The Care Quality Commission has called for renewed efforts to slash the number of cases of heart disease and reduce the inequalities in care between deprived and more affluent areas of the country.

The call follows the publication of a study into heart disease care and prevention in the UK, which applauded the work already undertaken to drive down the number of patients suffering from the illness but also found that much more can be done to improve the picture.

The government has already hit its target of cutting the number of deaths among people under 75 by at least 40% by 2010, and according to the CQC is also on track to achieve its goal of narrowing the divide between deprived areas and the country as a whole.

However, the UK still has one of the highest rates of cardiovascular disease in Europe, patients are still getting different standards of care depending on where they live, and GPs are not following proven practice consistently, according to the Commission.

Given that the disease claims more than 200,000 lives in the UK and costs the country more than £30 billion a year the need to shift the battle against the illness up a gear is urgent, particularly as experts believe levels of obesity – a major cause of CVD – are set to rocket in the coming years.

To help improve the situation the Commission says GPs and commissioners must get better at prescribing statins, managing cholesterol and targeting of poor areas of the country. “We must encourage our GP practices and other primary care services to make sure they do what the evidence shows works, making sure they redouble efforts in deprived areas and ensure prescribing is cost-efficient,” Young stressed.

The report suggests stretching the goals for cholesterol management set by the Quality and Outcomes Framework – an annual incentive and reward scheme for GPs – which currently gives practices the maximum allowance under the criteria if just 70% of patients reach acceptable cholesterol levels. The CQC says this payment threshold should be increased so that more patients are required to have acceptable cholesterol levels in order for practice to be awarded full payment.

Furthermore, the study found that too many GPs are dishing out expensive branded cholesterol-lowering statins instead of cheaper non-branded versions that are just as effective. It claims that £62.5 million could be shaved off the NHS’ bill for statins if, as suggested by the NHS Institute for Innovation and Improvement, 78% of prescriptions were for generic forms as opposed to branded ones. In addition, the Commission says it research has found that GPs prescribing less cost-efficiently are also performing less well on reaching cholesterol targets.

Unrecorded cases
On the inequalities side, GPs in deprived areas were found to be less likely to record whether someone has CVD, barring such patients from services they need to manage their disease. It is estimated that around 350,000 such cases go unrecorded every year, and that the majority of these are from poorer areas of the country. To help address this the CQC has called on primary care trusts to use outreach programmes to “target people at most risk when commissioning primary care practitioners to carry out vascular screening”.

CQC Chair Barbara Young said while it is “good news” that the number of deaths from cardiovascular disease has fallen “resting on those laurels is really not an option”, because “more people die here prematurely from CVD than in other countries and we cannot rest while health inequalities exist on the scale they do. People in the richest area can expect to live up to 23 years longer than people in the poorest”.

And Betty McBride, Policy & Communications Director at the British Heart Foundation, it is “alarming” that people in the more deprived areas are missing out on vital health services. “This is a national problem and needs a nationally integrated solution, one which puts tackling inequalities at the core of cardiac and vascular planning, and incentivises healthcare professionals to make the difference,” she stressed.