Cardiovascular disease (CVD)

Current programmes and pathways

Abdominal aortic aneurysm screening

An abdominal aortic aneurysm (AAA) is a weakening and expansion of the aorta, the main blood vessel in the body.  Large aneurysms are rare but can be very serious.  Approximately 3,000 men aged 65 and over in England and Wales die every year from ruptured abdominal aortic aneurysms.

Men aged 65 and over are eligible for AAA screening and the NHS invites men during the year they turn 65.  Men over 65 who have not been screened previously can arrange a screening appointment by contacting their local programme directly.

The proportion of men eligible for Abdominal Aortic Aneurysm screening to whom an initial offer of screening is made is recorded (coverage); the minimum standard is 75%.  In 2015/16, Bedfordshire CCG’s results were 81.2%.

NHS Health Checks programme

The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes, dementia and kidney disease.  Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions, will be invited once every five years to their GP practice to complete their NHS Health Check.

During the appointment a QRISK2 score is calculated for the patient’s predicted likelihood of having a heart attack or stroke in the next 10 years.  The appointment provides a platform to offer the patient individual advice and support to help them to reduce and/or manage their risk.   See the NHS Health Check chapter for more information.

Cardiology services

Primary care

There are 53 practices in Bedfordshire, all involved in the care of patients with cardiovascular diseases, 29 of these practices are principally providing primary care services to the population residing in Central Bedfordshire.  There are also staff members employed by Bedfordshire Community Health and local Acute Trusts who provide services in the community for people with heart failure rehabilitation, these services are however not provided universally across the county.

Bedford Hospital Trust

Cardiology services at Bedford Hospital and Luton & Dunstable Hospital are summarised here.

Stroke service

Victoria Stroke Unit at Bedford Hospital is a 15-bedded ward.  There is also a day room.  20.  Bedford Hospital acute pathway stopped admitting patients with acute stroke in 2016 to reduce the number of Hyper Acute Stroke Units (HASU) from four to three across Bedfordshire, Hertfordshire, Luton and Milton Keynes.  This is in line with national evidence that recommends that a small number of specialist services, such as thrombolysis for stroke and major trauma, are centred on fewer sites with the aim to improve services for patients.  Specialised centres that have frequently practicing teams and full facilities, with high patient throughput, generally have better patient outcomes.  The acute patients are now diverted to Lister and return to Bedford Hospital after the patients have been in hospital 72 hours and are stable.

The stroke consultant together with a multidisciplinary team leads the Victoria Stroke Unit.  The team is made up of doctors, a stroke specialist nurse, nurses, physiotherapists, occupational therapists, speech and language therapists and dieticians.

Luton and Dunstable hospital also have a stroke team who provide Hyperacute (clot buster), Acute and Rehabilitation services. The Stroke team include Specialist Stroke Consultants, and stroke physicians.

Both team work closely with other professionals such as pharmacists, social workers, community rehabilitation teams and the Stroke Association.

The Stroke Association provide high quality information, emotional support and practical advice in the aftermath of a stroke.  This includes signposting and referring to other services to help stroke survivors and their carers adapt to their condition.  They support people to make the best recovery that they can, to help them maintain their independence and avoid social isolation and loneliness.

Impact & effectiveness

CVD focus pack for NHS Bedfordshire CCG is produced by RightCare.  It is an in-depth look at our spend, activity, quality and outcomes.

NHS Health Checks

Economic modelling suggests that the estimated savings to the NHS budget nationally is around £57 million over four years, rising to £176 million over a fifteen-year period.

Comparison of costs and savings

  • Total life-time gain for Bedfordshire CCG is 2,223 QALY (1) per year as a result of the NHS Health Checks at a cost of about £1,900 per QALY.  There are very few health interventions where improvements in quality of life and survival can be achieved so cost effectively. 

Cost and implication of stroke/TIA on health economy

Stroke statistics, 2016 found that the average cost of care (acute and rehabilitation) per stroke patient is currently £23,315.  The economic costs of stroke in the UK from a societal perspective totals around £9 billion a year: health and social care costs are approximately £4.38 billion a year (49%), informal care costs are estimated to be £2.42 billion a year (27%), productivity losses (i.e. income lost) due to care, disability and death are estimated to be approximately £1.33 billion (15%) and benefit payments total approximately £841m (9%)


Reference

(1) QALY- Quality Adjusted Life Years.  It takes into account both the amount and quality of life generated by a healthcare intervention

Last updated Tuesday, 25th July 2017