1. Helen O’Kelly Health service engagement lead, south east
October 2018
Helen O’Kelly Health service engagement lead, south east

2. Health Services Engagement team

3. Our priorities

4. 45 minutes to improve detection and management of atrial fibrillation and hypertension
A quality improvement focused session to think of local changes to improve detection and management of AF and HTN at a CCG’s practice nurse education day
Brief and rapid introduction to HSE team and their local data – 1/40 had seen it before
2 minutes at the end of the session to fill out an action plan for steps they can take in the next week/month to put their ideas into practice
What are the barriers to your detecting and treating AF and HTN?
Asked them to answer 3 questions:
What are the things you are already doing that are successfully helping you to identify and treat AF and HTN? Are there any nuggets you can share with colleagues in the room?
What would ideally be in place in your practice to help with improving detection and treatment of AF and HTN?
What changes could you make to achieve this?
What does the CCG need to look at?

5. BHF national work Blood pressure AF Familial hypercholesteraemia
House of care
Plus more …..

6. Blood pressure BHF supporting 14 projects across UK:
Develop and test innovative ideas and approaches to detecting people with high blood pressure
Target areas of high social and health inequality, with high prevalence of cardiovascular disease and higher than average cardiovascular disease and premature mortality rates.
Disseminate best practice drawn from the evaluation of these projects and promote widespread adoption

7. Diagnosed HTN ranges from ~35- 70% across GP practices
Oxfordshire– HTN detection
Diagnosed HTN ranges from ~35- 70% across GP practices
Undiagnosed = 67,950

8. Treatment to 150/90 mmHg ranges from ~65-85% across GP practices
Oxfordshire– HTN treatment
Treatment to 150/90 mmHg ranges from ~65-85% across GP practices
Opportunity for 11,188 people to be treated to 150/90 mmHg

9. HTN - How can we do better?
What can practices do to find and treat the missing high risk patients?
Use the CVD Primary Care Intelligence Packs to identify the gap between recorded and expected prevalence
Use quality improvement to test new ideas for detecting and treating
Work with partners to promote public awareness of blood pressure and opportunities for testing and self-testing
Promote uptake of the NHS Health Check
Self-test BP stations in the waiting room
Audit practice records to identify people with high BP recordings who do not have a high BP code
Increase opportunistic blood pressure testing in the practice
Promote high standards in BP measurement, including machine calibration, signposting patients and staff to video training resources

10. Diagnosed AF ranges from 60- 100% across GP practices
Oxfordshire– AF detection
Undiagnosed = 3959
Diagnosed AF ranges from % across GP practices

11. Oxfordshire– AF treatment
Gap = 2185

12. Familial hypercholesteraemia
Affects approximately 1 in 250 people
Only 15% of the estimated 260,000 people in the UK with FH have been diagnosed.
The risk of death from CHD can be 80 times greater with FH at the ages of
Once individuals with FH are identified, treatment with statins can restore life expectancy to that of the general population.
For every 1,000 relatives tested, it is estimated that, over 20 years we will avert: 46 MIs, 50 cases of angina, 8 strokes and 16 deaths.
Cascade testing first-degree relatives of people with FH can help identify and treat at-risk family members, and is cost effective.
Lessons from BHF pilots offer practical suggestions for creating an effective local service - locally Wessex service now commissioned by CCGs
For more info:

13. House of care
Patients able to discussed what is important to them as part of their review
Patients happier with the information they have received.
Patients better able to cope with their condition
Patients felt their care and support was more joined up
Clinicians reported improved morale and increased enjoyment in their role.

14. Cardiac rehab in Scotland
Western Isles model – cardiac nurse does the rehab assessment. Lothian – specialist nurse focuses on assessment, and some high need patients. Assessment is front loaded - up to two hours and then self-directed as part of care plan. ~80% triage seamlessly into leisure activities in their area.. Need to bring local leisure services with you, plus training and may need infrastructure.

15. Resources and tools
Web based resources
Publications
AF resource
BP resource

16. Thank you