Report prepared by Professor Gill Furze and Dr Joe Mills, with the kind assistance of Professor Robert Henderson, National CVD Prevention Coordinator for UK and Honorary Secretary of the British Cardiac Society.
President of the British Association for Cardiovascular Prevention and Rehabilitation
Professor of Cardiovascular Rehabilitation, Centre for Technology Enabled Health Research, Coventry University
President-elect of the British Association for Cardiovascular Prevention and Rehabilitation
Consultant Interventional Cardiologist, Liverpool Heart and Chest National Health Service Foundation Trust
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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Prevalence of principal CVD risk factors (2011-12 data) – UK figures unless otherwise stated.
Source: Health & Social Care Information Centre: Statistics on Obesity, Physical Activity & Diet. 2014British Heart Foundation Cardiovascular Disease Statistics 2014
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.
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.
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.
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.
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