Optimum detection and remedy of cardiac danger might save thousands and thousands of lives and billions of kilos

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Optimal detection and treatment of cardiac risk could save millions of lives and billions of pounds

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Almost 3.5 million cases of heart disease and stroke could be prevented, and £ 68 billion in health and welfare costs could be saved over 25 years if every adult in England is at high risk for cardiovascular disease diagnosed and treated would analysis, published in the online journal BMJ Open.

Recording all undiagnosed cases of diabetes would bring the greatest health and financial benefits, the researchers calculate.

In England, more than 1.8 million people are on the registry for coronary artery disease and more than a million are on the registry for stroke or mini-stroke (TIA). It is estimated that cardiovascular disease cost the UK economy around £ 23.3 billion (EUR 26 billion) in 2015.

As part of its strategy to improve cardiovascular disease prevention, the NHS England has highlighted six high-risk diseases that are currently underdiagnosed and inadequately treated, despite a range of treatments and lifestyle changes available. The six high-risk conditions are: high blood pressure, high cholesterol, atrial fibrillation (irregular heartbeat), diabetes (types 1 and 2), high blood sugar, and chronic kidney disease.

Better diagnosis and treatment of these six conditions could improve health outcomes and potentially save significant amounts of money. However, so far the potential benefits have not been quantified, the researchers say.

To correct this, the researchers estimated the total cost savings and health improvements that could be achieved if all adults with one or more of these high-risk diseases in England were diagnosed and treated according to current standards of care or according to the National Institute for Health and Care Excellence (NICE) Guidelines.

Their analysis also looked at which high-risk groups would benefit most from optimal detection in terms of cost savings and health benefits.

They used a School for Public Health Research (SPHR) disease prevention model (CVD Prevention Model) that focused on the UK NHS and social services and the demographic and clinical characteristics of participants in the 2014 nationally representative health survey for England to make their estimates to inform.

They calculated incremental and cumulative costs, savings and Quality Adjusted Life Years (QALYs) – a measure of the years lived in good health and the net monetary benefit to the NHS and social services in the UK over 5, 10, and 25 years.

The interventions included in their modeling were taken from the NICE guidelines for each of the high risk conditions. These included: Diagnostics (NHS Health Check, annual review for people with an existing high-risk disease); Medications (used to lower cholesterol and high blood pressure, blood thinners, and treat diabetes); Lifestyle changes (weight management, smoking cessation, education about diabetes and nutritional advice for chronic kidney disease); as well as additional support (blood pressure self-monitoring, review of drug use).

The results showed that if every adult were diagnosed with one or more high risk conditions and then treated appropriately at current levels, they would save £ 68 billion, gain 4.9 million QALYs and 3.4 million cases of cardiovascular disease -Diseases could be prevented over a period of 25 years.

And if all of these people were managed according to NICE guidelines, it would save £ 61 billion, gain 8.1 million QALYs and prevent 5.2 million cases of cardiovascular disease. The greatest benefits would come from the short term ingestion of undiagnosed high cholesterol and the long term diagnosis of undiagnosed diabetes.

The researchers acknowledge that their results depended on an accurate modeling of current care in England, which in turn was based on a number of data sources, sometimes based on relatively small numbers. And the numbers could be underestimated as the model did not include some vascular conditions like peripheral vascular disease, they indicate.

Nonetheless, they conclude: "There would be significant cost savings and health benefits if everyone could be diagnosed with conditions that increase risk (cardiovascular disease), with detection of undiagnosed diabetes being the most beneficial. "

Adherence to the NICE guidelines would further increase health benefits and the "projected cost savings could be invested in developing acceptable and cost-effective solutions to improve detection and management".

The greatest risk of death is for people with newly diagnosed type 2 diabetes who have heart failure

More information:
What are the cost savings and health benefits of improved detection and treatment of six high cardiovascular risk diseases in England? An economic assessment, BMJ Open (2020). DOI: 10.1136 / bmjopen-2020-037486

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British Medical Journal

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