Benefits of Optimal Detection and Treatment of Cardiac Risk Patients

Detection and prevention of individuals who are at a higher risk of cardiovascular disease in England could save millions of cases of heart disease and stroke, according to a new study. //

The study is published in the online journal BMJ Open.

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‘3.5 million cases of heart disease and stroke could be prevented, and £68 billion could be saved in health and social care costs over 25 years if all individuals with at least one condition that increase cardiovascular disease risk could be diagnosed and treated. Detection of undiagnosed diabetes has the most significant benefits.’
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Detecting all the undiagnosed cases of diabetes would have the largest overall health and financial benefits.

There are more than 1.8 million people in England on the coronary heart disease register and more than one million people on the stroke or mini-stroke (TIA) register.

In 2015, cardiovascular disease was estimated to have cost the UK economy around £23.3bn (€26 bn).

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To prevent cardiovascular disease, NHS England has highlighted six high-risk conditions. These conditions are currently under-diagnosed and insufficiently well managed through a wide range of treatments are available. The six high risk conditions are:

High blood pressure
High cholesterol
Atrial fibrillation – irregular heartbeat
Type 1 and 2 diabetes
High blood glucose
Chronic kidney disease

Improving the diagnosis and treatment of these six conditions could improve health outcomes and potentially save substantial sums. However, till date, the potential benefits haven't been quantified.

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The researchers estimated the total health improvements and cost savings that might be achieved if all adults with at least one of these high-risk conditions in the UK were diagnosed and treated to current standards of care or by following the National Institute for Health and Care Excellence (NICE) guidelines.

They also studied which high-risk groups would benefit the most from optimal detection in terms of cost savings and health benefits.

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They used a disease prevention model known as the School for Public Health Research (SPHR) CVD Prevention Model.

The model focused on English NHS and social services, and the demographic and clinical features of participants in the nationally representative 2014 Health Survey for England to inform their estimates. They calculated savings, incremental and cumulative costs, quality-adjusted life-years (QALYs), the net monetary benefit to the NHS and social services in the UK, over 5, 10, and 25 years.

QALYs is a measure of years lived in good health of people.

The interventions were taken from NICE guidance for each of the high-risk conditions. These included:

Diagnostics - NHS Health Check, annual review for people with a pre-existing high risk condition)
Drugs - for lowering cholesterol and high blood pressure, blood thinners and treating diabetes
Lifestyle modifications -weight management, smoking cessation, diabetes education, and nutritional advice for chronic kidney disease
Supplementary assistance - blood pressure self-monitoring, medicines use review

The results showed that if every adult with at least one high-risk conditions were diagnosed and treated at current levels, £68bn could be saved, 4.9 million QALYs gained, and 3.4 million cases of cardiovascular disease could be prevented in 25 years.

If these people were managed according to NICE guidelines, £61bn would be saved, 8.1 million QALYs would be gained, and 5.2 million cases of cardiovascular disease could be prevented.

The greatest benefits would result from detecting undiagnosed high cholesterol in the short term and undiagnosed diabetes in the long term.

"Substantial cost savings and health benefits would accrue if all individuals with conditions that increase cardiovascular disease risk could be diagnosed, with detection of undiagnosed diabetes producing greatest benefits," the authors concluded.

Sticking to NICE guidance would further increase health benefits. The cost-savings could be used in developing efficient and cost-effective solutions for detection and treatment.

Source-Medindia