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Management of Cardiovascular Disease – The journey to personalised disease management

Cardiovascular disease (CVD) remains one of the biggest challenges facing the developed world, with the UK spending an estimated £12.5 billion in healthcare costs in 2015.

Furthermore, CVDs are responsible for some of the most significant healthcare inequalities seen in the UK and responsible for higher premature death rates in socio-economically deprived areas.

Bringing about reductions in CVD has become a national priority for the UK with the NHS Long Term Plan identifying cardiovascular disease as the single biggest risk area where lives can be saved in a decade.

Management of cardiovascular diseases at the national level requires a concerted approach combining a population strategy, aimed to reduce the determinants of disease in the population, with an individual strategy, which seeks to identify high-risk individuals susceptible to the disease to then offer specific treatment.

Population-level measures, though capable of effecting significant change in population health, tend to offer only small benefits to each individual. Identifying individuals deemed to be at high risk of developing cardiovascular disease to then target treatment yields high rewards as the relative risk reduction achievable is much higher than for people with a lower risk profile. However, the utility of this approach is limited in cases where the impact may only be small if the individuals identified as high risk contribute little to the overall CVD burden.

Without the population strategy, CVD events will continue to occur in a large number of people who each may have a low individual level of risk. Furthermore, eliminating some of the causes of disease by population-wide measures can cause a significant reduction in the incidence of CVD at the macro-level. Individual strategies targeted at “high risk” subjects act as an expedient to help protect susceptible individuals. The extent to which one strategy is emphasized over the other depends on achievable effectiveness, cost-effectiveness and resource considerations. A significant barrier on the road to personalised disease management remains the cost of screening large swathes of the population to identify high-risk individuals. HEE expects to see the development of new medical technologies which harness existing data streams from both medical and non-medical sources to create a dynamic way of identifying and monitoring high-risk individuals. Furthermore, the uptake of digital technologies, accelerated by COVID-19, offers the chance to use personalised digital health interventions based on people’s individual data profiles and risk scores with the potential to bring about lasting behaviour change and reduce CVD risk at the individual as well as the population level. 

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