Contemporary Themes in Healthcare: An Analysis of CHD Management in the UK

This essay analyzes six journal articles on the incidence and management of coronary heart disease (CHD) in the UK, and outlines key recommendations for healthcare system of UK in the reduction of the incidence of this disease. The articles cover topics such as prevalence of CHD, healthcare delivery models, policies for prevention of CVD, cost-effectiveness of prevention programs, and tobacco control strategies. The essay also discusses the limitations of the medical model for CHD treatment and the advantages of using the social model for care.

Running head: Contemporary themes in healthcare
Contemporary Themes in Healthcare
Name of the Student
Name of the University
Author Note

1Contemporary themes in healthcare
Six articles selected for the essay:
Journal References:
Article 1 Bhatnagar, P., Wickramasinghe, K., Williams, J., Rayner, M., and
Townsend, N. 2015. The epidemiology of cardiovascular
disease in the UK 2014. Heart, 101(15), 1182-1189.
Article 2 Bernard, S., Lux, L., and Lohr, K. 2009. Healthcare delivery
models for prevention of cardiovascular disease (CVD). The
Health Foundation, London.
Article 3 Levy, L., and Tedstone, A. 2017, February. UK Dietary Policy for
the Prevention of Cardiovascular Disease. In Healthcare(Vol. 5, No.
1, p. 9). Multidisciplinary Digital Publishing Institute.
Article 4 Collins, M., Mason, H., O’Flaherty, M., Guzman-Castillo, M.,
Critchley, J., and Capewell, S. 2014. An economic evaluation of salt
reduction policies to reduce coronary heart disease in England: a
policy modeling study. Value in Health, 17(5), 517-524.
Article 5 Barton, P., Andronis, L., Briggs, A., McPherson, K., and Capewell,
S. 2011. Effectiveness and cost effectiveness of cardiovascular
disease prevention in whole populations: modelling study. BMJ, 343,
d4044.
Article 6 Allen, K., Kypridemos, C., Hyseni, L., Gilmore, A. B., Diggle, P.,
Whitehead, M., ... and O’Flaherty, M. 2016. The effects of
maximizing the UK’s tobacco control score on inequalities in
smoking prevalence and premature coronary heart disease mortality:
a modelling study. BMC public health, 16(1), 292.

2Contemporary themes in healthcare
Introduction:
There is an increasing trend in the global rates of morbidity and mortality due to
cardiovascular diseases (CVD). This disease is considered as the leading contributors of
mortality rates all over the world. A review of the statistics on mortality due to CVD (as of
2015) shows that 17.7 million people have died because of this condition alone, which
amounts to about 31% of the total mortality rates in the global scale. CVD is an ‘umbrella
term’ which includes different types of cardiac diseases as well as coronary diseases which
are the most significant types of CVD. According to the World Health Organization,
Coronary and cardiac disease is responsible for approximately 7.4 million cases of mortality
as of 2015 (World Health Organization 2015). From this data, it can therefore be implied that
coronary heart disease (CHD) is a significant contributor to the global mortality rates. In the
UK, more than 25% of all mortality cases are due to CVD, while about 7 million others are
living with this disease in the UK. CHD is responsible for the highest number of death,
among all cardiovascular diseases (Bhf.org.uk. 2016). Keeping in mind such a high incidence
and health burden of this disease in the UK, the objective of the study is to analyze six
journal articles which study the incidence and management of CHD in the UK, and
understand how the disease can be managed. The paper also aims to study the frameworks,
policies as well as interventions which can be used to alleviate the risks associated with these
diseases. Based on these aspects, the paper will also outline key recommendations for
healthcare system of UK in the reduction of the incidence of this disease.
Discussion:
In order to develop a comprehension on the various management approaches,
frameworks and models applicable for UK, that are aimed to manage coronary heart diseases,

3Contemporary themes in healthcare
selection of 6 journal articles was done. This section provides the summary of these selected
articles, which will be discussed below:
Article 1 by Bhatnagar et al. (2015) studies the prevalence of CHD in the UK. The
article gives up to date statistical data on the rates of mortality, as well as the prevalence and
healthcare expenses associated with the disease in the UK. The article shows that CHD is the
most prevalent in Scotland and North England. The regional variations of these data are also
highlighted in the study. Article 2 by Bernard, Lux and Lohr (2009) analyses the different
themes associated with the delivery of healthcare in the UK, highlighting the management of
cardiac diseases like CHD. The care delivery models of CVD are summarized in the article,
outlining the preventative and palliative care and provide key insights into the care for CVD
and its prevention in a primary care setup in the UK. This was useful to understand the
preventative and primary care approaches, which was helpful to understand unknown cases
of CHD.
In the context of policies of the government aimed at the management of CHD risk
factors, two articles were identified that covered details of policies on the prevention of
cardiac diseases. In article 3 by Levy and Tedstone (2017), the authors analyses the themes
on dietary policies in the UK, aimed at the prevention of cardiac diseases. The article covers
key policy aspects in relation to the intake of energy, dietary salts, vegetable and fruits, as
well as saturated fats, oily fishes and dietary fiber required by the citizen to prevent or reduce
the risk of cardiac disease. The eat well guide is used to integrate the advices on healthy diet,
to help people understand how cardiovascular health can be improved through proper diet.
Article 4 by Collins et al. (2014) also discusses insights on policies aimed at the reduction of
salt intake to reduce the risks of CHD in England. This article helps to understand how
policies on heart diseases are designed in the UK through the analysis of cost effectiveness,
uncertainty and sensitivities of the different preventative strategies.

4Contemporary themes in healthcare
Information regarding the cost affectivity of the programs aimed to reduce the
population wide risk factors of the disease in England has been outlined by Barton et al.
(2011). The primary theoretical framework used in the study was the generic economic
model, which was used to decide how specific programs for the reduction of the risk factors
can help to lower the incidence of cardiac disease. It was also found that smoking was a
significant risk factor of CHD. Article 6 by Allen et al. (2016) studied how health inequalities
due to the prevalence of smoking and premature death because of coronary heart disease can
be reduced through tobacco control strategies. This helped to understand the merits of the
tobacco control policies in the reduction of the risks of this disease.
Therefore, it is vital to analyze the theories as well as the management strategies
outlined the selected articles. Article 1 gives information on the 2014 CVD statistics (19th
edition). Details on the morbidity, mortality and healthcare expense are used to determine the
burden of the disease in the UK. Data on the death rates due to the disease also showed that
since 2012, there had been some reduction in mortality rates due to CVD, as it fell from being
the first contributor of the rates of mortality to become the second most contributor towards
that effect (Bhatnager et al. 2015). The report also highlighted of gender based health
inequalities, as the rates of mortality due to CVD was found to be higher among women
compared to men. A higher rate of mortality due to CVD in North England (compared to
South) also showed a regional variation in the health inequality as well. Such aspects helped
to develop an understanding on the health inequalities. The article however did not cover how
health equity can be advanced and health disparities eliminated through effective leadership
in healthcare.
Graci and Ruffin (2014) highlighted that some agencies can foster leadership as well
as coordination in healthcare and help to reduce disparities in health. Effective leaderships in
public health can be a key aspect that can help to address these inequalities. In this context,

5Contemporary themes in healthcare
it’s possible to address the health inequalities though the theoretical approach of
transformational leadership. According to this theory, transformational leaders can use the
approach of bringing about a change in the individuals and social systems, and act as
inspiration and visionary to others (Banks et al. 2016). According to Koh and Nowinski
(2010), health equity objectives at the levels of community can be translated by a health
leader, and their presence can help to address the social determinants that affect the incidence
of the disease as well as foster equality in health in their regions. Developing gender
responsive health programs can also be strategic to address the gender based health
inequalities of CVD or CHD (World Health Organization 2015). Using such data, it can be
assumed that preventative strategies for CVD in the UK should address the different social
determinants of health and disparities in health seen in the UK.
Article 2 by Bernard, Lux and Lohr (2009) investigated care and preventative
strategies for CVD in the primary healthcare setup. In comparison to article 1, the article 2
analyzed the model for healthcare delivery for CVD. From article 1, the gender based
inequalities in the prevalence of the disease were understood, while from article 2, the
limitations of the screening processes for the disease can be outlined. A detailed
understanding of the different models of health delivery for CVD was provided in the article.
A significant limitation of the article was that sufficient evidence was not given to support the
interventions on exercise and diet in the healthcare delivery models of the UK. The authors
also pointed out that risk screening can be conducted well by general physicians, while issues
on time constraints indicated the need for training the allied health professionals in the
screening and assessment of the risks for CVD. As per Ryley and Middleton (2016), it is
important that healthcare professionals be empowered so as to help them to act as leaders for
change (transformational leadership) and thus help to improve the screening process,
especially in areas unobserved.

6Contemporary themes in healthcare
The health delivery model in the UK is primarily based on the medical model.
However, it must be pointed out that the bio-psychosocial model is also an important aspect
that should be a component of preventative strategies and in the improvisation of
participation in the preventative measures, as it can also help to empower the vulnerable
groups and foster improvement of their health. This implicates the Marmot Review which
suggested the development of sustainable places and ensuring health living standards for
everyone. This shows that focus should be given to both the prevention of t5he disease as
well as empowering the patients to regain control over their own lives and well being
(Goldblatt 2016). Such understanding on the limitations of the medical model for CHD
treatment and the advantages of using the social model for care can be utilized to successfully
implement the social model into programs aimed towards the prevention of the disease. This
is relevant to the Ottawa Charter that helps to develop a supportive environment and re-
orientation of the health services as vital aspects of the charter (Gagné and Lapalme 2017).
Strategies like healthy diet programs in schools and incorporating the importance of healthy
lifestyle among children can be effective ways to foster a supportive environment for the
citizens of the UK in the future. Additionally, including counselors and diet experts in the
promotional programs in schools for females can also help to re-orient the health services.
Article 3 by Levy and Tedstone (2017) provided information regarding the dietary
policies in the UK related to the prevention of CVD. The policies mainly give focus on the
control on the intake of dietary sugar and fiber. Recommendations of the UK government are
to take actions to limit the quantity of sugar sweetened beverages and consumption of sugar
among young people and children. The policies also recommended actions to improve the
intake of dietary fiber, which has strong associations with lowering the risks of heart
diseases. Therefore, it gives important considerations about changes in the diet for the
citizens of UK. It is however important to understand that encouraging people to follow such

7Contemporary themes in healthcare
a dietary recommendation is a challenging work for the government. In such context, it might
be helpful to target key stakeholders in the food industry, so that sufficient and proper
information regarding the nutrient value of the food are available to public and control in the
levels of salt and sugar in food is implemented in order to improve the public health
(Christoforou et al. 2016).
The article outlines that up to 4147 premature deaths can be averted through a
reduction of 1g in the intake of salt, and thus helps to reduce healthcare costs for the NHS in
UK. This sufficiently suggests that modifications in the diet as well as lifestyle can be made
more intense especially for individuals at high risk of the disease, since hypertension and
dietary salt intake is significantly related to the risk for CVD (Klaus, Hoyer and Middeke
2010). Government of UK has also involved food manufacturing companies to implement
campaigns in salt awareness and control of the intake of dietary salt in order to reduce the
risks of CHD. Such strategy provides crucial aspect that key stakeholders play an important
part to achieve the objective of preventing CHD. Since, the food industry can play I pivotal
role in fostering dietary modifications of the public, identification as well as management of
the actions of the key stakeholders can be a useful way to implement the change
(Christoforou 2016).
Article 4 by Collins et al. (2014) primarily focuses on the economic evaluation of the
policies aimed to reduce salt intake for CHD reduction in England. IN the UK, CHD is the
most common type of CVD, and high levels of intake of dietary salt is a significant
contributor towards the prevalence of CHD, as it increases blood pressure (Ettehad et al.,
2016). Modelling techniques were utilized to understand the effect of lowering the intake of
dietary salt on the cardiac health of individuals from England. Health promotion policies such
as Change4life, Health weight, Healthy lives strategy were the main aspects that helped to
implement the policies for reducing dietary salt intake. Such campaigns used advertising and

8Contemporary themes in healthcare
media in order to encourage the people to lead a healthier lifestyle and adopt healthy choice
for food. This study showed that campaigns by the media can be effective to bring about a
change in health behavior of the consumers, and also provides support to the food
manufacturing industry in the UK to make necessary changes in the packaging of food and
labeling them appropriately, such that the people are aware of the nutrient content of the food
they eat. Such policies can help to reduce the risk factors of CHD in the UK. Therefore, the
study by Collins et al. (2014) outlined the role of modeling technique to analyze the policies
of the government in context of changing the labeling and manufacturing of the food. In the
study, the authors used the IMPACT CHT model that is significant in the objective of the
study. These approaches can be effective to co9mprehend the different preventative measures
that can be used for CHD prevention.
Action of the government to utilize reduction of salt intake in important strategy for
management of cardiac diseases, since through lifestyle modifications, and the availability of
packaged food or increased consumption of salt can increase the risk factors of the disease
(Trieu et al. 2015). Therefore, with the availability of sufficient evidence on the effectiveness
of maintaining the dietary intake on the health of individuals, multiple interventions can be
implemented such as reformulating food items, proper food labeling and using campaigns on
media to raise awareness and reduce intake of dietary salts can be used by the UK
government to alleviate the future risks of CVD (Hyseni et al. 2017). Such strategies can be
effective especially since the intake of salt can be limited with these methods and therefore
reduce the risks of conditions like hypertension. It is however important to understand that
such will be a long process, and rapid success might not be achieved by this. Hence, patience
is an important virtue to get the desired result.
Article 5 uses the economic modeling strategy for the assessment of the cost
affectivity as well as the risk factors for CVD in Wales and England. Typical economic

9Contemporary themes in healthcare
model was developed for two situations: first regarding the lowering of blood pressure and
second regarding legislative frameworks that reduce salt and fat intake (Barton et al., 2011).
The generic model provides certain advantages like is offers method to understand cases of
CVD which were averted. This model is also useful to analyze the cost effectiveness of NHS
and improvement in the life expectancy or quality adjusted life years (QALY). The individual
benefit and accumulated benefit were also analyzed in the study. Sheffield prevention model
was used for performing the cost analysis. The model provides a deterministic and casual
model which can be used to study the econometric aspects and epidemiological aspects
(Katikireddi, Hilton and Bond 2016). Such techniques used for the study showed a lowering
of the risks of CVD by 1%, which can help to prevent 25000 new cases of CVD and even
avert 3500 deaths. This also implies an effective savings in healthcare costs by UK Pound 26
million. Barton et al. (2011) pointed out that such strategies can allow saving of up to 30
million pounds for a 10 year program.
For specific interventions, it was shown by Barton et al. (2011) that reduction of salt
intake by 3g per day (through salt intake policies), reduction of systolic blood pressure by
2.5mm Hg can be achieved. Furthermore, legislations on the ban of industrial fats showed
lowering of the energy intake by 0.5%, which further reduced mortality rates by 5%.
Therefore the study showed that even with the reduction of the risk of CVD by 1% can help
to make substantial cost savings on healthcare for the NHS (Barton et al. 2011). It can also be
suggested that the spreadsheet model for estimation of costs helped to develop a transparent
model for the estimation of expenses and thus help the UK government to track the progress
in CHD outcomes when such interventions are implemented at local levels. Including such a
model in the preventative strategies can be useful to produce changes in the right area and
learn the effect of the intervention on the health of the population. Such will also help to
produce a path towards a responsible regulation which fosters efficacy of healthcare

10Contemporary themes in healthcare
programs that are aimed to reduce the presence of CHD and CVD in the UK. Such an
approach also resonates creative and regulatory approaches which support the authorities to
address their key responsibilities on public health and wellbeing and help to improve actions
of the food industry towards the maintenance of public health (Magnusson and Reeve 2015).
Article 6 gives information on the management approaches which are needed to
prevent this chronic condition. It analyses the effect of the control of tobacco score on the
prevalence of smoking and premature death due to CHD. The model is responsive towards a
significant improvement in the policies on tobacco control which led to the reduction of the
health inequalities among the people in England (Allen et al. 2016). Such as aspect is vital
since smoking of tobacco is considered as a significant risk factor for CHD. Analysis of other
cohort based studies additionally supports the same relation between smoking and CHD. The
impact of smoking can also be highlighted by the fact that it increases the risks of mortality
by two fold, compared to non-smokers. However, such risks were found to be reduced
through interventions that aimed to reduce the dose of smoking (Mons et al. 2015). It can
therefore be understood that preventative strategies in this area will also help to reduce the
risks among older populations. Such strategy can be relevant to the theory of reasoned
actions, which states that the health behavior of a person can be affected by their attitudes
towards the behavior, and cessation programs should focus on changing the attitudes towards
smoking, with the knowledge of the potential health risks caused due to it (Montano and
Kasprzyk 2015).
From the 6 articles, it was evident that many deficits were outlined in the management
practices on CHD in the UK. The government of UK has recommended to priorities certain
actions for the future consideration. 1) Reduce the gender based health inequalities and
developing responsive management for CVD for women. 2) While implementing policies for
CHD prevention, going beyond patients with the diagnosis and focusing on the population

11Contemporary themes in healthcare
who are at risk of the disease in the future should be considered. 3) Health policies should
focus to evaluate the effectiveness and efficacy of the care program using the evidence based
approach which favors cost analysis as well as evaluation of the effectiveness of cost
associated with the care practice.
Conclusion:
The study shows an overview into the analysis of managerial practices for CHD in the
UK, though the analysis of 6 articles on the prevention of CHD and CVD. These articles
covered several vital aspects like the rate of prevalence, policies on the reduction of risks,
policies on diet, intake of salt and health model policies. The studies highlighted challenges
associated with health inequalities lack of vision in designing the program and a lack of
evidence about the affectivity of the interventions. The articles also gave vital insight into the
utilization of various models and frameworks in guiding the preventative policies. Based on
such information, it is possible to learn valuable sessions from such practices to inform and
develop a more effective approach to reduce the risks of CVD in the UK.

12Contemporary themes in healthcare
References:
Allen, K., Kypridemos, C., Hyseni, L., Gilmore, A. B., Diggle, P., Whitehead, M., ... and
O’Flaherty, M. 2016. The effects of maximizing the UK’s tobacco control score on
inequalities in smoking prevalence and premature coronary heart disease mortality: a
modelling study. BMC public health, 16(1), 292.
Banks, G.C., McCauley, K.D., Gardner, W.L. and Guler, C.E., 2016. A meta-analytic review
of authentic and transformational leadership: A test for redundancy. TheLeadership
Quarterly, 27(4), pp.634-652.
Barton, P., Andronis, L., Briggs, A., McPherson, K., and Capewell, S. 2011. Effectiveness
and cost effectiveness of cardiovascular disease prevention in whole populations: modelling
study. BMJ, 343, d4044.
Bernard, S., Lux, L., and Lohr, K. 2009. Healthcare delivery models for prevention of
cardiovascular disease (CVD). The Health Foundation, London.
Bhatnagar, P., Wickramasinghe, K., Williams, J., Rayner, M., and Townsend, N. 2015. The
epidemiology of cardiovascular disease in the UK 2014. Heart, 101(15), 1182-1189.
Bhf.org.uk. 2016 Heart statistics. Retrieved 3 March 2018, from
https://www.bhf.org.uk/research/heart-statistics
Christoforou, A., Trieu, K., Land, M.A., Bolam, B. and Webster, J., 2016. State-level and
community-level salt reduction initiatives: a systematic review of global programmes and
their impact. J Epidemiol Community Health, 70(11), pp.1140-1150.

13Contemporary themes in healthcare
Collins, M., Mason, H., O’Flaherty, M., Guzman-Castillo, M., Critchley, J., and Capewell, S.
2014. An economic evaluation of salt reduction policies to reduce coronary heart disease in
England: a policy modeling study. Value in Health, 17(5), 517-524.
Ettehad, D., Emdin, C.A., Kiran, A., Anderson, S.G., Callender, T., Emberson, J., Chalmers,
J., Rodgers, A. and Rahimi, K., 2016. Blood pressure lowering for prevention of
cardiovascular disease and death: a systematic review and meta-analysis. The
Lancet, 387(10022), pp.957-967.
Gagné, T. and Lapalme, J., 2017. 1986: Ottawa and onwards. The Lancet Public Health, 2(2),
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Goldblatt, P.O., 2016. Moving forward monitoring of the social determinants of health in a
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Hyseni, L., Elliot-Green, A., Lloyd-Williams, F., Kypridemos, C., O’Flaherty, M., McGill,
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14Contemporary themes in healthcare
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