Associate feature: The pandemic has shown the need for a new heart disease strategy

Every day for four months Nicola Sturgeon stood at a podium and read out statistics on the impact of COVID-19: the number of people with the virus, the number of deaths, the number of people in hospital.

National Records of Scotland (NRS) took this another step further. A weekly report with a demographic breakdown, the number of deaths involving stroke, heart disease, cancer, dementia, the number of deaths with COVID-19 mentioned on their certificate.

For the British Heart Foundation (BHF) Scotland, this data helped identify that there had been an increase in people dying from a heart attack at home.

“If you look at the excess deaths, heart disease was the second biggest excess death behind Alzheimer’s and dementia. And, fundamentally, our biggest concern was about people presenting at A&E when they needed to,” BHF Scotland senior policy and public affairs manager David McColgan tells Holyrood.

The data showed there were 594 more deaths registered between 27 April to 3 May compared to the average for that time of year – 83 per cent of these had COVID-19 as the underlying cause of death, and eight per cent were due to an increase in deaths from circulatory diseases.

“What we saw here was an increase in people dying at home where a heart attack was attributed to their death,” McColgan says.

“We know that eight out of ten people that suffer a heart attack survive nowadays. It is a condition that doesn’t have to be fatal, but if you don’t present early enough then your chances of survival decrease and obviously during the COVID-19 crisis there was a concern that people may not be presenting at A&E and that’s what potentially led to that excess in mortality on the five-year average.

“Now, you could argue that if this data wasn’t available to us on a weekly basis, there wouldn’t have been pressure on the Scottish Government or pressure within the government to launch the NHS is Open campaign.

“What it showed was that open and transparent data allows us to be as responsive and timely as possible.”

Attendance at A&E in the week beginning 29 March was 11,020 – less than half of the normal average attendance of 25,000 per week.

By the end of April, a national media campaign titled “the NHS is Open” was launched to encourage people to seek medical help for urgent health issues unrelated to COVID-19.

“If all of the coronavirus data was released in October, then we wouldn’t be able to respond to the problems that were happening there and then,” McColgan says.

“The data came out at a very clear and consistent time and allowed people to make approaches to government, engage on issues that are actually happening right now, and then there’s the issue around accessibility of the data and how easy it is to interpret.”

The BHF has spent the past year developing a new heart disease strategy for Scotland. The work has been extensive, with consultations held with the clinicians, patients and the wider public.

It has led to a vision of how Scotland can beat heart disease: by tackling risk factors; offering timely and equitable access to diagnosis, treatment and care; and ensuring that high-quality, standardised data is available and used effectively to support clinical decision-making, understand patient outcomes and enable better service-planning.

McColgan says: “We’ve been heavily engaged with all the political parties over the last year and I think we’ve been very clear from the start what our ambitions are – that is a new heart disease strategy for Scotland. The current one was published in 2014 and that was just a refresh of a 2009 document, so by the time the election comes around it’ll be six or seven-years-old.

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“Rather than creating a list of asks that we want, we’ve been specific, but we’ve also put our money where our mouth is and taken a very significant process in consulting with the clinical community in Scotland and the patient community. I’d like to think that that will be well-received and that post-May 2021, the successful government will be willing to work in partnership with the BHF, and others, to drive forward the implementation of a new heart disease strategy for Scotland.”

McColgan says the pandemic has confirmed the need for a new heart disease strategy for Scotland.

“I think what COVID-19 has done is actually almost confirmed that our thinking was along the right lines, and the consultation we’ve done with the clinical community still stands the test of time,” he says.

“We’ve come out the back of COVID-19 a lot more assertive and confident in the consultations we’ve done so far. The document we’ve got to now is in a really strong position.”

Like many charities, coronavirus and the lockdown had a major impact on the BHF’s funding and medical research. A message on the BHF website, calling for donations, states that the organisation is “on the verge of having to cut our research funding by half this year”.

The BHF’s income is raised by donations from events, charity shops and other fundraising, all of which had to be cancelled because of the pandemic.

“All income that we would expect to get on an annual basis has now dried up because of events having to be cancelled, understandably,” McColgan explains.

“Supporting people with heart and circulatory diseases is the British Heart Foundation’s top priority. But the coronavirus crisis will unfortunately have a long-lasting impact on charities like ours and that’s why we need the public’s support now more than ever.”

As the largest independent funder of medical research in the UK, when the BHF’s research centres had to ground to a halt that posed another “major challenge” for the organisation, he says.

“If funding is diminished, then it will have a profound effect on universities and research institutions across the UK, and ultimately risks slowing that crucial pipeline of research advances that in time will save lives across the world.”

But there have been some positives in the research arena. “What’s been great to see is many of our funded researchers have actually volunteered to support COVID-19 testing and laboratory work. It’s been amazing to see our PhD students, our early-year scientists and some of our senior scientists, moving over to perform that function,” McColgan says.

The BHF has also quickly mobilised COVID-19 research grants to look at the virus’ impact on the heart and circulatory system.

“There’s a lot of theories and thoughts that COVID-19, long-term, will impact people’s heart health, for those who contracted it, but there’s no real medical basis on that,” he says.

“So, we’ve partnered with a number of organisations to fund research, some of that’s happening here in Scotland, to look at what the long-term heart health will be for people who contracted coronavirus and were treated and survived it. Medical research will help us shine the light on the way out of COVID-19.”

In Scotland more than 720,000 people are living with heart and circulatory disease. For many of these people the pandemic has meant months without the normal services on offer, from specialist heart failure nurse appointments, to going to the GP to get their blood pressure taken.

“The BHF has been supporting patients in a number of ways. Our Heart Helpline, for example, which anyone in the UK can call and speak to our specialist nurses, was expanded – we extended the hours, we opened at the weekends, and we saw a spike in calls,” McColgan says.

Staff across the organisation were internally redeployed to support that service to “make sure that everyone who called got the chance to speak to someone”, he says.

Additionally, the BHF moved to set up the Cardiac Rehab at Home programme. “Cardiac rehab is traditionally done in a kind of a group setting, maybe ten to 20 people who have had a heart episode,” McColgan explains. “They’re there with a specialist nurse, and they go through their exercises, it reduces the risk of a future event, but obviously people couldn’t engage in that setting or that format.

“What the BHF did was work with the cardiac rehab community and we created our Cardiac Rehab at Home programme – we basically digitised cardiac rehab and put it into people’s living rooms, so they didn’t have to leave the house. We’ve seen a huge uptake, and we’ve had great feedback from across the UK about different models of using it.”

When the pandemic struck, NHS Scotland transformed the way it worked in a matter of days, embracing the digital space like never before. The BHF hopes this leads to new ways of working going forward.

“Everyone who works within the healthcare system at this point in time would say, it’s amazing how quickly in the space of a week the NHS just completely redesigned itself,” McColgan says.

“And how long have people been working on digital health care or working on multidisciplinary teams and a whole range of different ideas that just never come to fruition over the years – but in the space of a week the NHS just mobilised, turned around, and responded to the problem.”

He adds: “There’s an argument to say we don’t necessarily need to go all the way back to the old way of doing things. We don’t necessarily need to go back to February 2020.

“Maybe COVID-19, in the impact that’s had on the NHS as a system and a structure, offers an opportunity to learn lessons and to look at new ways of working going forward.”

This piece was sponsored by BHF Scotland.