CVD Secondary Prevention plans within Thames Valley Gita Sundareshwar Network Quality Improvement Lead 18/09/2018

CVD UK Key Facts- BHF

Information from size of the prize - PHE The diagnosis and treatment gap in 2015/16 for the Thames Valley region   Frimley health Buckinghamshire, Oxfordshire and Berkshire West Estimated adult population with Hypertension 161,900 390,200 Estimated adult population with undiagnosed hypertension 69,200 166,200 GP registered hypertensives not treated to 150/90 mm/Hg target 19,500 45,200 GP registered population with Atrial Fibrillation (AF) 11,200 29,600 Estimated GP registered population with undiagnosed Atrial Fibrillation 5,700 13,100 GP registered high risk AF patients (CHA2DS2VASc >=2) not anticoagulated 2,300 5,000 Estimated adult population 30 to 85 years with 10 year CVD risk >20% 52,700 121,300 Estimated percentage of people with CVD risk ≥20% treated with statins 49% The burden: first ever CVD events, 2015/16 Frimley Health Buckinghamshire, Oxfordshire and Berkshire West Coronary Heart disease 1,700 3,000 Stroke 750 1,750 Heart Failure 550 1,150

Information from size of the prize - PHE The opportunity: potential events averted and savings over 3 years by optimising treatment in hypertension, 2015/16 – info from size of the prize for STPs Buckinghamshire, Oxfordshire and Berkshire West STP 270 heart attacks Up to £2.00 million saved 400 strokes £5.40 million saved Frimley health STP 120 heart attacks £0.90 million saved 170 strokes £2.50 million saved Optimally treating high risk AF patients averts within 3 years £6.60 million saved 180 strokes £3.10 million saved

Thames Valley Strategic Clinical Network (TVSCN) plans in progress The TV SCN:- 1. Is establishing a core group of CVD clinical leads to complement STP prevention groups. This group will- provide strategic direction and leadership across the system set a clear ambition, targets and trajectories for improvement of the cardiovascular health for the TV population by focussing on increasing earlier detection and better management of cardiovascular diseases with reduced variation between practices, resulting in the reduction of CVD incidents and improved patient outcomes. determine the scope of work 2. Has produced an example case for change. Offering each locality a detailed analysis of the CVD outcomes, and current and projected burden of the different CVD events. In addition practice level data highlighting variation and the sharing good practice initiatives to improve patient outcomes and reduce the cost burden. 3. Is scoping local initiatives to provide a comprehensive picture across TV for the clinical leads with potential collaboration between network, Year of Care and a small number of GP practices testing out the application of Care and Support Planning approach in a group based setting for people diagnosed with hypertension. 4. Is working with key partners- British heart Foundation (BHF), AHSN, BoB and Frimley STP prevention boards

Proposed Thames valley Ambitions and Target

My email address: Sangeetha.sundareshwar@nhs.net