Extending the IMPACT coronary heart disease model to different policy contexts

Lead Research Organisation: University of Liverpool
Department Name: Population Community and Behavioural Sci

Abstract

Coronary heart disease (CHD) remains a top policy priority in the UK, and elsewhere.

In Britain, almost three million people suffer from CHD, and over 110,000 die every year. Nearly half these deaths are premature. Worse still, premature CHD is THREE times more common in deprived communities, making CHD an important cause of health inequalities.

The good news is that firstly, 90% of premature CHD is PREVENTABLE. Secondly, CHD death rates in Britain have halved in the last two decades. But why has this decline happened, and can things improve further?

We have investigated this important subject using a computer-based statistical model called IMPACT. We found that about 40% of the recent fall in CHD deaths was due to medical treatments and about 60% to people stopping smoking and eating healthier food.

Our IMPACT model has now helped to explain CHD trends in a variety of populations including England and Wales, Scotland, Ireland, Finland, New Zealand, and China.

IMPACT is the only CHD policy model that has been convincingly calibrated for the UK population of 60 million. It is comprehensive, covering all the important groups of CHD patients, all the standard treatments and all the major risk factors such as smoking, exercise and obesity. Our results have been reassuringly consistent with other studies in different countries.

However, our current model is complicated to use. It is only appreciated by a small number of researchers. The people making decisions in the NHS and in the Department of Health would obviously like a more ?user friendly? version of the model.

We are therefore requesting funding to work with decision-makers at national and local levels; obtain their views and suggestions, discover how they interact with the model, revise the model, then let them test it out again, before making further improvements.

This new, improved IMPACT model would be more efficient and user friendly; a decision support system to help answer different questions about reducing heart disease. For instance, deciding which future health programmes are likely to be most successful (and best value for money). For instance, comparing the advantages and costs of new treatments (like defibrillators) and new ideas for prevention (like smoke free restaurants or healthier school meals).

Creating a web-based version of the improved model would then enable us to share it with people trying to control epidemics of heart disease in other countries.

Technical Summary

Coronary heart disease (CHD) remains a top policy priority in the UK, and elsewhere. Almost three million Britons suffer from CHD, and over 110,000 die each year - many prematurely. Furthermore, premature CHD is THREE times more common in deprived communities, representing an important cause of health inequalities.

We investigated this issue using a computer-based statistical model called IMPACT. Approximately 40% of the recent, substantial fall in UK CHD deaths was due to medical treatments, and 60% to risk factor improvements, particularly smoking.

IMPACT is the only comprehensive CHD policy model that has been convincingly calibrated for the UK population. It is truly comprehensive, including all patient groups, all standard treatments and all major risk factors. Conceptually simple, but methodologically sophisticated, all assumptions are explicit, transparent, and subjected to rigorous sensitivity analyses.

Published model outputs include deaths postponed, life-years-gained, and cost effectiveness of different interventions. Policy issues explored include the potential benefits from (surprisingly small) decreases in particular risk factors versus increases in specific treatments.

Our IMPACT model has helped to explain CHD trends in diverse populations including England and Wales, Scotland, Ireland, Finland, New Zealand, and China. Our findings have been reassuringly consistent with other studies using contrasting methods in different countries.

However, the current IMPACT Model is complicated to use. Decision makers in the NHS and policy makers in the UK Department of Health and elsewhere would prefer a more ?user friendly? version. One that could answer different questions about reducing CHD. For instance, comparing the advantages and costs of new treatments (like defibrillators or rimonabant) and new prevention approaches (for instance, smoke free restaurants or healthier school meals).

AIM
We therefore wish to extend the IMPACT CHD Model, in order to maximise its value to policy makers and decision makers.


OBJECTIVES

EXTEND THE IMPACT MODEL BY
1. Undertaking further refinements and incorporating diverse methods and approaches;
2. Creating additional epidemiological outputs (including population-based rates for mortality,
hospital admissions, need for revascularisation, changes in life-expectancy, population impact number, quality of life, cost effectiveness etc);
3. Using simulation to improve the precision of the estimates and explore the uncertainty;


4. MAXIMISE THE MODEL?S POLICY VALUE BY
Working with policy makers and decision makers to
i) Create a user-friendly interface for the model,
ii) Offer a range of different populations to examine at national, regional and local levels, and
iii) Be able to address current and future policy issues.

Publications

10 25 50

publication icon
Bennett K (2009) Cost-effectiveness of treatments reducing coronary heart disease mortality in Ireland, 2000 to 2010. in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

publication icon
Capewell S (2008) Maximising secondary prevention therapies in patients with coronary heart disease. in Heart (British Cardiac Society)

publication icon
Capewell S (2008) What explains declining coronary mortality? Lessons and warnings. in Heart (British Cardiac Society)

publication icon
Capewell S (2009) Trends in cardiovascular disease: are we winning the war? in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

 
Description BHF Prevention & Care Committee
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact Potentially Influential
 
Description Chair of UK Faculty of Public Health Cardiovascular Health Committee
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact Occasionally positive
 
Description Future of Cardiac Services Project Reference Group
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact This project is reviewing the National Service Framework for Coronary Heart Disease, and planning services for subsequent years. The Future of Cardiac Services Project Reference Group is cahired by Prof Roger Boyle, the National Clinical Director for Heart Disease and Stroke.
 
Description Marie Curie Training Courses in 2007 and 2008
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Impact Many of these researchers have now involved senior colleagues in relevant activities around CVD epidemiology, modelling & prevention
 
Description Member, European Society of Cardiology Sub-Committee on Prevention
Geographic Reach Europe 
Policy Influence Type Participation in a advisory committee
Impact Potentally large.
 
Description Trustee & Board Member, National Heart Forum
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
Impact Occasionally substantial
 
Description Vice Chair, NICE Programme Development Group: CVD prevention in populations
Geographic Reach National 
Policy Influence Type Membership of a guideline committee
Impact Ongoing. Potentially substantial.
 
Description British Heart Foundation & Cardio Vascular Coalition
Amount £60,000 (GBP)
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2008 
End 03/2009
 
Description European Commission PHEA: "DYNAMO HIA" DYNAmic MOdel for Health Impact Assesment (1.2m euros across 25 participants)
Amount £39,360 (GBP)
Organisation European Commission 
Sector Public
Country European Union (EU)
Start 04/2007 
End 03/2010
 
Description European Commission PHEA: "MedCHAMPS" Mediterranean Studies of Cardiovascular disease and Hyperglycaemia: Analytical Modelling of Population Socio-economic transitions (3m euros across 9 participants)
Amount £246,306 (GBP)
Funding ID 223075 
Organisation European Commission 
Sector Public
Country European Union (EU)
Start 04/2009 
End 03/2012
 
Description Liverpool Primary Care Trust: "MerseyBEAT"
Amount £2,000,000 (GBP)
Organisation Liverpool Primary Care Trust (PCT) 
Sector Public
Country United Kingdom
Start 04/2009 
End 03/2012
 
Description MerseyBEAT: "CVD Policy project"
Amount £50,000 (GBP)
Organisation Liverpool Primary Care Trust (PCT) 
Sector Public
Country United Kingdom
Start 04/2009 
End 03/2010
 
Description NPRI
Amount £130,700 (GBP)
Organisation Medical Research Council (MRC) 
Sector Academic/University
Country United Kingdom
Start 04/2006 
End 03/2008
 
Description National Prevention Research Initiative (NPRI): Gabbay
Amount £242,900 (GBP)
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2006 
End 03/2010
 
Description National Prevention Research Initiative (NPRI3): Prevention IMPACT
Amount £500,000 (GBP)
Organisation British Heart Foundation (BHF) 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2010 
End 03/2013
 
Title IMPACT CHD Policy Model 
Description The IMPACT CHD Policy Model is a large EXCEL spreadsheet. This permits synthesis of diverse population data to explain past trends in CHD mortality, and compare future policy options, such as increasing tretaments, or decreasing specific risk factors like smoking. 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2007 
Provided To Others? Yes  
Impact Ongoing, continuous development since 1996. This was much enhanced by MRC funding from 2006 onwards. Projects completed or ongoing include: USA, Canada, Sweden, Italy, Ireland, Spain, Poland, Czech Republic, & Portugal. 
 
Title IMPACT SEC 
Description A development of the basic IMPACT CHD Policy model. This splits the UK data into five socio-economic quintiles 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2009 
Provided To Others? Yes  
Impact Internal presentations to SEC Steering Group. Abstracts submitted for EuroPrevent 2010 conference. Manuscript writing and publication timetable agreed. 
 
Title IMPACT2/CLAHRC CVD Policy Model 
Description The IMPACT2 CVD Policy Model. It is a large discrete event simulation [DES] model, hosted on a server, and provided as a user-friendly facility on a website. It permits synthesis of diverse population data to explain past trends in CHD mortality, and quantify treatment benefits in specific patient groups. Ongoing work is addressing: trends in population risk factors, future trends and projections, and contrasting policy options. 
Type Of Material Model of mechanisms or symptoms - human 
Provided To Others? No  
Impact Ongoing 
 
Title MedCHAMPS CVD policy models 
Description Our MedCHAMPS CVD policy models identify, access, appraise and use the [limited ] local data from middle income countries to explain current trends, and make future projections for diabetes, stroke and CVD 
Type Of Material Model of mechanisms or symptoms - human 
Provided To Others? No  
Impact Ongoing 
 
Description CLAHRC/IMPACT 
Organisation University of Manchester
Department Faculty of Life Sciences
Country United Kingdom 
Sector Academic/University 
PI Contribution Dr Martin O'Flaherty and I lead the cardiovascular modelling component of this research, based in Manchester University [Prof Iain Buchan & colleagues]
Collaborator Contribution Close and extensive partnership working
Impact Prof Buchan's research is extensively funded by ESRC, NIHR and other agencies. Some £2.9 million comes from the NIHR CLAHRC scheme.
Start Year 2007
 
Description EuroHeart 2 
Organisation European Heart Network EHN
Country Belgium 
Sector Charity/Non Profit 
PI Contribution Major role in developing and finalising EU bid [now successful].
Collaborator Contribution Strengthened and extended a European network collaborating on policy improvements in food and tobacco [heart health]Effective policy collaborations
Impact Funding of 1.3 million Euros. Project will run over three years 2011-2014
Start Year 2010
 
Description EuroHeart 2 
Organisation European Society of Cardiology (ESC)
Country European Union (EU) 
Sector Charity/Non Profit 
PI Contribution Major role in developing and finalising EU bid [now successful].
Collaborator Contribution Strengthened and extended a European network collaborating on policy improvements in food and tobacco [heart health]Effective policy collaborations
Impact Funding of 1.3 million Euros. Project will run over three years 2011-2014
Start Year 2010
 
Description MedCHAMPS 
Organisation Newcastle University
Department Institute of Health and Society
Country United Kingdom 
Sector Academic/University 
PI Contribution Expert input covering CVD epidemiology & modelling
Collaborator Contribution A strong stimulation partnership with colleagues in Newcastle, Manchester, Dublin, Syria, Tunisia, Palestine & Turkey
Impact No publications - however, can demonstrate a lot of process activity. This is summarised on the website: http://research.ncl.ac.uk/medchamps/ Therefore assume from this information no output?
Start Year 2007
 
Title IMPACT CHD and CVD Policy Models 
Description Validated methods for modelling trends in CHD and CVD in diverse populations, and then examining future policy options. 
IP Reference  
Protection Protection not required
Year Protection Granted 2007
Licensed Yes
Impact Successful replication in a wide variety of countries.
 
Description EuroPREVENT Conference. EACPR, ESC. Paris 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Talks on: Favourable cardiovascular risk profiles in the population Low risk: calculating the public health benefits. and • High risk strategies preventing CVD.

Abstract, led to published manuscripts in peer reviewed journals
Year(s) Of Engagement Activity 2008
 
Description EuroPREVENT Conference. EACPR, ESC. Stockholm 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Chairing & plenary talks

Abstracts which will lead to published manuscripts in peer reviewed journals
Year(s) Of Engagement Activity 2009
 
Description NICE Programme Development Group (PDG) on CVD Prevention in Populations 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact A series of presentations to the multi-disciplinary NICE PDG.
Key points fed through into the published guidance

NICE guidance published June 2010.
Major media coverage.
Widely quoted since
Year(s) Of Engagement Activity 2009,2010
URL https://www.nice.org.uk/guidance/PH25/documents/prevention-of-cardiovascular-disease-review-decision...
 
Description Seminar, Manchester University Primary Care Research 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? Yes
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact • Developing a web-based user-friendly decision support tool for NHS planners and policy makers. Case study: heart disease. NPCRCD National Primary Care Research & Development Centre. Manchester

Stimulate discussion
Year(s) Of Engagement Activity 2008
 
Description Sunday Times front page article on preventing heart disease 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Sunday Times front page article on preventing heart disease

Considerable media interest
Year(s) Of Engagement Activity 2008
 
Description UK Health Serves Research Network Autumn Meeting, Liverpool, (05 Nov 2008) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? Yes
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Title of day's conference: What is the impact of health services on population health? Case study: cardiovascular disease [CVD]; including talks on "Why study cardiovascular disease [CVD]?" and " overview of CVD treatments & Evidence Based Medicine"

50 participants registered for this conference.
Year(s) Of Engagement Activity 2008