British Association for Cardiovascular Prevention and Rehabilitation (BACPR). The UK Government has had a strategy for cardiovascular prevention in England since 2000, which is regularly updated – most recently as the Cardiovascular Disease Outcomes Strategy, and is delivered by NHS England and Public Health England. Similar initiatives are in place in the devolved nations of Scotland, Wales and Northern Ireland.

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Prevention activities

There have been a large number of campaigns to promote cardiovascular health within the UK, including: the social marketing campaign “Change 4 Life” targeted at both families and individuals; the Joint British Consensus Statement on prevention in cardiovascular disease (3rd Edition – JBS3), which now includes a lifetime risk approach in addition to the 10 year risk approach – with an innovative risk calculator for use by both professionals and the public; a multi-faceted smoking cessation campaign combining the law, health professional support and subsidised pharmaceutical cessation aids with smoking cessation marketing campaigns; Act FAST – an initiative to increase recognition of the signs of stroke, which has had significant impact on care.

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Cardiac Rehabilitation

Cardiac rehabilitation services are delivered in a 7 stage pathway, from initiating event through to long term care. There are approximately 350 multi-disciplinary cardiac rehabilitation programmes in the UK, usually delivering the main programme as a group programme for ~8-12 weeks incorporating exercise and support for risk factor reduction. Other options for rehabilitation include individual home-based rehabilitation and more recently for web-based remote rehabilitation. Uptake across the main conditions (acute coronary syndrome, percutaneous coronary intervention (PCI) coronary artery bypass graft (CABG)) is 45%, but this figure masks variance between the conditions, with uptake for post myocardial infarction without PCI at 33%, through to uptake post CABG at 80%.

Cardiac rehabilitation is audited through voluntary reporting to the National Audit for Cardiac Rehabilitation (NACR) which operates in England, Wales and Northern Ireland. The majority of cardiac rehabilitation programmes in these countries do report to NACR. The addition of Scotland to the audit is currently under review. The NACR collects both programme specific data (uptake, length and frequency of programme) but also patient level data including details of physical and psychological functioning and quality of life. BACPR and NACR are launching (in summer 2015) a voluntary certification programme attesting whether cardiac rehabilitation programmes meet minimum standards.

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Aims for the future

  • To translate governmental initiatives for cardiovascular disease prevention into clinical practice in order to reduce CVD-related morbidity and mortality.
  • To promote uptake of JBS3 across the UK in order to provide consistent and evidence-based care and education for the public.
  • Encourage senior cardiologists to be more involved in and to champion prevention and rehabilitation services.

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Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.