A tale of my grandfathers and the revolution in cardiovascular disease prevention

A tale of my grandfathers and the revolution in cardiovascular disease prevention

Laura Semple, Programme Director for Diabetes & Stroke Prevention at Health Innovation Network, reflects on how new prevention techniques might have changed her grandparents’ lives.

I’ve often wished I’d had the chance to meet my grandfathers, Gerry and David. They were both fascinating and spirited people, who led interesting lives. Gerry travelled the world, had a successful career in industry and loved fishing for trout in the Welsh countryside. David worked in finance for London Transport and enjoyed vintage cars.

Sadly, I didn’t get to meet them because, like many people of their generation, they died too soon from cardiovascular disease in the 1970s and early 1980s.

This part of my family history is far from unique. It’s also a big reason why I find it so rewarding to be part of the movement of committed people working to prevent cardiovascular deaths in this country. February is National Heart Month and I’m thoughtful about the real progress that we’re seeing in south London in this area.

One of the main drivers of cardiovascular disease in the UK that Gerry and David grew up in was a lack of understanding around the impact of certain foods and other lifestyle aspects on heart health. It was very common to eat a high fat diet and the true scale of tobacco-related harm was not yet understood. But since the 1970s we have gained a rich understanding of the impacts of diet, exercise, tobacco and medication on heart health.

What’s more, we now have risk models, which enable us to accurately predict how likely it is that someone will have a heart attack or stroke in the next 10 years, simply by knowing their BMI, blood pressure, cholesterol and blood glucose measurements today.

This all makes me wonder just how different it could have been for Gerry and David. Not only are we now able to offer preventative care that extends lives, but crucially these are also improving the quality of those lives.

At its core, most of our work is really about giving Londoners the support they need to live full lives without the burden of diabetes and cardiovascular disease.

The first success to highlight on the prevention front is south London’s contribution to the Academic Health Science Network’s national stroke prevention programme.

Atrial Fibrillation (AF) is one of the most common types of irregular heart rhythm and contributes to one in five strokes. If Gerry and David had been born 20 years later, there’s a good chance that they could have been two of the more than 4,500 additional south Londoners whose AF has been newly detected since 2017.

The latest national stroke audit data shows that in the two years to March 2019 there were approximately 150 fewer AF-related strokes in south London than would have been expected from the previous years’ data. This is 150 Gerrys, Davids, Simones, Ritas, Mohammeds, and many others, who are still thriving as a result. We’ve recently published the results of our innovative work in improving AF detection through mobile ECG devices here and an ongoing pilot of 14-day ECG patches on page 12 of Cardiac Rhythm News January 2020 here.

Then there’s diabetes.

This is a major driver of cardiovascular disease and it’s simply astonishing how much our experience and understanding has transformed since Gerry and David were alive. Back in the 1960s and 1970s, we were not as good at detecting type 2 diabetes, so some people lived with the condition for many years without a diagnosis, which in itself increased their risk of preventable ill health.

In general, there was far less freedom and choice for people with diabetes in how they lived their lives, with many being told to stick to rigid set diets.

But in 2020, we believe in giving people with diabetes as much freedom as possible to live the lives they want, without diabetes getting in the way. South London has a formidable partnership of colleagues committed to minimising the impact of diabetes on citizens’ lives. Together we represent 12 clinical commissioning groups, 12 local authorities, seven acute hospitals, two universities, the King’s Health Partners Institute of Diabetes, Endocrinology and Obesity, the Applied Research Collaborative, several industry partners and community organisations like the Wandsworth Community Empowerment Network The last two years has seen a major focus on type 2 diabetes prevention, with over 30,000 south Londoners referred to the NHS.

I’m curious as to what Gerry, David and their friends might have chosen if they had had access to Diabetes Book & Learn, a radical move to scrap the previous postcode lottery of self-management support for people with diabetes. In this new system, south Londoners are learning how to live well with diabetes at a time and place that works for them in their busy lives, with different languages, digital options, evening and weekend courses and telephone coaching all available.

Would Gerry and David’s employers have supported their access to diabetes education through the learnings of our Think Diabetes report?

People with type 2 diabetes are also increasingly taking charge and setting the agenda for their doctors and nurses in the innovative You & Type 2 programme in primary care.

Would Gerry and David’s employers have supported their access to diabetes education through the learnings of our Think Diabetes report? This was supported by former Labour Party deputy leader Tom Watson. Many forward-thinking employers are using the recommendations in this report to offer support directly in the workplace.

At its core, most of our work is really about giving Londoners the support they need to live full lives without the burden of diabetes and cardiovascular disease. Healthy living is far from easy. People need holistic and non-judgemental support and this is why the offer of psychological support is built into Diabetes Book & Learn and many other new services.

There is a great deal more to do to prevent cardiovascular disease and exciting plans are afoot to do even more to tackle the longstanding health inequalities in our region. For now, I’m asking everyone who has played a role in the great progress so far to take a moment this heart month to remember the strides we have made together and renew our energy to take this to the next level.

If you are keen to join the fantastic team of people saving lives by preventing cardiovascular disease in south London please visit our webpages on diabetes and cardiovascular.  Alternatively, get in touch with me on laurasemple@nhs.net. This year we will be focussing on cholesterol and blood pressure as well as continuing to support our members with AF detection and improvements in diabetes care. The more collaborators we have, the more lives we can save.

I know that Gerry and David would be only too happy to see that things are different and getting even better, for the generations who came after them.

Share this Post

NB: Gerry and David are not the grandfathers’ real names.

BBC news broadcasts special feature on ESCAPE-pain programme

As part of National Arthritis Week, BBC London have featured the innovative rehabilitation programme, created by Prof Mike Hurley, Clinical Director at Health Innovation Network.

The special report included the fact that over 1,000 people have been trained to deliver this programme at 230 sites, including at least one in every region in England. In a boost to out-of-hospital care, an ambition of the NHS’ Long Term Plan, these trained professionals include fitness instructors delivering the programme in community halls and leisure centres, as well as hospital-based physiotherapists. ESCAPE-pain’s rapid growth over the past two years has been supported by the NHS’ innovation bodies, Academic Health Science Networks, NHS England, charity Versus Arthritis, and Sport England.

It is estimated that over 14,000 people will have taken part in ESCAPE-pain programmes across 230 sites in the UK.ESCAPE-pain is for people with chronic knee and hip pain (known as osteoarthritis, a musculoskeletal condition) and has been shown to make marked improvements to quality of life for people living with the condition. The success of ESCAPE-pain has also led to a newpilot programme for back pain being launched.

Around 8.75 million people aged 45 years and over (33 percent) in the UK have sought treatment for osteoarthritis. Despite the risk of side effects and high costs, treatment for osteoarthritis has traditionally been the prescription of painkillers, typically non-steroidal anti-inflammatory drugs (NSAID), with little practical support.

ESCAPE-pain’sfocus on education and exercise offers people and GPs options to better manage pain associated to osteoarthritis.The programme runs for a total of 12 sessions over six weeks with participants attending two, hour-long classes a week.The classes teach people the skills they need to self-manage and reduce their pain.Each class starts with a brief discussion about pain and how it can be reduced and is then followed by an individualised exercise programme.

ESCAPE-pain creator Professor Mike Hurley said:

“Chronic joint pain is miserable. It creates a vicious cycle of severe pain, leading to prolonged rest, which leads to further muscle weakness, which leads to physical instability and fatigue. This inactivity increases the risk of co-morbidities such as diabetes and cardiovascular disease. These physical health issues and disability then contribute to social isolation, feelings of helplessness, anxiety and depression, and long-term use of pain killers that people don’t like taking and haven’t been proven to work in the longer term.

“I wanted to find a better way to help people living with chronic pain and with ESCAPE-pain, we’ve shown that a combination of education, self-management, coping strategies and individualised exercise regimes can achieve better outcomes.”

David Rawlings, exercise referral specialist at gym and leisure centre, Leisure at Cheltenham, has been running the ESCAPE-pain programme at the centre with physiotherapists from Cheltenham General Hospital for over three years.

David said:

“People love it and for some it literally is life-changing. Some of the participants we have had on the course had stopped going out and participating in family life or in their community.  After attending ESCAPE-pain they become more active, are able to manage their pain and their arthritis better and build the confidence to move and become more active again.”

Jenn Holeman, senior musculoskeletal physiotherapist at Cheltenham General Hospital leads the ESCAPE-pain programme at the leisure centre said:

“I would recommend the ESCAPE-pain programme 100 percent both professionally and personally.  It is great and I think all areas should be taking it up.  It saves the NHS money because rather than 30 minute one-to-one physiotherapy sessions up to 16 people are having group sessions with one physiotherapist and gym instructor twice a week and it relieves the pressure on GPs because it cuts down on the amount of patients seeking treatment for their symptoms.”

Recent independent evaluations have also reinforced how much money the NHS saves by taking this approach, showing that every £1 invested returns over £5 in wider health and social value through people needing to use services and medication less. Overall it equates to an estimated £1.3 million total savings in health and social care for every 1,000 participants who undertake ESCAPE-pain.

Now, Londoners with chronic back problems have been given the opportunity to access a similar self-management programme. This pilot programme available at four London Trusts and over 150 people have benefitted to date.

Matt Whitty, deputy director of Innovation and Life Sciences, NHS England and NHS Improvement says that the ESCAPE-pain programme is a: “great example of a proven, low-cost innovation that transforms lives.”

“It will mean more people with chronic joint pain getting better care in their local communities and being able to live more independently with a higher quality of life. Responding to needs through this sort of cross sector working is crucial to how we will deliver the NHS Long Term Plan,” he continued.

Sarah Worbey, health and inactivity national partnerships lead at Sport England adds:

“The Sport England Active Ageing fund supports innovative approaches that aim to tackle inactivity among older people, the ESCAPE-pain programme fits perfectly into this.

“We are pleased to have partnered with the Health Innovation Network and Versus Arthritis to enable this programme to be tested through community and leisure settings, for those who are the least active and need it the most.

“It is encouraging for us to hear how participants are making important lifestyle changes and becoming more physically active through their participation in the programme.”

Data gathered from over the last three years from more than 5,000 ESCAPE-pain participants shows consistent improvements in pain levels, quality of life, and movement.

Almost three quarters of the participants who took part in the programme (70 percent) reported to have improved their ability to take part in daily activities, 66 percent reporting pain reduction and 59 percent having a better quality of life and mental wellbeing.

Further information

Learn more about ESCAPE-pain and find a class near you here.

Click here

We're here to help

If you have any questions or would like more information about ESCAPE-pain. Please contact us.

Get in touch