Management Of Coronary Heart Disease In The UK: A Critical Review
Overview of Coronary Heart Disease
There is an increasing trend in the global rates of morbidity and mortality due to cardiovascular diseases (CVD). This disease is considered as the leading contributors of mortality rates all over the world. A review of the statistics on mortality due to CVD (as of 2015) shows that 17.7 million people have died because of this condition alone, which amounts to about 31% of the total mortality rates in the global scale. CVD is an ‘umbrella term’ which includes different types of cardiac diseases as well as coronary diseases which are the most significant types of CVD. According to the World Health Organization, Coronary and cardiac disease is responsible for approximately 7.4 million cases of mortality as of 2015 (World Health Organization 2015). From this data, it can therefore be implied that coronary heart disease (CHD) is a significant contributor to the global mortality rates. In the UK, more than 25% of all mortality cases are due to CVD, while about 7 million others are living with this disease in the UK. CHD is responsible for the highest number of death, among all cardiovascular diseases (Bhf.org.uk. 2016). Keeping in mind such a high incidence and health burden of this disease in the UK, the objective of the study is to analyze six journal articles which study the incidence and management of CHD in the UK, and understand how the disease can be managed. The paper also aims to study the frameworks, policies as well as interventions which can be used to alleviate the risks associated with these diseases. Based on these aspects, the paper will also outline key recommendations for healthcare system of UK in the reduction of the incidence of this disease.
In order to develop a comprehension on the various management approaches, frameworks and models applicable for UK, that are aimed to manage coronary heart diseases, selection of 6 journal articles was done. This section provides the summary of these selected articles, which will be discussed below:
Article 1 by Bhatnagar et al. (2015) studies the prevalence of CHD in the UK. The article gives up to date statistical data on the rates of mortality, as well as the prevalence and healthcare expenses associated with the disease in the UK. The article shows that CHD is the most prevalent in Scotland and North England. The regional variations of these data are also highlighted in the study. Article 2 by Bernard, Lux and Lohr (2009) analyses the different themes associated with the delivery of healthcare in the UK, highlighting the management of cardiac diseases like CHD. The care delivery models of CVD are summarized in the article, outlining the preventative and palliative care and provide key insights into the care for CVD and its prevention in a primary care setup in the UK. This was useful to understand the preventative and primary care approaches, which was helpful to understand unknown cases of CHD.
Selected Articles and Key Findings
In the context of policies of the government aimed at the management of CHD risk factors, two articles were identified that covered details of policies on the prevention of cardiac diseases. In article 3 by Levy and Tedstone (2017), the authors analyses the themes on dietary policies in the UK, aimed at the prevention of cardiac diseases. The article covers key policy aspects in relation to the intake of energy, dietary salts, vegetable and fruits, as well as saturated fats, oily fishes and dietary fiber required by the citizen to prevent or reduce the risk of cardiac disease. The eat well guide is used to integrate the advices on healthy diet, to help people understand how cardiovascular health can be improved through proper diet. Article 4 by Collins et al. (2014) also discusses insights on policies aimed at the reduction of salt intake to reduce the risks of CHD in England. This article helps to understand how policies on heart diseases are designed in the UK through the analysis of cost effectiveness, uncertainty and sensitivities of the different preventative strategies.
Information regarding the cost affectivity of the programs aimed to reduce the population wide risk factors of the disease in England has been outlined by Barton et al. (2011). The primary theoretical framework used in the study was the generic economic model, which was used to decide how specific programs for the reduction of the risk factors can help to lower the incidence of cardiac disease. It was also found that smoking was a significant risk factor of CHD. Article 6 by Allen et al. (2016) studied how health inequalities due to the prevalence of smoking and premature death because of coronary heart disease can be reduced through tobacco control strategies. This helped to understand the merits of the tobacco control policies in the reduction of the risks of this disease.
Therefore, it is vital to analyze the theories as well as the management strategies outlined the selected articles. Article 1 gives information on the 2014 CVD statistics (19th edition). Details on the morbidity, mortality and healthcare expense are used to determine the burden of the disease in the UK. Data on the death rates due to the disease also showed that since 2012, there had been some reduction in mortality rates due to CVD, as it fell from being the first contributor of the rates of mortality to become the second most contributor towards that effect (Bhatnager et al. 2015). The report also highlighted of gender based health inequalities, as the rates of mortality due to CVD was found to be higher among women compared to men. A higher rate of mortality due to CVD in North England (compared to South) also showed a regional variation in the health inequality as well. Such aspects helped to develop an understanding on the health inequalities. The article however did not cover how health equity can be advanced and health disparities eliminated through effective leadership in healthcare.
Analysis of Findings
Graci and Ruffin (2014) highlighted that some agencies can foster leadership as well as coordination in healthcare and help to reduce disparities in health. Effective leaderships in public health can be a key aspect that can help to address these inequalities. In this context, it’s possible to address the health inequalities though the theoretical approach of transformational leadership. According to this theory, transformational leaders can use the approach of bringing about a change in the individuals and social systems, and act as inspiration and visionary to others (Banks et al. 2016). According to Koh and Nowinski (2010), health equity objectives at the levels of community can be translated by a health leader, and their presence can help to address the social determinants that affect the incidence of the disease as well as foster equality in health in their regions. Developing gender responsive health programs can also be strategic to address the gender based health inequalities of CVD or CHD (World Health Organization 2015). Using such data, it can be assumed that preventative strategies for CVD in the UK should address the different social determinants of health and disparities in health seen in the UK.
Article 2 by Bernard, Lux and Lohr (2009) investigated care and preventative strategies for CVD in the primary healthcare setup. In comparison to article 1, the article 2 analyzed the model for healthcare delivery for CVD. From article 1, the gender based inequalities in the prevalence of the disease were understood, while from article 2, the limitations of the screening processes for the disease can be outlined. A detailed understanding of the different models of health delivery for CVD was provided in the article. A significant limitation of the article was that sufficient evidence was not given to support the interventions on exercise and diet in the healthcare delivery models of the UK. The authors also pointed out that risk screening can be conducted well by general physicians, while issues on time constraints indicated the need for training the allied health professionals in the screening and assessment of the risks for CVD. As per Ryley and Middleton (2016), it is important that healthcare professionals be empowered so as to help them to act as leaders for change (transformational leadership) and thus help to improve the screening process, especially in areas unobserved.
The health delivery model in the UK is primarily based on the medical model. However, it must be pointed out that the bio-psychosocial model is also an important aspect that should be a component of preventative strategies and in the improvisation of participation in the preventative measures, as it can also help to empower the vulnerable groups and foster improvement of their health. This implicates the Marmot Review which suggested the development of sustainable places and ensuring health living standards for everyone. This shows that focus should be given to both the prevention of t5he disease as well as empowering the patients to regain control over their own lives and well being (Goldblatt 2016). Such understanding on the limitations of the medical model for CHD treatment and the advantages of using the social model for care can be utilized to successfully implement the social model into programs aimed towards the prevention of the disease. This is relevant to the Ottawa Charter that helps to develop a supportive environment and re-orientation of the health services as vital aspects of the charter (Gagné and Lapalme 2017). Strategies like healthy diet programs in schools and incorporating the importance of healthy lifestyle among children can be effective ways to foster a supportive environment for the citizens of the UK in the future. Additionally, including counselors and diet experts in the promotional programs in schools for females can also help to re-orient the health services.
Health Equity and Transformational Leadership
Article 3 by Levy and Tedstone (2017) provided information regarding the dietary policies in the UK related to the prevention of CVD. The policies mainly give focus on the control on the intake of dietary sugar and fiber. Recommendations of the UK government are to take actions to limit the quantity of sugar sweetened beverages and consumption of sugar among young people and children. The policies also recommended actions to improve the intake of dietary fiber, which has strong associations with lowering the risks of heart diseases. Therefore, it gives important considerations about changes in the diet for the citizens of UK. It is however important to understand that encouraging people to follow such a dietary recommendation is a challenging work for the government. In such context, it might be helpful to target key stakeholders in the food industry, so that sufficient and proper information regarding the nutrient value of the food are available to public and control in the levels of salt and sugar in food is implemented in order to improve the public health (Christoforou et al. 2016).
The article outlines that up to 4147 premature deaths can be averted through a reduction of 1g in the intake of salt, and thus helps to reduce healthcare costs for the NHS in UK. This sufficiently suggests that modifications in the diet as well as lifestyle can be made more intense especially for individuals at high risk of the disease, since hypertension and dietary salt intake is significantly related to the risk for CVD (Klaus, Hoyer and Middeke 2010). Government of UK has also involved food manufacturing companies to implement campaigns in salt awareness and control of the intake of dietary salt in order to reduce the risks of CHD. Such strategy provides crucial aspect that key stakeholders play an important part to achieve the objective of preventing CHD. Since, the food industry can play I pivotal role in fostering dietary modifications of the public, identification as well as management of the actions of the key stakeholders can be a useful way to implement the change (Christoforou 2016).
Article 4 by Collins et al. (2014) primarily focuses on the economic evaluation of the policies aimed to reduce salt intake for CHD reduction in England. IN the UK, CHD is the most common type of CVD, and high levels of intake of dietary salt is a significant contributor towards the prevalence of CHD, as it increases blood pressure (Ettehad et al., 2016). Modelling techniques were utilized to understand the effect of lowering the intake of dietary salt on the cardiac health of individuals from England. Health promotion policies such as Change4life, Health weight, Healthy lives strategy were the main aspects that helped to implement the policies for reducing dietary salt intake. Such campaigns used advertising and media in order to encourage the people to lead a healthier lifestyle and adopt healthy choice for food. This study showed that campaigns by the media can be effective to bring about a change in health behavior of the consumers, and also provides support to the food manufacturing industry in the UK to make necessary changes in the packaging of food and labeling them appropriately, such that the people are aware of the nutrient content of the food they eat. Such policies can help to reduce the risk factors of CHD in the UK. Therefore, the study by Collins et al. (2014) outlined the role of modeling technique to analyze the policies of the government in context of changing the labeling and manufacturing of the food. In the study, the authors used the IMPACT CHT model that is significant in the objective of the study. These approaches can be effective to co9mprehend the different preventative measures that can be used for CHD prevention.
Healthcare Delivery Model and Bio-psychosocial Model
Action of the government to utilize reduction of salt intake in important strategy for management of cardiac diseases, since through lifestyle modifications, and the availability of packaged food or increased consumption of salt can increase the risk factors of the disease (Trieu et al. 2015). Therefore, with the availability of sufficient evidence on the effectiveness of maintaining the dietary intake on the health of individuals, multiple interventions can be implemented such as reformulating food items, proper food labeling and using campaigns on media to raise awareness and reduce intake of dietary salts can be used by the UK government to alleviate the future risks of CVD (Hyseni et al. 2017). Such strategies can be effective especially since the intake of salt can be limited with these methods and therefore reduce the risks of conditions like hypertension. It is however important to understand that such will be a long process, and rapid success might not be achieved by this. Hence, patience is an important virtue to get the desired result.
Article 5 uses the economic modeling strategy for the assessment of the cost affectivity as well as the risk factors for CVD in Wales and England. Typical economic model was developed for two situations: first regarding the lowering of blood pressure and second regarding legislative frameworks that reduce salt and fat intake (Barton et al., 2011). The generic model provides certain advantages like is offers method to understand cases of CVD which were averted. This model is also useful to analyze the cost effectiveness of NHS and improvement in the life expectancy or quality adjusted life years (QALY). The individual benefit and accumulated benefit were also analyzed in the study. Sheffield prevention model was used for performing the cost analysis. The model provides a deterministic and casual model which can be used to study the econometric aspects and epidemiological aspects (Katikireddi, Hilton and Bond 2016). Such techniques used for the study showed a lowering of the risks of CVD by 1%, which can help to prevent 25000 new cases of CVD and even avert 3500 deaths. This also implies an effective savings in healthcare costs by UK Pound 26 million. Barton et al. (2011) pointed out that such strategies can allow saving of up to 30 million pounds for a 10 year program.
For specific interventions, it was shown by Barton et al. (2011) that reduction of salt intake by 3g per day (through salt intake policies), reduction of systolic blood pressure by 2.5mm Hg can be achieved. Furthermore, legislations on the ban of industrial fats showed lowering of the energy intake by 0.5%, which further reduced mortality rates by 5%. Therefore the study showed that even with the reduction of the risk of CVD by 1% can help to make substantial cost savings on healthcare for the NHS (Barton et al. 2011). It can also be suggested that the spreadsheet model for estimation of costs helped to develop a transparent model for the estimation of expenses and thus help the UK government to track the progress in CHD outcomes when such interventions are implemented at local levels. Including such a model in the preventative strategies can be useful to produce changes in the right area and learn the effect of the intervention on the health of the population. Such will also help to produce a path towards a responsible regulation which fosters efficacy of healthcare programs that are aimed to reduce the presence of CHD and CVD in the UK. Such an approach also resonates creative and regulatory approaches which support the authorities to address their key responsibilities on public health and wellbeing and help to improve actions of the food industry towards the maintenance of public health (Magnusson and Reeve 2015).
Dietary Policies for the Prevention of CVD
Article 6 gives information on the management approaches which are needed to prevent this chronic condition. It analyses the effect of the control of tobacco score on the prevalence of smoking and premature death due to CHD. The model is responsive towards a significant improvement in the policies on tobacco control which led to the reduction of the health inequalities among the people in England (Allen et al. 2016). Such as aspect is vital since smoking of tobacco is considered as a significant risk factor for CHD. Analysis of other cohort based studies additionally supports the same relation between smoking and CHD. The impact of smoking can also be highlighted by the fact that it increases the risks of mortality by two fold, compared to non-smokers. However, such risks were found to be reduced through interventions that aimed to reduce the dose of smoking (Mons et al. 2015). It can therefore be understood that preventative strategies in this area will also help to reduce the risks among older populations. Such strategy can be relevant to the theory of reasoned actions, which states that the health behavior of a person can be affected by their attitudes towards the behavior, and cessation programs should focus on changing the attitudes towards smoking, with the knowledge of the potential health risks caused due to it (Montano and Kasprzyk 2015).
From the 6 articles, it was evident that many deficits were outlined in the management practices on CHD in the UK. The government of UK has recommended to priorities certain actions for the future consideration. 1) Reduce the gender based health inequalities and developing responsive management for CVD for women. 2) While implementing policies for CHD prevention, going beyond patients with the diagnosis and focusing on the population who are at risk of the disease in the future should be considered. 3) Health policies should focus to evaluate the effectiveness and efficacy of the care program using the evidence based approach which favors cost analysis as well as evaluation of the effectiveness of cost associated with the care practice.
Conclusion:
The study shows an overview into the analysis of managerial practices for CHD in the UK, though the analysis of 6 articles on the prevention of CHD and CVD. These articles covered several vital aspects like the rate of prevalence, policies on the reduction of risks, policies on diet, intake of salt and health model policies. The studies highlighted challenges associated with health inequalities lack of vision in designing the program and a lack of evidence about the affectivity of the interventions. The articles also gave vital insight into the utilization of various models and frameworks in guiding the preventative policies. Based on such information, it is possible to learn valuable sessions from such practices to inform and develop a more effective approach to reduce the risks of CVD in the UK.
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