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CVD

Equity in Cardiovascular Care: Closing the Gaps in Hypertension and Lipid Management

Despite advances in cardiovascular disease (CVD) prevention, deep inequalities persist in who is diagnosed, treated, and controlled. With CVD responsible for a quarter of all deaths in England and prevention now a Core20PLUS5 priority, tackling these disparities is essential for both population health and QOF achievement.

The Inequality Problem

 

  • Ethnicity: People of African/Afro-Caribbean ethnicity are around 24% less likely to be prescribed statins compared with white Europeans, while South Asian patients are around 9% less likely. Eliminating these disparities could prevent 12,600 cardiovascular events in people with diabetes alone [UCL, 2021].
  • Socioeconomic status: Patients in the most deprived quintiles are more likely to have raised blood pressure and cholesterol but are less likely to be diagnosed or adequately treated [PHE, 2021].
  • Gender and age: Women and younger adults remain disproportionately under-treated for CVD risk factors.

These inequalities are not just statistics, they translate directly into avoidable strokes, heart attacks, and premature deaths.

What Practices Can Do Now

 

  1. Stratify and Prioritise

Segment patients by Index of Multiple Deprivation (IMD) score and ethnicity. This helps identify high-risk groups where prescribing rates are low or hypertension control is poor. Platforms like Attend2 CVD Indicators make this process immediate, surfacing treatment gaps by demographic group.

  1. Tailor Outreach

  • Provide translated invitations or culturally tailored patient information.
  • Run opportunistic BP checks in community settings (pharmacies, local events) to engage harder-to-reach groups.
  • Train staff to address common myths about statins and antihypertensives in specific communities.

  1. Remove Barriers to Treatment

  • Audit “no statin” lists by ethnicity and deprivation quintile — many gaps result from missing offers or outdated exception codes.
  • Support adherence through pharmacist-led consultations, especially where side-effect concerns or polypharmacy create drop-off.
  • Encourage home BP monitoring for patients who struggle to attend surgery-based reviews.

 

How Attend2 CVD Supports Equity

 

Attend2 CVD integrates IMD score and ethnicity data directly into its dashboards, enabling practices and PCNs to:

  • Identify treatment gaps by population group (e.g. statin prescribing by ethnicity, BP control by deprivation quintile).
  • Track improvement over time, showing commissioners how targeted interventions are narrowing health gaps.
  • Evidence progress against Core20PLUS5 priorities, supporting both QOF achievement and ICB reporting requirements.

This transforms equity from a strategic aspiration into a measurable outcome.

 

The Bottom Line

 

CVD prevention isn’t just about hitting QOF thresholds, it’s about hitting them fairly. By stratifying patient data, tailoring outreach, and addressing barriers to treatment, practices can close long-standing gaps in care. With built-in IMD and ethnicity insights, Attend2 CVD gives primary care teams the tools to make equity a reality, improving QOF performance while reducing avoidable cardiovascular events.

 

References
  1. UCL News. Black and South Asian people less likely to be prescribed statins than white Europeans. January 2021.
  2. British Heart Foundation. 5 million people in UK living with undiagnosed high blood pressure. June 2024.
  3. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet. 2016; 387:957–967. doi:10.1016/S0140-6736(16)31378-9
  4. Public Health England. Health Profile for England 2021.
  5. NHS England. The NHS Long Term Plan. 2025.

 

 

Introducing CVD Indicators

 

 

 

 

 

Interface can support practices navigate changes to QOF CVD indicators, to drive QOF income and cardiovascular care for your patients 

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