Cardiovascular disease (CVD) is one of the leading causes of death and disability in the UK. The implications for the NHS are profound, as increasing hospital admissions strain resources and escalate wait times. Currently, people with one or more long-term conditions use 50% of all general practitioner (GP) appointments, 64% of all outpatient appointments, and 70% of hospital beds.1 With CVD now the cause of one in four premature deaths2 in the UK, transforming the way CVD is prevented and care is provided, is becoming increasingly crucial.
With National Health Service England (NHSE) recently publishing their 2025/26 priorities and operational planning guidance,3 there is a need for systems to address inequalities and shift towards prevention. To address this challenge in the West Midlands, a transformative approach to CVD prevention and management was taken that included early diagnosis, effective management and comprehensive education. The work was led by Health Innovation West Midlands (HIWM) and colleagues from primary and secondary care across all six integrated care systems (ICSs).
The urgency of early diagnosis
CVD accounts for 27% of all deaths in the UK,4 and heart failure is also becoming increasingly prevalent, with over 780,000 people on their GP’s heart failure register.5 The earlier a patient begins treatment for CVD or heart failure, the better their chances of reducing hospitalisation and improving outcomes. Each admission not only adds to the strain on the NHS, but also significantly increases the risk of mortality.
Timely recognition of acute symptoms and expedited diagnosis must be at the forefront of our efforts. This is why we are supporting initiatives, such as the Pumping Marvellous charity’s B.E.A.T. methodology,6 which provides a simple and understandable acronym for patients and healthcare professionals to recognise the symptoms of heart failure – Breathlessness, Exhaustion, Ankle swelling, Time for a simple blood test, or Time to tell your GP.
Other cardiovascular conditions, such as hypertension and dyslipidaemia, can be more challenging to recognise. HIWM has supported primary care with implementing innovative approaches like case-finding tools, to enable patients with cardiovascular conditions to be identified and treated sooner. Supporting primary care with the adoption of such tools will help to establish a timely diagnosis, where appropriate, and provide better review and management of cardiovascular risk factors for patients.
The HIWM view is that, in the hands of care providers in a community setting, innovative technologies and ways of working, including point-of-care blood tests and point-of-care ultrasound, can help to quickly identify whether heart failure is likely. When used alongside other point-of-care tests and clinical assessments, a provisional diagnosis can be made quickly, and allow treatment to begin, while additional tests are requested to be undertaken by a specialist team.
The HIWM ambition is to continue supporting these initiatives to improve heart failure management.
Approaches to CVD prevention
Managing cardiovascular risk factors in both primary and secondary prevention, is key to reducing the occurrence of CVD events. Upskilling of clinicians and sharing of good practice are essential in supporting the management of cardiovascular risk factors and CVD prevention. In the West Midlands, a clinical trainer was embedded within the HIWM CVD team to deliver virtual education sessions to primary healthcare professionals on CVD prevention, ensuring that clinicians and their support teams are upskilled in the most up-to-date guidelines and treatment of these conditions.
HIWM created and launched a heart failure toolkit for primary care networks (PCNs), to give primary care teams the relevant information to support optimal care delivery for a heart failure patient. They also helped to establish heart failure champions within integrated care boards (ICBs) to allow for hands-on education, training and support. This has meant healthcare professionals, such as PCN pharmacists, physician associates and advanced clinical practitioners have been upskilled in heart failure care, enabling more professionals to identify, diagnose and start treating patients with heart failure.
Around 80% of heart failure diagnoses in England are made in hospital, despite 40% of patients having symptoms that should have triggered an earlier assessment.7
If we provide the right support to primary care we can re-address the balance so that fewer diagnoses are made in hospital, and more patients can be diagnosed within a community setting, avoiding the need to visit secondary care. This also frees up capacity within secondary care, enhancing the overall efficiency of the healthcare system.
Focusing on familial hypercholesterolaemia
Not all causes of CVD are lifestyle related; familial hypercholesterolaemia (FH) is a hereditary condition affecting about one in 250 individuals. It significantly increases cardiovascular risk.8 HIWM was one of seven health innovation networks to be involved with a pilot project to identify FH. They invited PCNs and practices to take part, and the West Midlands was the third highest screening area during the project. This was enabled by a strong relationship with the West Midlands Familial Hypercholesterolaemia service, which is a regional nurse-led assessment and genetic testing service based out of University Hospitals Birmingham. The service provided support in identifying areas where additional education and training may be required for primary care, to improve the rate of appropriate referrals.
This enabled HIWM to undertake a child–parent screening programme, which involved a heel-prick blood test during a child’s routine one-year immunisation appointment, as a method of identifying children, and their parents, with FH.9 In turn, this supported cascade testing to identify other relatives with FH and increase the detection rate for the condition. The goal is to achieve a 25% population prevalence of identified cases, contributing to the NHS’s long-term strategy for improved lipid management.
It is unlikely that population screening of adults alone will help attain the target stipulated, so child–parent screening will be a crucial tool in order to meet this ambition. By identifying hereditary causes for CVD early, we can help more individuals to manage their cholesterol levels and reduce the risk of experiencing a cardiovascular event, such as heart attack or stroke.
Implementing a population health management approach
Another way in which HIWM has been supporting CVD and heart failure treatment, is through adopting a population health management approach. This involves leveraging data to identify at-risk populations and ensuring that health interventions are tailored to meet individual patients’ needs.
Research shows that those in the most deprived 10% of the population are almost twice as likely to die of CVD, compared with those in the least deprived 10% of the population.10 Tailored outreach and education in these communities can bridge gaps in care and improve overall health outcomes.
With a population of over 6.2 million spanning six ICSs, the West Midlands is home to a diverse patient landscape; and to extensive rural populations, as well as two of England’s most deprived ICSs. More than 65% of the region’s population is considered to be in the most deprived 20% of the national population.11
There are noteworthy differences in the rates of circulatory disease, such as heart disease and stroke, between the most and least affluent, highlighting the need to improve access for underserved populations, particularly those in areas of deprivation.
HIWM’s Healthcare Inequalities Programme worked with four ICSs to target CVD management in underserved communities. The work engaged 2,200 individuals from seldom heard communities and resulted in 1,700 blood pressure checks and 650 cholesterol tests being undertaken.
By expanding interventions such as these into the broader health system, we can work to reduce health inequalities and ensure all individuals have access to the resources they need for effective heart disease prevention and management. But improving CVD and heart failure management is a collective responsibility that requires the commitment of healthcare professionals, policymakers, and the public. By focusing on early diagnosis, integrated management, comprehensive education and new technologies, we can transform the landscape of CVD care. The approach we have taken supports the shifts required within the new 10-year Health Plan for England, of moving care from hospital to communities, making better use of technology and focusing on preventing sickness.
Our overarching goal must be clear: to prevent heart attacks and strokes, ensure timely diagnosis of heart failure, and ultimately improve the quality of life for those affected. In doing so, we not only enhance health outcomes for the individual, but also alleviate pressure on our NHS, ensuring a sustainable future for CVD care.
Conflicts of interest
None declared.
Funding
None.
Sources of further information
https://www.healthinnovationwestmidlands.org/impact-report-2023-2024/
https://www.healthinnovationwestmidlands.org/cardiovascular-disease-portfolio/
Contact: Communications team
References
1. NHS England. NQB Workshop to inform Long-Term Plan. https://www.england.nhs.uk/wp-content/uploads/2019/08/NQB-Workshop-to-inform-Long-Term-Plan.pdf
2. NHS England. Cardiovascular Disease Clinical Policy. https://www.england.nhs.uk/ourwork/clinical-policy/cvd
3. NHS England. 2025/26 Priorities and Operational Planning Guidance. https://www.england.nhs.uk/publication/2025-26-priorities-and-operational-planning-guidance/
4. NICE Clinical Knowledge Summaries. CVD Risk Assessment and Management. https://cks.nice.org.uk/topics/cvd-risk-assessment-management/background-information/burden-of-cvd/
5. British Heart Foundation. UK CVD Statistics Factsheet. https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf
6. Pumping Marvellous Foundation. Think B.E.A.T Posters. https://pumpingmarvellous.org/wp-content/uploads/2024/07/Think-BEAT-posters.pdf
7. British Heart Foundation Fact Sheet BHF UK CVD Factsheet. https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf
8. Health Innovation West Midlands. Child-Parent Screening for FH. https://www.healthinnovationwestmidlands.org/our_work/child-parent-screening-2/
9. Wald DS, BestwickJP, Morris JK et al. Child–Parent Screening for Familial Hypercholesterolemia. N Eng J Med 2016;375:1628–37 https://www.nejm.org/doi/full/10.1056/NEJMoa1602777
10. NHS England Cardiovascular Disease (CVD). https://www.england.nhs.uk/ourwork/clinical-policy/cvd/
11. Health Innovation West Midlands. Impact Report 2024. https://www.healthinnovationwestmidlands.org/wp-content/uploads/HIWM-Impact-Report-2024-FV.pdf
