New UK joint working initiative addresses heart disease

Paul Tunnah

pharmaphorum

The old saying goes that “prevention is better than cure” and, as words of wisdom go, it’s hard to disagree with in most circumstances.

For example, look at the humble motor car. You don’t need to understand the detailed mechanics of a car to know that there are many things that can go wrong in such a complex piece of machinery. You have tyres pounding the tarmac every day, engines with heavy bits of metal spinning around at up to several thousand revolutions per minute and paintwork which is exposed to all manner of grit, rain and insect life being flung at it. However, for most of us it’s rare that we need to “cure” our car in the sense of major repair work. We tend to be quite diligent at checking tyres, oil level and ensuring a regular all-round service to pick up any impending disasters.

But if you think a car is a complex piece of kit, just consider the human body for a moment. Think of all the different organs and cells involved in keeping us going, think of what the body is exposed to every day and then think about the cumulative effect of that over many years. Consider the human heart, which beats around 100,000 times every day, which is 36.5 million beats a year and well over 2.5 billion beats in the average lifetime. It’s hardly surprising that as we grow older the risk of cardiovascular events increases significantly, especially if we live a lifestyle that exposes us to risk factors such as a fatty diet, low levels of exercise, smoking or stressful work.

 

“Consider the human heart, which beats around 100,000 times every day, which is 36.5 million beats a year and well over 2.5 billion beats in the average lifetime.”

 

Sadly, signs of impending cardiovascular problems are not quite as obvious as a chipped windscreen. So, earlier in July the Primary Care Cardiovascular Society (PCCS) launched the ‘Partners in Health’ program to encourage collaboration in tackling the rising tide of heart disease. During a Monday morning briefing, the objectives for the campaign were outlined, before attendees were invited for their own health check (if you want to find out whether I agreed to needles being stuck in me then read on…).

As the location for the launch was the Houses of Parliament, this invitation to “attendees” has also been extended to MPs, with Professor Neil Poulter using the occasion to also launch a study to assess the health of our politicians. For the first time, we will get a rough sense of how our politicians’ heart and lung age compare to the general population – for those brave enough to take part!

The partnership aims to bring together life sciences companies, their industry associations, the NHS and the third sector to encourage further joint working in order to improve cardiovascular health screening and disease prevention. As an illustration of the broad support for the initiative, the panel of speakers launching the event included:

• Fran Sivers (Chief Executive of the PCCS)

• Margot James MP (newly elected MP for Stourbridge, Conservative party Vice-Chairman and original Founder of the PR and medical education company Shire Health)

• Dr. Richard Barker (Director General of the Association of the British Pharmaceutical Industry [ABPI])

• Professor Keith Fox (Professor of Cardiology at the University of Edinburgh and President of the British Cardiovascular Society)

• Professor Neil Poulter (Professor of Preventative Cardiovascular Medicine at Imperial College, London and Director of the Imperial Clinical Trials Unit)

In addition, the event had garnered sponsorship from a number of companies and groups from across the partnership spectrum, with a number of organisations showcasing at the event some of the successful joint working initiatives that are already in place.

Fran Sivers opened proceedings, highlighting the fact that ‘Partners in Health’ is all about building on past initiatives, bringing the different groups across healthcare together. She also stressed the timeliness of the meeting, both in the coincidental launch of the White Paper on Health handing power back to the GPs and also just a week after the ‘Follow Your Heart’ project (a joint working initiative between the PCCS, HEART UK and Pfizer) had won the ‘Best Partnership Award’ at the Communique Awards. Co-chair, Margot James, echoed these sentiments, describing it as a “real privilege” to be asked to host the day’s events and reinforcing the valuable work conducted by groups such as the PCCS.

MPs Margot James (left) and Virendra Sharma (right) participate in the health check

Dr. Richard Barker outlined the importance of the UK’s life sciences industry, noting that it employs almost 150,000 people across over 4,000 companies, which have a combined turnover of more than £30bn per year and contribute £7bn per annum to the UK balance of trade (something which will not escape the notice of the coalition government in such tight financial times!).

In addition, the UK industry was described as having “punched well above its weight”, as evidenced by the fact that one in five of the top 100 global medicines had originated from the UK, according to Dr. Barker. But the key point here was that the UK industry needs to keep innovating and developing to maintain a strong position, something that can be achieved through being at the forefront of joint working. It is clear there are challenges to be overcome, not least a lingering suspicion of such novel ways of working from those sitting outside the commercial companies, but also clear guidelines being put in place to ensure these new initiatives have a real focus on improving healthcare provision for the patient.

So where do the cardiovascular experts sit in this process?

Well, Professor Keith Fox remains so close to the patient that he would be dashing back up to Scotland after the meeting to be on call as a Cardiologist at Edinburgh Royal Infirmary. His observations of the patients he meets have taught him that we have seen considerable success in managing cardiovascular disease recently. In fact, over the last ten years the mortality rate due to heart disease for the average 60 year old has halved, which he attributed to improved acute care and better lifestyle in equal measure. So whilst we may not have found a “cure” we have enabled people to live longer, with Cardiologists now performing heart bypasses on people in their 70s, 80s and even 90s.

 

“…the current health checks for cardiovascular disease are designed to assess relatively short (ten year) risk rather than lifetime risk.”

 

But here’s the challenge – the current health checks for cardiovascular disease are designed to assess relatively short (ten year) risk rather than lifetime risk. This means that a 39 year-old woman who presents with diabetes and a familial history of heart disease would inevitably be placed firmly in the low risk category for the next ten years, despite the likely heart age of 50 and consequent significant lifetime risk.

Professor Neil Poulter reaffirmed this view, stressing that current treatments will not dismiss the epidemic, but merely bolster its scale as more people present at the acute stage without loss of life. In fact, once a patient has presented with an acute episode such as a heart attack or stroke, there is no cure – that option has gone.

This means that prevention has to start early in life and perhaps as early as childhood for those deemed to be high risk. This point was well illustrated during the subsequent question and answer session, where Professor Poulter stated that the NHS spends around £1m every hour in treating type 2 diabetes. Remember, this disease is becoming both more prevalent and occurring more frequently in younger people, due to lifestyles developed well before adulthood.

So we need to start thinking long, long term to really prevent cardiovascular disease, a tough ask for any government that is seeking re-election every four to five years. Perhaps, despite some of the criticism, the new White Paper may help here as it devolves a majority of the NHS budget to the GPs. They are, after all closest to the patient and, in theory, those within the NHS that are least influenced by government targets and control. Where the industry is concerned, it is at least used to spending a significant proportion of money on early-stage R&amp,D that will not yield a return for ten years or more, so is familiar with the notion of spend now for benefit in the long term.

For patients, the point was also made that it is those who most need screening who are least likely to seek it out, so there is educational work to be done. In addition, the idea of health checks that talk about your lifetime risk and provide specific actions should also help change lifestyle behaviour.

 

“…once a patient has presented with an acute episode such as a heart attack or stroke, there is no cure – that option has gone.”

 

To revisit our car analogy, most people don’t change their car oil because they have been told that it is generally a good idea. They do it because a little indicator lights up on the dashboard (at least in more modern cars) telling them that their car needs its oil topping up or it will break down and they will have to walk, pay expensive bills to repair the engine or even have to buy a new car (this is where the analogy sadly stops when compared to the human body).

So was I brave enough to take my health check before leaving?

Well, my curiosity overcame my fear of the needle. I was actually quite intrigued to know what it would say and watched with interest as my blood pressure was checked, a pin-prick of blood taken to assess my cholesterol levels and my lung function tested (the hardest of the lot as I had to actually do something!).

And the results? Well, I didn’t check myself into the nearest Cardiac ward on the way home…but I did take time to visit the gym!

About the author:

Paul Tunnah is Founder and Managing Director of pharmaphorum, the exciting new online discussion and networking site for the pharma, medical devices and diagnostics industry. For queries he can be reached through the site contact form.

For more information on the Primary Care Cardiovascular Society visit www.pccs.org.uk.

How can joint working support heart disease prevention?