X-PERT Blog: Introducing X-PERT Heart
Dr. Sean Wheatley, PhD – Research and Trainer in Public Health/17 October 2016
* NOTE: As with many things, plans change! Since this article was initially written (way back in 2016) a lot has happened here at X-PERT, with new programmes, numerous developments to existing ones, and many other new and/or improved tools and resources besides. As a result, progress on X-PERT Heart hasn’t been quite as quick as we had intended. That’s not to say this is no longer on the agenda, and we’ll keep you all up to date when there is any news. *
This blog post will be the first of (hopefully) many written by the team at X-PERT Health. The posts will be used as a means to provide useful information to patients, professionals and the general public about a variety of health related subjects. Future blog posts could be about anything health related: such as responses to big health related media stories, to provide some useful practical tips, or to highlight some interesting new research. Whatever the subject, we hope you find it interesting and informative. We’re always open to hear what you think about any of our posts (good or bad!); so if you have any feedback, or suggestions for future posts that you would find interesting, feel free to get in touch.
This first two blog posts (the seconds one is also available now, here) are about new programmes we have in the pipeline; X-PERT Heart (being led by me) and X-PERT Weight (being led by Matt Whitaker). There will also be two blogs published next week, looking at how research is sometimes misrepresented in the media and what you can look for to judge if this has happened, before we go to weekly editions from the week after. We hope you enjoy.
Why do we need X-PERT Heart?
According to the British Heart Foundation cardiovascular disease (CVD) is responsible for more than a quarter of deaths in the UK, nearly 160,000 every year; whilst over 7 million people are estimated to be living with CVD.1 Many millions more are at an increased risk of developing CVD, so it is very important that measures are taken to address this.
One method that can be effective for reducing many of the factors which can lead to CVD is lifestyle modification. Indeed, the primary prevention recommendation for people with, or at risk of, CVD is to discuss lifestyle modification.2 Unfortunately however GP’s, nurses and many other health professionals do not have the time or training to provide the guidance that would be required to give people the advice and support needed for this to be effective. As a result, a large number of people move straight to the secondary prevention stage: treatment with statins.
Although there is little debate regarding the efficacy of using statins in high risk patients there is some controversy regarding their use in people with lower, but still elevated, risk.3 In particular there are doubts regarding the possible side effects, and whether these are acceptable in relation to the observed benefits. Beyond this, the cost to the over-stretched and under-funded NHS of prescribing statins exceeded £150 million in England in 2015.4 Now I’m not about to wade into the raging debate around the pros and cons of this form of medication (there’s plenty of that available elsewhere if you’re interested!), but where there is a safer and cheaper alternative this would be beneficial for many individuals and for the NHS as a whole. Anywhere it is possible to avoid medication this is always likely to be better for the patient. Lifestyle modification can provide a safe and effective alternative to these drugs; and charities such as X-PERT Health are well positioned to provide the education and support to take some of the strain off the NHS.
Why are X-PERT Health the right people for the job?
X-PERT Health, as many of you reading this will be aware, currently offer several educational courses that have been shown to be effective in helping patients who have (or who are at risk of getting) diabetes. On the 28th September we celebrated the successes of our centres at our annual awards in Manchester, and released the results of our 2016 audit which demonstrated there have been (on average) meaningful improvements in glycaemic control, body weight, blood pressure and lipid outcomes for patients on our programmes (the full report is available here). A lot of the underlying risk factors leading to type 2 diabetes (as well as some of the markers which were improved through the diabetes programmes) are the same for CVD, so our successful (award winning!) programmes can provide a template to help people with CVD too.
The success of our diabetes prevention and management programmes has been achieved through patient-centred education, helping people to understand their condition and how the choices they make (about diet and exercise for example) can affect it. We don’t tell people what to do, but rather we provide the education that can help people to feel more empowered to make their own decisions about what measures they can take (we provide information on a variety of approaches); and which will best fit with their lifestyle and personal needs. One size definitely does not fit all! The X-PERT Heart and X-PERT Weight programmes are being developed based on these same principles.
How are we going about it?
In order to develop evidence based programmes (another important part of the X-PERT Health ethos) it is crucial to review the evidence available, including the most recent research, to inform any new content. For X-PERT Heart this will include reviewing evidence that will allow us to inform patients about which dietary approaches are most likely to reduce their CVD risk, which forms of activity might be most beneficial for them, and to consider which of the many risk markers that they may have had measured- such as blood pressure or different blood lipids/lipoproteins- are most important in relation to their long term health. We’ll also use reviews that have been published in peer-reviewed journals (after we’ve considered their quality, risk of bias, and relevance) and reviews that we’ve already completed for our other programmes (updating them where necessary).
Once we’ve reviewed the relevant evidence the findings will be used to help us develop new materials for the programmes. Parts of the current diabetes prevention and management programmes are also still relevant to people looking to reduce their risk of CVD, so will simply be adapted. When this is all done and the new educator manuals and patient handbooks are complete we’ll seek feedback from patients and professionals, and we’ll pilot the programme once any changes have been made.
We hope that this programmes can address the needs of people with increased CVD risk who are wanting to make some positive lifestyle changes but find it difficult to do so in the face of conflicting and confusing advice. We’ll be working hard to make these programmes clear and helpful, and we will keep you up to date with how we are getting on! We’ll also be seeking input and feedback from experts and patients at multiple stages of their development, so watch this space (or get in touch) if you would be interested in being part of this.
If you have any feedback, questions or suggestions then feel free to send me a message at email@example.com.
1. Townsend, N., Bhatnagar, P., Wilkins, E., Wickramasinghe, K. and Rayner, M. (2015). Cardiovascular Disease Statistics, 2015. British Heart Foundation: London.
2. National Institute for Health and Care Excellence. (2014). Cardiovascular disease: risk assessment and reduction, including lipid modification. (Accessible at NICE.org.uk/guidance/cg181).
3. Godlee, F. (2016). Statins: we need an independent review. BMJ, 354, i4992.
4. Health and Social Care Information Centre. (2016). Prescriptions Dispensed in the Community: England 2005-2015.