Evaluation of six articles related to coronary heart disease management in UK

Articles used for the essay:

Journal	References
1st Journal article	Allen, K., Kypridemos, C., Hyseni, L., Gilmore, A. B., Diggle, P., Whitehead, M., … and  O’Flaherty, M. 2016. The effects of maximising 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. Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper
2nd article	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.
3rd article	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.
4th article	Gemmell, I., Heller, R.F., Payne, K., Edwards, R., Roland, M. and Durrington, P., 2006. Potential population impact of the UK government strategy for reducing the burden of coronary heart disease in England: comparing primary and secondary prevention strategies. BMJ Quality & Safety, 15(5), pp.339-343.
5th article	Armstrong, M.E., Green, J., Reeves, G.K., Beral, V. and Cairns, B.J., 2015. Frequent physical activity may not reduce vascular disease risk as much as moderate activity: large prospective study of UK women. Circulation, pp.CIRCULATIONAHA-114.
6th article	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.

Cardiovascular diseases (CVD) are one of the leading causes of death worldwide. The prevalence of cardiovascular disease has been associated with many management challenges for the health care sector due to the high rate of mortality and morbidity associated with the diagnosis of the condition. The significance of the issue is understood from alarming 2015 global statistics that CVD represents 31% of all global deaths and out of this 7.4 million were caused by coronary heart disease (CHD) (World Health Organization, 2015).  CHD is a type of heart disease associated with narrowing of the coronary arteries and blood vessels that affects the supply of blood to the heart. It is the most common type of heart disease and one of the leading cause of death in UK. Nearly one in every seven men and one in every twelve women die from CHD in UK and the number of deaths annually is about 66,000 (Bhf.org.uk, 2016).  UK government is also dealing with the rise in deaths from CHD and the number of people living with the condition and implemented many intervention and preventive programs to reduce the rate of CHD. Due to such statistics on incidence of CHD in UK, it is necessary to evaluate preventive work done for CHD in UK by linking it with appropriate management theories, leadership framework and management of change. Hence, the main purpose of this essay is to identify and critically evaluate 6 articles related to the management of CHD in UK and then present recommendation for improving health care management practices targeting CVD.

The first article that covered the topic of management of CHD in UK includes the article by Allen et al. (2016) which focused on estimating the cumulative effect of tobacco control policies in UK on smoking prevalence and premature CHD related mortality. Six different types of policy were evaluated in the study and the IMPACT (International Model for Policy Analysis of Agricultural Commodities and Trade) Policy model was used to link changes associated with policies to smoking prevalence and CHD and with the use of this model, the study proved the efficacy of tobacco control policy on  reducing health inequalities in England. The focus on evaluating tobacco control policy is a significant step in this research because smoking greatly increases the risk of developing heart diseases like CHD and stroke. Smoking narrows the artery by build of fatty materials on its walls (Messner and Bernhard 2014). For this reason, smoking is always associated with coronary heart disease and preventive work also focuses on smoking cessation to reduce the prevalence of the disorder. In the last half century, smoking and CHD has been increasing in Britain in a similar fashion and recognizing this trend, UK government implemented many tobacco control policies (Stallones 2015).

Significance of the issue

Allen et al. (2016) evaluated smoking prevalence by comparison with seven domains of deprivation. In addition, status of UK tobacco control policies were also judged by comparison with data on price of cigarettes, smoke-free places, public information campaigns, advertising bans, health warning and treatment. Selection of all these areas was an effective approach as tobacco control policies has direct implications on these factors.  Allen et al. (2016) evaluated the strength of UK’S tobacco control policies by means of Tobacco Control Scale (TCS) score and revealed high TCS score for smoke free place, price, treatment and advertising bans. However, the weak areas included health warnings and public information campaigns thus indicating that UK government need to spend more on mass media campaigns and smoking cessation services that as significant impact on tobacco control. This health care management approach is related to the contingency approach as it states that while taking a decision, a manager must takes into account all aspects of situation and act on those areas that are the key to the situation at hand. Hence, in the context of CHD prevention, tobacco consumption is the main barrier to cardiovascular health and it increases the likelihood of risk factor of CHD. Therefore, the study gave indication that basic premise of contingency theory should be applied to strengthen tobacco control policies and reduce health inequality. Hackshaw et al. (2018) showed that even light smoking increases the risk of CHD, therefore this can be used as reference to create innovative and strong public health campaigns in the future.

The second article by Collins et al. (2014) gave idea about managing CHD by reducing consumption of salt. As high level of dietary salt intake is directly linked to hypertension and increases risk of cardiovascular events, the research mainly focused on quantifying and economically evaluating policies implemented in UK to reduce salt intake. This was done by means of IMPACT CHD model and the four policies that were evaluated in the study included Change4Life health promotion campaign, mandatory reformulation strategy, front of pack traffic light labeling to display salt content and Food Standards Agency. Hence, this study on focused risk reduction by controlling salt intake and focusing on this area was important because salt intake directly reduces blood pressure by 4/2 mm Hg and as risk of CHD increases with increase in blood pressure, dietary salt restriction is the most practicable form of primary prevention for CVD (Klaus, Hoyer and Middeke 2010).

Overview of CHD in the UK

Collins et al. (2014) mainly focused on evaluating the effectiveness of each policy by means of percentage reduction in dietary salt intake from UK baseline salt intake of 8.1g/d. It revealed that all policies were cost saving except mandatory reformulation which increased the manufacturing cost for the food industry. The study gave the implication that cost effectiveness is a necessary part of interventions related to CHD and targeting salt intake is an effective strategy to reduce health expenditure related to CHD. The preventive programs like Change4Life as mentioned in the study were successful as it focused on stakeholder analysis and identifying the food industry stakeholders who can play a role in the health management of CHD in UK. Targeting food manufactures is an effective step as it reduces the chances of high salt in processed food. Many non-governmental organizations also advocate for corporate action to reduce salt intake in food, however future policies should also focus in offering a strategy to food industry that is acceptable and feasible for them (Trevena et al. 2017). One of the significant challenges in the management practices related to salt intake is that health leaders find it difficult to convince regarding the changes in salt limits and packaging process. This can be improved by means of stricter legislation and constant monitoring of nutritional composition in processed food (Webster et al., 2014). The practices related to salt intake can also be improved by adapting relevant models for changes that can enhances the goals of healthy food for people in UK.

The Ottawa Charter for health promotion mentioned five priority action areas such as that of building healthy public policy, creating supportive environment, strengthening community action, developing personal skills, reorienting health services and moving into the future (Gagné and Lapalme 2017). The preventive practices presented in the second article also fulfilled one of the action areas of building healthy public policy by the focusing on identifying obstacle (high salt intake) that would acts as barrier in reducing prevalence of CHD in UK. The third article is also gives detail on dietary policy implemented in UK for the prevention of CVD, however in this study covers other aspects of diet too such as free sugars, energy intake, oily fish, fiber, vegetables and fruits. The articles explores in depth about the UK recommendation for prevention of heart disease and improving diet of the population (Levy and Tedstone 2017).

Evaluation of tobacco control policy

According to Levy and Tedstone (2017), the UK government reinforced the need to reduce sugar consumption, minimize consumption of dietary fibers, reduce salt intake and meet fruit and vegetable consumption to reduce risk of CHD. The diet recommendation was made easier by translating it into a food model visual so that public could easily follow a diet consistent with health. The food guide was revised and relaunched in the form of Eatwell Guide in 2016.  This resulted in longer and healthier lives for people. The change proposed is related to change management theory as it focused on developing a model that would make it easier for public to adapt to change. Brining behavioral change in consumer is critical to improve the quality and reduced mortality associated with CHD.  Even if dietary policies are implemented, they cannot be successful unless consumers are oriented towards the changes. Hence, health care leaders can adapt the transtheoretical model of behavioral change to find out how consumers are likely to accept and orient to dietary restriction policies. The model is an ideal integrative theory that can support leaders to understand and assess citizen’s readiness to act on a new behavior (Ahn et al. 2017).

The fourth article focused on evaluating the impact of UK government strategy for reducing CHD by comparing both primary and secondary prevention strategies. The preventive strategies were guided by the National Service Framework (NSF) for CHD and the uniqueness of the NSF framework is that it mainly emphasizes on health promotion activities. Secondly, population impact measures (PIMs) were also calculated to find out impact of prevention strategies on reducing prevalence of risk factors in the population. The analysis of primary prevention in England revealed that the program lead to reduction in smoking rate increase in moderate exercise level, increase in obesity and fruit and vegetable consumption. Secondly, in the area of secondary prevention, the data on the basis of eligibility for secondary prevention were recorded (Gemmell et al. 2006). The focus on analyzing the population of both primary and secondary prevention strategy is a commendable step as this would help to evaluate management practices implemented at community level to reduce risk of CVD (Ginter 2018). This would also help to evaluate the kind of leadership needed to realize the goals of the program and reach out to high risk individual in an easy manner. Leadership theory in the context of health management has been found to influence the activities of an organized group and take the right steps towards goal achievement (Eriksson et al. 2017).

Evaluation of policies to reduce salt intake

The review of the study results showed that primary prevention work is the most important factor that has the greatest impact on the population health as well as on improving the efficacy of secondary prevention strategy. For example, the study revealed that when cholesterol level is reduced below 6.5mmol/l, about 59, 680 CHD events are prevented (Gemmell et al. 2006). This in turn would improve levels of drug treatment for high risk individual. In addition, lifestyle intervention has also been found to reduce the rate of cardiovascular event. Other evidence also suggest that implementation of lifestyle-focused intervention by means of text messaging or other digital media results in modest improvement in cholesterol level and great improvement in cardiovascular disease risk factors (Chow et al. 2015). The outcome of the fourth research also propose that population approach is necessary in health promotion for a clinical challenges that reached such alarming level both in UK as well as globally. This is dependent not only on simple management strategies like lifestyle advice, but also based on ither wide range of strategies like effective public policy, health education and reorientation of policies towards primary prevention. Another advantage of the population approach is that it has potential to address all forms of health inequities among population groups too (Sallis, Owen and Fisher 2015).

The fifth article by Armstrong et al. (2015) is an important research study as it gives idea about the effectiveness of physical activity intervention on reducing risk of CHD. It was a prospective population based study done with UK women and the main purpose was to find out the effects of frequency and duration of physical activity on cardiovascular disease. Sedentary behavior highly increases the risk of CVD and other risk factors of CVD like obesity, hypertension and type 2 diabetes. According to the UK physical activity guidelines for adults, it is necessary for adults to engage in 150 minutes of moderate aerobic activity such as cycling every week, however changes in lifestyle pattern has made people physically inactive. Riding care and watching TV are two common sedentary behaviors in adults and a study done with such men has revealed that such activity greatly increases the risk of CVD mortality (Warren et al. 2010). Hence, physical activity or exercise interventions are best preventive approach to minimize the risk of CHD.

Armstrong et al. (2015) recruited and included 1.3 million women above 50 to 64 years in the Million Women Study and used survey method to ask questions on physical activity, lifestyle, health, anthropometry and socio-demographic factors. The survey questionnaires were resent to them after 3 years of recruitment to get information of volume of each activity. By means of statistical analysis of research data, the study showed that with increase in physical activity, there are a decrease in BMI and percentage of women treated for hypertension. Secondly, women who spent more hours in physical activity had lower mean BMI compared to physical activity. Hence, the evidence indicated that different types of physical activity are beneficial in reducing the rate of CHD. Physical activity diminishes risk factors of CHD by decreasing systemic inflammation, improving endothelial function and lipoprotein levels. This study has great implications for health management of CHD and the role of clinician is considered more important for incorporating physical activity in the life of people. Even 60 minutes of moderate exercise three times a week can play a role in decreasing cholesterol value and CVD risk factors (Dalibalta, Mirshafiei and Davison 2017). In the future, the clinicians need to adapt the leadership role by elucidating the optimal timing, duration and modality of physical activity and exercise training. They are in the best position to judge which type of physical activity are feasible and useful for different population group. They can use their leadership skills for integrated care, negotiation and team work (Nayor and Vasan 2015).

Evaluation of dietary policy implemented in UK

The above five articles mentioned about primary and secondary intervention, dietary policies and tobacco control policies implemented in UK to tackle CHD. However, the last article by Bhatnagar et al. (2015) gives an overview about the prevalence rate of CVD in UK. The mortality data and prevalence rate data were collected from the Office for National Statistics and the Clinical Practice Research Datalink (CPRD) GOLD database respectively. CVD was the main cause of death in the middle of the 20^th century, however in 2012 it became the second leading cause of death in UK. Regional variations in prevalence rate were found as CVD incidence was higher in Scotland and North England compared to South of England. This implies that health inequality was an issue in certain regions thus pointing out to the future role of leaders in driving positive change process. Transformational leadership theory states that leadership is an approach that causes change in individual and social system by redesigning perceptions and values of employees and organization (Northouse 2018). Hence, clinical leaders can address health disparities and inequalities related to CHD by translating health equity goals at community level. They can work to improve social determinants factors that significant impact on health and well-being of an individual (Koh and Nowinski 2010).  

The essay focused on evaluating heath management issue of CHD by looking at preventive strategies, government policies and prevalence rate of the condition UK. The review of six articles gave idea about current status in the management of risk factors of CVD and the way to tackle with the condition. The areas that have been covered in the articles include tobacco control policy, salt reduction policy, UK dietary policy, analysis of primary and secondary prevention strategy, physical activity intervention and prevalence rate of CVD. Each of these points out to the management strategies for reducing prevalence rate of CVD, however certain flaws have been found too. This section provides useful recommendation to improve policies or strategies that has been implemented so far to tackle the condition. The first article discussed about effect of tobacco control score on reducing inequalities in smoking prevalence and mortality rate and it showed that health gain can be maximized when health related inequalities are addressed (Allen et al. 2016). Hence, it is recommended that UK government should focus on framing a tobacco control policy that addresses inequity related to smoking.  Targeting social determinants will be a necessary step and local environment of citizens can be improves by strengthening social policies (Purcell, O’Rourke and Rivis, 2015).

Applications of management theories and frameworks in CHD prevention

The second and the third article discussed about salt reduction and dietary policy and its effectiveness in reducing CHD. They key recommendations from these evidences are that UK needs to take innovative steps to ensure that policies are feasible to be implemented both for consumers as well as other stakeholders. The last article related to the prevalence rate also pointed out to the role of gender difference in CHD prevalence rate. To address gender related biasness in prevalence rate, it is recommended that health promotion programs and CBD management program advocate for the health of women (Braveman 2014). Another important insight gained from review of policies was that success of policies needs to be promoted by focusing on cost effectiveness of care and their role in reducing health care cost and burden. To maximize the effectiveness of preventive work for CVD, it is also recommended that leaders adapt transformational style of leadership to encourage health care staffs to acquire skills to communicate and encourage healthy behavior in people.

In conclusion, it can be said that CHD is major public health burden and UK has taken many useful steps to reduce the risk factors of CHD. The review of six articles gave idea about preventive strategies, policies and interventions implemented in UK to reduce the rate of CHD. UK has comprehensive dietary policy and the review of methods used in research studies gives many important implications of health management of the condition. For instance, it could pave way for better cost analysis of policies and developing acceptable and feasible policies that can be easily implemented by food industry. Health behavioral changes has also been found a major determinant of well-being and by means of physical activity and exercise intervention, it is possible to address sedentary habits of adults decrease cases of hypertension and other illness that increase the risk of CHD. Constructive step towards change is possible if management practices are incorporated with appropriate theory and change management theories.

References:

Ahn, S.H., Kwon, J.S., Kim, K. and Kim, H.K., 2017. Stages of Behavioral Change for Reducing Sodium Intake in Korean Consumers: Comparison of Characteristics Based on Social Cognitive Theory. Nutrients, 9(8), p.808.

Allen, K., Kypridemos, C., Hyseni, L., Gilmore, A. B., Diggle, P., Whitehead, M., … and  O’Flaherty, M. 2016. The effects of maximising 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.

Challenges in CHD prevention

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.

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Chow, C.K., Redfern, J., Hillis, G.S., Thakkar, J., Santo, K., Hackett, M.L., Jan, S., Graves, N., de Keizer, L., Barry, T. and Bompoint, S., 2015. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial. Jama, 314(12), pp.1255-1263.

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.

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