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Cardiovascular disease

Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels. CVD includes all heart and circulatory diseases, such as coronary heart disease, angina, heart attack, congenital heart disease, hypertension, stroke and vascular dementia. Having an ageing population means that if we do nothing the number of heart attacks and strokes will increase.

The NHS Long Term Plan sets the ambition for the NHS to help prevent over 150,000 heart attacks, strokes and dementia cases over the next 10 years and outlines how we, and partners, will meet this ambition.

Low diagnosis rates in England mean that:

5 million people will have undiagnosed high blood pressure (hypertension)
40% of people with diagnosed hypertension are not treated to the NICE 140/90 target
Half of all people with known atrial fibrillation (AF) who have a stroke are not anticoagulated

Fewer than one person in 10 survives an out-of-hospital cardiac arrest (OHCA) in the UK and a national network of community first responders and defibrillators will help save up to 4,000 lives each year by 2028. In addition, only 53% of people are referred to cardiac rehabilitation after a heart attack/ cardiac surgery and only 33% of those with heart failure

NEW! Training Directory for heart disease specialty (published October 2023)

Heart disease is a key clinical priority, set out in the NHS Long Term Plan. There are currently 6.4 million people across England, living with heart disease and some are facing agonising waits for care.

It is for this reason that job retention and development and upskilling of the multidisciplinary (MDT) heart team must be improved. The development of extended roles and upskilling the whole heart team is important to the delivery of high quality and integrated services.

A new training directory has been developed by the Long Term Conditions programme team, which is a centralised repository of career competencies and pathways, higher education resources and short courses, to help the NHS workforce develop a career in heart disease specialty and expand their clinical expertise.

Download Training Directory

Working with partners, our aims are:

(1) Prevent high risk cardiovascular conditions by supporting actions on workforce training for CVDPREVENT

(2) Improving survival from out of hospital cardiac arrest (OHCA) by supporting any training and workforce requirements on improving the heart attack pathway

(3) Improving diagnosis of heart failure and heart valve disease by supporting training and workforce needs for:

- Diagnostic capacity and capability in primary care to improve heart failure and heart valve disease diagnosis

- Earlier detection of heart failure through earlier recognition and assessment (in primary care or through diagnostic networks).

- Rapid access to heart failure nurses following hospital admission (more nurses, better supply and credentialing implicated)

- Better access to primary care echo

(4) Increasing cardiac rehabilitation by supporting workforce training to:

- Increase the availability of cardiac rehabilitation, and testing combined models with pulmonary rehabilitation

- Digital approaches to education and self-management

- Upscaling and marketing of cardiac rehab to improve uptake.

(5) Support workforce training on salt and harm reduction (ABC, alcohol, smoking, activity etc.) to contribute to 150,000 reduction in CVD endpoints

- Developing The Cardiovascular Disease (CVD) elearning programme to provide an overview of CVD care across the entire patient pathway and promote better patient care. It aims to provide all health and social care professionals and multidisciplinary teams with the appropriate level of knowledge, skills and experience they need to deliver effective CVD prevention and care to people with CVD, and at risk of CVD.

- The programme contains the Cardiovascular Diseases (CVD) Toolkit, that provides learners with a comprehensive list of online resources that can be used to support workforce upskilling, training and development. The toolkit is a digital version of the CVD training guide and addresses a national gap in a central portal for CVD resources.

- Developing Heart Failure and Heart Valve Disease elearning programme to support health and care professionals from a range of multidisciplinary backgrounds, in understanding heart failure and heart valve disease. Targeted at clinicians in primary and community care settings, including GPs.

- Contributed to the Cardiac Workforce Toolkit, in conjunction with FutureNHS, British Society of Echocardiography, the National School of Health Care Science and the National Audit of Cardiac Rehabilitation. This is a repository of information that focusses on 4 areas of key challenges for the cardiac workforce, including workforce redesign tools, and resources to support development of the cardiac workforce.

- The HEE Workforce Transformation Team worked closely with the Echo and Cardiac Rehab programme teams to understand the key workforce shortages in each area, and build the context around this through wider stakeholder engagement. For Echo, we concentrated on the shortage of Echocardiographers and for Cardiac Rehab, we concentrated on maximising the potential of the multi-disciplinary team. Following the initial context building, we then held Star workshops (see our HEE Star webpage for more information on this) with a range of subject experts from each professional group to ‘deep-dive’ into the workforce challenges using some key themes (supply, upskilling, new roles, new ways of working, and leadership). The output from these workshops was a list of potential projects that could be implemented by organisations, networks or systems to overcome the identified workforce challenges. HEE also provided some initial funding to support the implementation of a chosen few projects across a variety of networks. The impact of these will be evaluated and best practice and learning will be shared nationally through Echo and Cardiac Rehabs in future. All Echo and Cardiac Rehab networks are now being encouraged to revisit the project list and look at what they can implement locally to help overcome their specific challenges. For more information on the projects and support available to networks, please email england.cpip@nhs.net for Echo and england.clinicalpolicy@nhs.net for Cardiac Rehab.

CVD affects around seven million people in the UK and is a significant cause of disability and death. It is responsible for one in four premature deaths in the UK and accounts for the largest gap in healthy life expectancy and is identified as a clinical priority in the NHS Long Term Plan. Therefore, it was felt important that NHSE and HEE programme teams and other stakeholders come together in a workshop and identify how as a national programme we can draw on available expertise to help shape the workforce agenda for heart disease. The aims are to understand current priorities for the heart disease workforce, the pressures and challenges they face, suggest solutions to them and identify current barriers to achieving these ambitions and changes.

This report provides an overview of the facilitated discussions from an organised workshop, held on August 11th 2022. It identifies what the collective short-medium and long-term actions need to be at all levels in addressing workforce challenges for heart disease aligned with emerging service priorities and needs, including education and training.

Download and read the full report.

Download and read the executive summary.