CARDIOVASCULAR & METABOLIC

Pharmafile speaks to Scott Curley about CVD, the impact COVID-19 had on the pharma industry specifically in relation to CVD and the next steps for cardiovascular treatment in the UK

Scott Curley (SC): One of the main impacts is the rising number of heart-related deaths due to cardiovascular disease (CVD). A recent article published by the British Heart Foundation (BHF) suggests that the pandemic could be linked to up to 30,000 additional heart deaths. We all know that the number of excess deaths related to COVID-19 is far greater than that, but this is still a significant number of potentially avoidable deaths due to CVD.

A second impact of the pandemic was the inability to get an appointment, which unfortunately led to a lot of missed or delayed diagnoses. Research done by Heart UK looking at the evolving system of healthcare shows the impact of COVID-19 over the last 12 months, while also benchmarking it against the previous 12 months. This research estimates that, during this time, there were more than a million missed health checks, including blood tests and general patient health checks. This, of course, includes checks for CVD.

We generally find that those who have been diagnosed and are being treated have had their healthy heart check-ups. However, it’s estimated that up to eight out of ten patients who are eligible for these check-ups have either not been contacted or have not yet had this check-up, which includes important lipid profile tests. Unfortunately, even some who were being treated and were getting regular check-ups haven’t had follow-up appointments. This also presents a huge challenge as, if they’ve already had a primary event, a high number of these patients could have a secondary, catastrophic event.

Another impact of the pandemic, despite the excellent services the NHS provides, is that waiting lists are at an all-time high, even as much as 50% higher than they were before the pandemic. So, when the ticking time bomb that is CVD starts to make its way into an already pressurised NHS, it will take some time to work through.

SC: First, I would like to say that, during the pandemic, we all faced unprecedented challenges under exceptional circumstances.

Those in the NHS did the very best they could, all the while putting themselves on the line and facing a disease that wasn’t yet fully understood, and tragically many of the staff succumbed to COVID-19 in the early stages.

In recognition of the outstanding work the NHS was doing, so many of us stood outside our houses applauding their heroic efforts – it’s important that we don’t forget that and that we continue to show our appreciation for the NHS.

A recent publication by NHS England, the Secondary Prevention Programme, looks at patients who have had an event and who have received hospital treatment, and have then gone back into the community. There’s a huge risk for these patients and if we don’t continue to monitor them, it’s possible they will have a secondary event, which may be far worse than the initial one. The NHS is looking at high-impact interventions through patient identification and medicine optimisation clinics to treat cardiovascular and other diseases – developments and prevention strategies that they are already supporting. There is a focus on secondary prevention and ensuring that patients who are most at risk get the treatment they need. Through NHS England, in partnership with NICE, new integrated care systems (ICSs) and integrated care boards (ICBs) have developed resource packs detailing the most impactful interventions that can be implemented to delay or reduce secondary events.

However, it’s clear that one of the most pressing challenges currently is that the NHS is already in crisis – underfunded, under-resourced and striking for the right to decent pay – so implementing new processes and procedures will be extremely difficult in such turbulent times.

SC: I worked in China, Hong Kong and Asia for a number of years and, in many instances, these countries look at the interventions made by Western countries, because they’re on a different path – that is certainly what I’ve seen historically. Over the last five years, it looks like NHS England, NICE and the new ICSs and ICBs are leading the way, to some extent, in terms of how we tackle the potential burden of the excess deaths related to CVD. When speaking to colleagues in these other markets, I haven’t seen an approach that’s quite as focused or as determined. I have very high hopes that we can lead the way and that others may then benefit from this.

SC: I wish I had a definitive answer. There’s definitely a need to completely rethink CVD and the typical patient profile if we are going to be successful in tackling the rising mortality rates. NICE recommends that high-quality cardiovascular risk assessments need to be done, and the recently produced new national guidelines that support this include more robust, detailed lipid profiles, which will give a better indication of each patient’s risk.

We also need to be innovative through, for example, the use of point-of-care testing and identifying ways to better educate patients. Organisations such as the European Society of Cardiology are looking to support the development of national strategies such as those from NHS England on secondary prevention and recently, more pharma companies have partnered with the NHS.

Historically, collaborations have been more focused on R&D, for example working together on new innovative medicines, new trials and new opportunities to support patients at high risk, but what we’ve seen more locally are collaborations looking at the expertise and resources that pharma companies have, and using these collaborations to identify the most at-risk patients and provide them with the right level of care.

After new guidelines have been made available and new protocols have been introduced, the right support mechanisms need to be in place to ensure that eligible patients at higher risk get the right treatment at the right time. This requires collaboration and trust, and working together to help as many patients as possible, in order to have a really positive impact on current CVD mortality rates, which are a legacy of the COVID-19 pandemic.

SC: In a nutshell – behaviour change. But it is extremely difficult to encourage people to make the changes needed to lead a healthy lifestyle, such as eating healthy food, limiting alcohol intake, stopping smoking, exercising and maintaining a healthy weight. People live fast-paced lives – they often don’t have the time and energy to implement these changes, and this is understandable.

It’s important to recognise just how difficult these lifestyle changes are and the huge efforts they require to implement and maintain. Everyone would like to lead healthier lives, but that’s not always possible. This is where cognitive behavioural change comes in, as it can help people understand how much difference even small changes can make.

One other key thing is to book an appointment with your GP to ensure that you get the necessary check-ups. In addition to this, people should always be encouraged to seek good medical advice. This is available through services like 111 and GP surgeries, and there are also charities in the UK, such as Heart UK and the British Heart Foundation (BHF) in particular that can provide helpful information. It’s important to take control, as understanding your existing and future health risks can enable you to take the right steps and get the right treatment at the right time.

We need to remember that the outlook for CVD has changed considerably from previous years. It used to be seen as something that was associated with your grandparents’ generation, with a generally accepted view that it affected older men – but it affects women as much as it affects men, and it also affects younger people, as well as those who are older. Atherosclerotic disease can affect those in their 30s, so there needs to be much more awareness of this, to enable people to take the right steps to protect their health. As mentioned, it’s easy to suggest lifestyle interventions and advise people to ‘eat more healthy foods’, but one of the most important things is to get those check-ups done. Like most diseases, when CVD is caught early, there are effective treatments and interventions that can help to delay or prevent later events.

Behaviour change is always difficult and no one should be blamed for developing CVD. What’s important is to help people access the different healthcare options available to enable them to live a longer, healthier life.

SC: What we do know is that this disease is a silent killer – many people don’t realise they have CVD until it’s too late, and it’s important to recognise that. For outcomes to improve, it’s vital for people to have the right check-ups and the right tests, to enable them to receive treatment, medication or advice on lifestyle changes. There is an important opportunity here to completely rethink the treatment paradigms. NICE offers world-class health technology appraisals of new medicines and, when it believes that a new innovative treatment can make a huge difference, it backs that treatment and publishes its guidelines. At this point, there is a need for the ICSs, ICBs and other health boards to implement these guidances much more rapidly.

As new, innovative treatments are developed, it’s up to NICE to decide if they will be added to the available treatments for CVD. If that answer is yes, the changes to the protocols and pathways that are needed to implement these new medicines need to be made as quickly as possible.

The NHS needs to identify those who are most at risk, so they can be offered treatment that may prevent or delay that first event. This is even more important for those who already had an event, as they are more likely to have a secondary event. There are many innovative medicines on the horizon, a number of which have only recently been launched. Together with the NHS, we can make a huge difference to the impact of CVD on patients’ lives.

This article was originally published in Pharmafocus.