James Cant: We need a heart-to-heart talk about treating Scotland’s biggest killer

James Cant, BHF Scotland Director
James Cant, BHF Scotland Director
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Scotland has a problem with heart disease. Ischaemic heart disease (IHD) remains Scotland’s single biggest killer and constitutes the country’s single ­biggest health burden.

Beyond this much-used line ­however, heart disease has a ­profound impact on our health care system, our clinical community, and most importantly, people the length and breadth of the country.

Scotland is at a crossroads in our national focus on heart disease. ­Currently the Scottish Government’s actions on heart disease are set out in the Heart Disease Improvement Plan (2014). This was a refresh of the Better Heart Disease and Stroke Care Action Plan (2009) which refocused attention on six key priority areas, previously identified by the Action Plan in 2009. However, the healthcare ­system and the policies that underpin it have changed substantially since 2009, and we are facing an even greater pace of change over the next ten years.

Healthcare policy in Scotland has also moved on significantly since 2009. The Digital Health and Care Strategy 2017-2022 provides a broad policy framework for the way in which the health care system in Scotland can grasp the opportunities afforded by technology.

Meanwhile, the 2018 General ­Medical Services Contract in ­Scotland reimagines how people with long-term conditions engage with a wide range of healthcare ­professionals and the Chief Medical Officer’s concept of Realistic Medicine promotes core aims of innovating to improve, building a personalised approach to care and encouraging shared decision making between patient and clinician.

Technology and expanding access to data will impact significantly on healthcare, while advances in ­medical science mean that many ­people are now surviving cardiac events like a heart attack. But many more are living with long term ­conditions – risk factors including high blood pressure or high cholesterol affect increasing numbers of people in Scotland and have not yet been fully addressed.

It is time for Scotland to seize the pioneering spirit of Dr Desmond Julian, who set up the first coronary care unit in Europe in Edinburgh; through to the world-class researchers of today who continue to ­deliver breakthroughs and broaden our knowledge and understanding of heart disease.

Now, we have an opportunity to reflect on the great success of the 2009 and 2014 plans, as we should, but we also have an excellent opportunity to look to the future, and ensure our healthcare system is ­delivering for people with heart disease today and ready for the challenges of tomorrow.

A national conversation is required; one that considers the challenges for a primary care system that must ­support increasing numbers of ­people living with long term conditions and is cognisant of a secondary care environment that is dealing with more complex cases at a time of rapid technological advancement.

A national conversation that puts patients first; one that reflects their needs and wishes and thinks about what living with and dying well with heart disease means to them.

A national conversation that is collaborative with Government, clinicians, patients and the third sector working together to ­deliver a strategy for Scotland that is ambitious, forward ­thinking and built on breakthroughs.

James Cant, BHF Scotland ­director.