Health Awareness
What is a
cardiac rehabilitation programme and who should attend?
Attending a cardiac rehabilitation programme is essential to recovery and will minimise the risk of future heart problems.
Cardiac rehabilitation programmes include education on behaviour change and healthier lifestyles, advice on risk factors and medicines and either supervised or home exercise sessions.
They are free NHS programmes, delivered by a team of healthcare professionals including cardiac nurses, physiotherapists, exercise professionals, occupational therapists and dieticians. Programmes usually run over two to three months but can be adapted to individual needs.
Cardiac rehabilitation programmes offer psychological support
Heart events can be traumatic and isolating. Therefore, psychological support is an essential part of the programme, with patients able to ask questions about their health concerns. After the programme, patients are encouraged to keep healthy and are advised on how to access appropriate self-funded services in the community.
Who can attend?
Traditionally, programmes were offered only to those who had a heart attack or surgery. Now, they also benefit individuals with heart failure or angina. Patients can be referred to a programme by their GP, or they can self-refer. However, most people are referred after a hospital stay by their consultant or healthcare team. Programmes should be inclusive and respectful of all protected characteristics including gender, age, ethnicity and disability.
Why should I attend?
Cardiac rehabilitation programmes include education sessions on numerous topics to give patients the confidence to make lifestyle changes and teach them the safest ways to exercise to improve heart health (both aerobic exercise and strength training). Importantly, attending will help reduce the risk of further heart problems or being readmitted to hospital.
Does it mean group exercise?
A good cardiac rehabilitation programme should be able to offer individualised options to suit each patient’s preferences and lifestyle. In-person group exercise is one available option, but many programmes also offer online options, including live classes with close monitoring and home-based programmes with regular check-ins. Additionally, web and app-based options are increasingly used. Completing a cardiac rehabilitation programme can improve quality of life and offer valuable support for recovery.
Cardiovascular Health
WRITTEN BY Heather Probert President, British
How AI tools are driving advances in heart care
By harnessing artificial intelligence (AI), research is breaking new ground, finding new ways to diagnose, treat and care for those with heart conditions.
Medical technology is rapidly evolving, and AI innovations continue to drive advances in risk stratification and the better detection and treatment of cardiovascular disease.
Two new research studies funded by the British Heart Foundation (BHF) have embraced the power of NHS data to generate AI algorithms that have the potential to improve care for heart patients.
AI to accelerate clinical decisions
The first study — led by Dario Sesia, a BHFsupported PhD student at Imperial College London — developed a new AI tool that could help tens of thousands avoid unnecessary hospital stays each year in the UK. In the study of over 33,000 UK patients, their AI tool — Rapid-RO — successfully ruled out heart attacks in over a third of patients.
Rapidly ruling out heart attacks in those attending A&E could have a huge impact, allowing people to be reassured and safely sent home from hospital. Promising technology like this could help accelerate clinical decision-making and help people avoid unnecessary hospital admissions, as well as allow valuable NHS time and resources to be redirected to where it could have the greatest benefit.
Identifying heart failure risk
Another study, led by Professor Chris Gale at the University of Leeds has used machine learning to spot people at risk of heart failure earlier.
The new tool — FIND-HF — identifies tell-tale patterns in individuals’ GP records to spot those at
highest risk of developing heart failure. The team found that FIND-HF could accurately predict who was at highest risk of developing heart failure and who would consequently be hospitalised in the next five years.
Over 1 million people in the UK are affected by heart failure. In the future, tools like this could be instrumental in helping spot some of the 200,000 new heart failure cases that are diagnosed every year in the UK. Earlier diagnosis could help many patients start treatments sooner — when heart failure symptoms can be managed more effectively and its progress can be slowed.
Advancing tools to mitigate heart diseases
Pioneering technologies funded by donations to the BHF have the potential to save and improve thousands of lives across the UK and globally. It’s only with funding that we can continue to drive forward new tools and treatments for heart and circulatory diseases, helping us achieve our mission to beat heartbreak forever.
Giving cardiac devices — and people — a second chance at life
We can make a lasting impact on the health and wellbeing of people in low and middle-income countries (LMIC) by recycling pacemakers, which are currently put into landfills.
Recycling explanted cardiac devices to countries where they would not otherwise have the opportunity to receive treatment for heart rhythm disorders can provide valuable medical support.
Inequity of life-saving cardiac technology
In the UK, cardiac implantable devices give approximately 68,000 individuals a second chance at life each year. Yet, when a device user dies, the device is buried with them, or if the deceased chooses to be cremated, it is discarded and goes to landfill.
Many times, a device has many years of battery life left and yet, it is a ‘throwaway.’ In stark contrast, in LMIC, around 2.5 million people die every year because they do not have enough money or access to a lifesaving cardiac device operation.
How cardiac devices can save a life, twice Arrhythmia Alliance Pace4Life (A-A P4L) is a charity that tackles this disparity head-on by donating cardiac devices to people in need in LMIC who otherwise would not be able to afford the lifesaving implant. The charity sources cardiac devices, identifies viable clinics in LMIC, sets up programmes at these clinics, trains local cardiac teams, organises pacing missions and provides ongoing online
Novel procedure provides tricuspid valve repair without surgery
New minimally invasive procedures can repair tricuspid valve regurgitation, a potentially serious heart condition — and avoid the need for open-heart surgery.
There’s a good reason why the tricuspid heart valve is known as ‘the forgotten valve’, notes Dr Robert Smith, consultant interventional cardiologist based at Royal Brompton and Harefield hospitals, part of Guy’s and St Thomas’ NHS Foundation Trust. “Traditionally, if the valve leaks or fails, little can be done to treat it,” he says.
Tricuspid valve regurgitation consequences
Despite being historically overlooked, the tricuspid valve is crucial to heart health. A leak of the valve — known as tricuspid valve regurgitation — is common. It’s thought to affect up to 5% of the population in the UK aged over 75 and may be due to various factors including age and atrial fibrillation (AF). “However, severe cases are associated with significant
support to those programmes. This is an opportunity that can protect our planet from harmful waste and provide lifesaving cardiac care to others.
Repurposing cardiac devices for impact
The key is connecting LMIC and higher-income countries (HIC) communities through the reuse and recycling of pacemakers and other cardiac devices once they are no longer needed. By gathering these life-saving devices from hospitals, funeral homes, crematoriums and mortuaries, this programme can make a real difference in the lives of those in need. The aim is to ensure that every cardiac device is given a second chance to bring hope and healing to those who need it most.
A-A P4L has created a system that allows the repurposing of explanted and end-of-shelf-life cardiac devices and equipment. By redirecting these items to a distribution centre, the used devices are collected by a re-processing company, cleaned, decontaminated, tested and re-packaged sterile. The devices can positively impact the lives of those in need while contributing to a sustainable future by avoiding landfill.
mortality,” warns Dr Smith. At an early stage, symptoms can be mild; but, as the condition worsens, patients may experience breathlessness, fatigue and swelling of the ankles and legs and, rarely, the abdomen. While diuretic medication may alleviate some symptoms, only reparative surgery can properly restore valve function. As this involves open heart surgery, it’s usually only performed while the patient is having an operation for another heart condition.
Two types of low-risk non-surgical intervention
A minimally invasive non-surgical treatment is now being used at a small number of hospitals globally, including Royal Brompton and Harefield hospitals. This could be a game-changer for patients with tricuspid valve regurgitation,
particularly those who are too high-risk for open-heart tricuspid valve repair because they are older, have additional health issues or have advanced heart failure.
The procedure is performed with a catheter — a tube-like device, which delivers direct treatment to the heart via a small incision in the groin.
“There are two treatments available to patients,” explains Dr Smith.
“The first is transcatheter edgeto-edge repair (TEER) where a clip is used to reduce the leak. The second is transcatheter tricuspid valve replacement (TTVR), a newer procedure where the valve is replaced and the leak is obliterated.” Both procedures are low-risk and take around two hours.
Tricuspid valve regurgitation procedure recovery
After a few days of monitoring, the patient is usually able to go home. Currently, the procedures are not available on the NHS, but Dr Smith hopes this will change. “One of our patients — who was elderly, frail and possibly facing a palliative care pathway — had the TEER procedure and, a month later, went salmon fishing,” he says. “There’s no doubt it can make a real difference to people’s lives.”
WRITTEN BY Andrea Baer Programmes and
Specialist, Arrhythmia Alliance
by Royal Brompton and Harefield
INTERVIEW WITH Dr Robert Smith
Cardiologist, Royal Brompton and Harefield Hospital, part of Guy’s and St Thomas’ NHS Foundation Trust
WRITTEN BY Tony Greenway
To find out more about this programme and how to donate your device, contact Andrea Baer at a.baer@heartrhythmalliance.org or visit pace4life.org
WRITTEN BY Trudie Lobban MBE Founder And Trustee, Arrhythmia Alliance
Why
cardiovascular disease in women is under-diagnosed and under-treated
Cardiovascular disease is a leading cause of death in women. Better treatments are needed, so it’s vital that female patients with the condition participate in research studies.
It’s time to shatter the myth that only men are affected by cardiovascular disease (CVD), such as high blood pressure and stroke. In reality, it’s a leading cause of death in women in the UK and worldwide.
Cardiovascular disease risk in women
Women face additional CVD risk factors, including those related to pregnancy (such as preeclampsia, eclampsia and gestational diabetes) and menopause. Moreover, a high proportion of women with long-term health conditions, such as cancer, develop cardiovascular disease. So, it’s vital that all women — and their clinicians — understand that CVD doesn’t discriminate and are aware of its symptoms.
“Take coronary artery disease, which kills one in 14 women in the UK,” says Professor Vijay Kunadian, National Specialty Lead for Cardiovascular
Modernising obesity care by enhancing education for physicians
Obesity is an escalating epidemic impacting hundreds of millions worldwide. Its prevalence has increased dramatically in recent decades among adults, children and adolescents.
Obesity and heart health are directly linked. People with obesity are more likely to experience heart and circulatory diseases like heart attacks and strokes. Previously, obesity was considered a minor risk factor for cardiovascular disease. However, since 2021, it has been acknowledged as a chronic disease in its own right, significantly impacting heart and circulatory system health.
Gaps in obesity care and education
Obesity is a neglected public health problem. Causes can be multifactorial, including psychological, environmental, economic, cultural, societal and genetic. However, there continues to be a societal misperception that people with obesity are simply lazy and unmotivated. Negative stereotypes lead to poor healthcare
Disease, National Institute for Health and Care Research (NIHR).
Under-representation of women in clinical research
One reason why women with CVD have been under-diagnosed and under-treated is because they have been under-represented in clinical research. In 2021, the Lancet Women and Cardiovascular Disease Commission published a series of new recommendations to reduce the global burden of CVD in women by 2030. These included appropriate representation of women in clinical trials and prioritising sex-specific research.
There are various factors behind low female research participation, notes Prof Kunadian, who works on the Commission. “For example, women may feel they don’t have time because of their caring responsibilities.”
provision for people living with obesity.
In 2023, Medscape Education performed a survey of 92 multidisciplinary physicians in Europe. Almost all survey participants considered obesity to be associated with serious health risks; however, only two-thirds viewed obesity as a chronic disease. Physicians considered that the main barriers to patients achieving sustained weight loss were economic and societal factors, lack of willpower and lack of education. Findings from other studies1,2,3 highlight a need to increase understanding of obesity and its causation.
Multifaceted obesity treatment
Managing the complexities of obesity requires a multifaceted approach, including lifestyle changes and appropriate drug therapy. New weight loss medications are changing the
Why research is vital for patient care and treatment
Professor Amitava Banerjee, National Specialty Lead for Cardiovascular Disease, NIHR, agrees that it must be made easier for male and female patients to seamlessly enter clinical trials and research.
“This can be challenging because they may view research as an extra hurdle to cross when they simply want quick treatment,” he says.
“Yet, without that research, quick treatment would not be possible. When we explain this — and that it will potentially give them exposure to better treatment and increase our knowledge to benefit all patients — they tend to say ‘yes’.”
How to take part in clinical research
It’s important to get involved, says Prof Kunadian. Anyone interested in taking part in clinical research — including patients with a health condition, such as CVD, or those with no health condition — can find studies and register their interest via NIHR’s Be Part of Research website. It helps people across the UK make informed decisions about taking part in research; explaining what research is and how you can get involved.
treatment landscape. Healthcare providers must be kept informed of the latest clinical advances to elevate patient care in this evolving field.
Improving global education for physicians
As the largest online education platform for primary and secondary care physicians, Medscape Education has reached over 100,000 healthcare professionals, including 88,000 physicians from 29 specialties, with obesity education since 2022. This valuable education has been made even more accessible through the Medscape App, which has been downloaded over 17 million times since its launch in 2009.
Physicians participating in Medscape programmes globally have consistently shown improvements in understanding obesity management and its best applications in clinical practice. They aim to improve obesity-related health outcomes for those living with this chronic, progressive disease by addressing learning gaps and educational needs of healthcare professionals through targeted programmes.
References
1. Hughes CA, et al. Changing the narrative around obesity in the UK: a survey of people with obesity and healthcare professionals from the ACTION-IO study. BMJ Open. 2021;11:e045616.
2. Jeffers L, et al. Healthcare professionals’ perceptions and experiences of obesity and overweight and its management in primary care settings: a qualitative systematic review. Prim Health Care Res Dev. 2024;25:e5.
3. Rubino F, et al. Attitudes about the treatment of obesity among healthcare providers involved in the care of obesityrelated diseases: a survey across medical specialties in multiple European countries. Obes Sci Pract. 2021;7:659-668.
WRITTEN BY Ellen Jenner
Associate Director
Clinical Strategy, Medscape
ImageprovidedbyMedscape
INTERVIEW WITH Professor Vijay Kunadian National Specialty Lead for Cardiovascular Disease, National Institute for Health and Care Research (NIHR)
INTERVIEW WITH Professor Amitava Banerjee National Specialty Lead for Cardiovascular Disease, National Institute for Health and Care Research (NIHR)
WRITTEN BY Tony Greenway
Find out more at nihr.ac.uk
Paid for by National Institute for Health and Care Research
Understanding Dementia Pages
Survey highlights wi d e spre ad stigma faced by people living with dementia
Despite 55 million people worldwide living with dementia, a new study reveals that most people still lack a clear understanding of the condition.
Dementia is now the seventh leading cause of death globally and the leading cause of death in the United Kingdom. Currently, over 55 million people worldwide are living with dementia, a number expected to rise to 78 million by 2030. On average, someone develops the condition every three seconds.
Despite its prevalence, many people living with dementia still face significant stigma and discrimination due to widespread misconceptions and a lack of understanding about what dementia actually is.
World Alzheimer Report 2024
Today, Alzheimer’s Disease International published the 2024 World Alzheimer Report: Global Changes in Attitudes to Dementia. This report presents findings from our recent survey of over 40,000 people, including those living with dementia, caregivers, healthcare practitioners and members of the general public across 166 countries and territories. The results were both enlightening and concerning.
Stigma impacts dementia patients and caregivers
These misconceptions have real-world consequences. A concerning 88% of people living with dementia report experiencing discrimination. Due to the fear of stigma, 29% of those living with the condition avoid or discontinue close personal relationships, and 31% steer clear of social situations because they worry about others’ reactions.
fear of stigma, 29% of those living with the condition avoid or discontinue close personal relationships.
The report reveals that 65% of healthcare practitioners and 80% of the general public mistakenly consider dementia to be a normal part of ageing. Even more troubling, between 29% (in high-income countries) and 32% (in low and middle-income countries) believe that people living with dementia are dangerous more often than not. Furthermore, 64% of respondents viewed people with dementia as impulsive and unpredictable.
Caregivers are also significantly impacted. Around 43% have stopped inviting friends over out of concern for how they might treat their loved one, and almost half have declined invitations to visit friends or family.
Make an impact on World Alzheimer’s Month Each September, Alzheimer’s Disease International organises the global awareness campaign, World Alzheimer’s Month. The theme for 2024 is #TimeToActOnDementia and #TimeToActOnAlzheimers, focused on addressing the stigma and misunderstanding that is clearly so prevalent.
Throughout the month, we encourage everyone to take action to improve dementia awareness worldwide — whether on social media, through memory walks or simply in daily conversations. Together, we can make a difference.
Accelerating research into vascular dementia
A new centre will find treatments for vascular dementia and help build a future of healthy brain ageing.
The launch of the BHF-UK DRI Centre for Vascular Dementia Research at the UK Dementia Research Institute this year marks a major step forward in understanding and combating the condition, for which there are very limited treatments.
What is vascular dementia?
“When it comes to research, vascular dementia has always been the poor cousin,” explains Prof David Attwell, Director of the new research centre, funded by the UK Dementia Research Institute (UK DRI) and the British Heart Foundation. Vascular dementia, the second most common dementia type after Alzheimer’s, is estimated to affect around 175,000 people in the UK, caused by dysfunction of the brain’s blood vessels.
Vascular health crucial in dementia
The centre’s work has wider implications because studies show that reduced blood flow to the brain — a hallmark of vascular dementia — also plays a role in Alzheimer’s. This suggests addressing vascular health could benefit people who are living with or at risk of multiple dementia types.
Attwell’s team are tasked with unravelling the mechanisms underlying vascular dementia. This involves identifying the chemicals that cause blood vessel constriction and blood-brain barrier dysfunction, with the aim of halting the processes completely.
“Preventative treatment of stroke and heart disease by managing blood pressure has revolutionised outcomes,” explains Attwell. “That’s exactly the approach we need for dementia.”
Advancing drug repurposing
Clinical trials are underway to repurpose existing drugs that can preserve small vessels in the brain and ensure blood flow continues.
“Early trials in vascular dementia have shown that these drugs can significantly slow cognitive decline,” says Attwell, who is hopeful that, combined with antibody drugs, they could significantly help people with Alzheimer’s, too. This is key to building a future of healthy brain ageing for all.
Dementia remains a huge societal and economic challenge. The number of people living with vascular dementia is expected to double by 2050, reaching 350,000. The team at the new centre will leverage resources and insights from both the UK DRI and the BHF to drive research forward.
WRITTEN BY Kate Sharma
Dementia care can and must be fixed — we need to start now
The new health secretary has claimed the NHS is broken. Dementia care is the perfect place to start the job of fixing it.
When Wes Streeting arrived in Whitehall as the new Secretary of State for Health and Care, his first speech stated that “the NHS is broken.” For dementia care, we should ask whether our health and social care systems were ever truly working in the first place.
Dementia care remains inadequate
Despite incredible work by dedicated health and care professionals, including Dementia UK’s specialist dementia Admiral Nurses, people often miss out on vital care needed to manage dementia’s complex challenges.
The number of people living with dementia is set to exceed 1 million within the first year of this Government. With no cure and a lack of support in place, many will find themselves left to cope with the devastating effects of dementia alone. As our population ages, it will be the defining health and social care challenge of our time.
Where to start in fixing dementia care
Despite some positive progress and well-intentioned announcements over the years, the wholesale strategic approach to dementia care required has slipped between the cracks of government agendas for too long. With enough political will, Dementia UK believes this parliament can be the one that fixes dementia care.
Whether addressing barriers to vital care funding, recognising that dementia is a complex condition that needs specialist support or supporting the one in four people in hospital beds who are living with dementia, we’ve worked with people affected by dementia and
our specialist nurses to identify where to start:
• Improve support at the point of diagnosis by increasing access to vital health reviews and specialist dementia nurses.
• Review NHS continuing healthcare funding to recognise the impact of dementia as a complex and long-term condition.
• Increase the number of dementia specialist Admiral Nurses in hospital settings to improve health outcomes and reduce hospital stays for people with dementia.
• Create a new pathway of age-appropriate support for people living with young-onset dementia, where symptoms occur before the age of 65.
Moving dementia up the agenda
Streeting’s speech concluded with: “It will take time; we never pretended that the NHS could be fixed overnight.” We agree, however, the one in two of us who will be affected by dementia in our lifetime cannot afford to wait to take the first steps. The Government has a unique chance to transform dementia care. If they want to fix a broken NHS, dementia care is the perfect place to start.
A whole ecosystem approach to tackling Alzheimer’s disease
Learn about one company’s efforts to advance Alzheimer’s research and diagnostics — and why the new Government must make Alzheimer’s disease a political priority.
WRITTEN BY
At Lilly, we have been on a journey to blazing new trails in the research of therapies and diagnostics for people affected by Alzheimer’s disease. As science continues to progress, we need to work together to ensure our healthcare system is ready to adapt.
Call for enhanced Alzheimer’s care
Currently, there are significant barriers to timely detection, accurate diagnosis and appropriate treatment. That’s why we’re calling on the new Government to deliver its manifesto commitment to put Britain at the forefront of transforming treatment for dementia.
Our long-standing dedication to Alzheimer’s disease is driven by our commitment to improving lives. Alzheimer’s disease, the most common type of dementia,1 is a debilitating and fatal neurodegenerative disease that robs people of their memories, independence, relationships and futures.2,3 It has a devastating impact that relentlessly increases as it progresses.
We are proud to make a difference to people affected by the disease not only through our research but also through our commitment to support our local communities.
Alzheimer’s awareness and community service
September is World Alzheimer’s Month, a time dedicated to raising awareness and challenging the stigma that persists around the disease.
A biomarker diagnosis provides clarity for people and their loved ones while also unlocking access to research opportunities now and scientific innovations in the future. Currently, people with dementia are waiting up to two years for a diagnosis4 — with one in three never receiving one at all.1
As a first step, urgent improvement is required so that the NHS has the right pathway and infrastructure in place to adopt the newest medical advances. Currently, England has fewer MRI scanners than comparable countries, and only 2% of people in the UK can access advanced diagnostic tests like PET scans or lumbar punctures on the NHS.5
While innovative blood-based biomarker tests, which have the potential to revolutionise early diagnosis, are being trialled in the UK,5 the availability of existing infrastructure and tests should be rapidly expanded. To make this a reality, we are working with leading NHS partners across England to enable Cerebrospinal Fluid Biomarkers (CSF) testing to be further adopted in clinical practice.
Urgent improvement is required so that the NHS has the right pathway and infrastructure in place to adopt the newest medical advances.
September also marks Lilly’s annual Global Day of Service (GDOS), a day when all employees globally have the chance to volunteer in their communities. Since 2008, GDOS has enabled us to collaborate with leading high-impact organisations, helping us to drive meaningful progress in addressing community needs.
Our UK GDOS this year is focused on charities that support people living with Alzheimer’s disease, their carers and their loved ones. As such, our team will volunteer across the country to support the vital work of these organisations, extending the reach of our impact and connecting with our communities.
The need for action from the new Government
While we will continue our work to improve the lives of those impacted by the condition, we ask the Government to turn their focus to Alzheimer’s disease, too. This means making progress to increase access to a timely and accurate diagnosis using specific biomarkers.
Timely action needed for Alzheimer’s
At Lilly, we envision a future where, within 10 years, timely detection, accurate diagnosis, appropriate treatment and ultimately prevention will be a reality for people with Alzheimer’s disease. To realise this, the NHS and Government must act now to make Alzheimer’s disease a political priority and develop a patient pathway that supports healthcare systems to adapt for the benefit of people today and tomorrow.
References
1. NHS England (2024). Primary Care Dementia Data, June 2024. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/primary-caredementia-data/june-2024#:~:text=487%2C432%20patients%20had%20a%20 recorded,patients%20since%2031%20May%202024.&text=65.0%25%20of%20 patients%20aged%2065,64.8%25%20on%2031%20May%202024. [Accessed July 2024]
2. EBC and EFPIA (2023). ‘RETHINKING Alzheimer’s disease: Detection and diagnosis.’ Available at: https://www.efpia.eu/media/677162/rethinkalzheimerdisease-report_def_hd.pdf [Accessed July 2024]
3. World Health Organization (2023). ‘Dementia.’ Available at: https://www.who.int/ news-room/fact-sheets/detail/dementia [Accessed July 2024]
4. Alzheimer’s Society (2022). People with dementia face up to a two year wait for diagnosis. Available at: https://www.alzheimers.org.uk/news/2022-09-23/peopledementia-face-two-year-wait-diagnosis [Accessed July 2024]
5. UCL (2024). ‘Blood tests for diagnosing dementia to be offered in UK trial’. Available at: https://www.ucl.ac.uk/news/2024/apr/blood-tests-diagnosingdementia-be-offered-uk-trial [Accessed July 2024]
Christopher Stokes President and General Manager Lilly UK, Ireland & Northern Europe
Investing in dementia and its diagnosis can transform care and cut
costs
Dementia is the greatest challenge currently faced by our health and social care system. It is the UK’s biggest killer, costing our economy £42 billion this year (Alzheimer’s Society, 2024).
WRITTEN BY Mark MacDonald Associate Director of Evidence, Policy and Influencing, Alzheimer’s Society
Dementia affects every part of the system, from primary care to hospital and hospice care. People living with dementia are also the largest users of social care.
Addressing dementia challenges to help NHS
Secretary of State for Health and Social Care Wes Streeting says the NHS is ‘broken.’ By understanding the challenges posed by dementia, Ministers can understand the challenges faced by the entire system — and how to address them.
Without action, the cost of dementia will be £90 billion annually by 2040. We must think and act differently on a condition that has been under-prioritised for decades.
Diagnosis for dementia cost-efficiency
The cornerstone of any plan to address dementia must start with diagnosis. As Lord Darzi said when launching his new investigation into the NHS: “As every clinician and patient knows, the first step to
addressing any health problem is a proper diagnosis.”
As the disease progresses, total costs increase significantly, from £29,000 per year for mild dementia to £81,000 for severe dementia. Getting a diagnosis eases system pressure and cost. Existing treatments to manage symptoms are effective at reducing stressful and costly crisis points. Yet, only 1.4% of total dementia healthcare costs are spent on diagnosis and treatments. That doesn’t make sense for a system so clearly stretched.
Just 1% of people living with dementia told us they saw no benefit in getting a diagnosis.
Diagnosis essential for care access
Just 1% of people living with dementia told us they saw no benefit in getting a diagnosis. Yet, over a third of people living with dementia in England
and Northern Ireland never get a diagnosis. In Wales, around half do not.
Only a diagnosis can unlock access to care, support and treatments. People are less likely to escalate into a crisis, such as an unplanned hospital or A&E admission or a last-minute search for a care home place. Without an early and accurate diagnosis, people with Alzheimer’s disease will never be able to access treatments we hope will be part of a more hopeful future.
Prioritise dementia for budget impact
More ambitious diagnosis targets and greater investment in diagnostics, including getting ready for new treatments and blood tests for dementia are key to reducing the devastating personal impact of dementia and the immense cost and pressures it brings to the NHS and social care system. The Government would do well to prioritise dementia as it prepares for the budget in October.
How AI-enabled socks can measure emotional distress in dementia patients Dementia prevention measures you can take to protect brain health today
Socks fitted with AI technology can help carers recognise early signs of distress in people living with dementia so that appropriate calming interventions can be made.
Afamily crisis prompted Dr Zeke Steer to create an innovative wearable technology that detects distress in people living with dementia.
AI socks to detect distress early “My great-grandmother was diagnosed with dementia,” he says. “Her aggressive and agitated behaviour became very challenging and my family were eventually left with no option but to place her in a care home.”
This agitation and aggression were the result of pain, anxiety and confusion linked to the dementia. A particular challenge for caregivers is recognising signs of distress — especially in people with communication difficulties — before they manifest into something more serious.
there are reasons they work well. “In care home trials, people living with dementia found SmartSocks to be comfortable and familiar. In contrast, wrist-worn devices can be intrusive and add to distress, leading to their removal,” says Dr Steer. “There’s also a biological reason for favouring socks over a wristband. One of our sensors measures a sweat response called electrodermal activity. The soles of the feet have among the highest densities of sweat glands on the body.”
One of our sensors measures a sweat response called electrodermal activity.
Dr Steer’s research at the Bristol Robotics Laboratory led to the design of AI-enabled socks fitted with sensors that measure pulse, temperature, sweat and motion. Caregivers are alerted to the wearer’s distress, enabling timely care interventions.
Sensors pick up stress signals from sweat glands
Socks might not be the most obvious wearable dementia technology, but
Dr Steer is founder and CEO of digital health company Milbotix. Milbotix is funded by Alzheimer’s Society through the Accelerator programme, with UK Dementia Research Institute among its collaborators. The socks are intended for use by families, domiciliary carers and care home staff and are now in care home trials.
“Following the painful experience with my great grandmother, I’d like to see SmartSocks helping people living with dementia thrive in whatever place they call home. The next version of the product will measure vital signs, track digital biomarkers of disease and help prevent falls,” says Dr Steer.
Learn how promoting lifelong brain health could be a game-changer for dementia prevention.
There are various things we can do throughout life to protect our brain health — and it’s never too early or too late to start. The World Health Organization has suggested that up to 40% of dementia cases globally could be preventable, but many things need to change for that to be achieved. By taking steps to protect brain health now, we may reduce the risk of developing dementia in the future.
Dementia prevention in action
Alzheimer Scotland launched Brain Health Scotland in 2020 — the start of a movement to highlight the potential of dementia prevention. Its goal is to promote lifelong brain health and create a legacy of long-term dementia prevention strategies. By reaching out as early as possible to our schools and wider communities, we can actively engage with the public and target people known to be at risk of brain diseases.
Positive steps to protect brain health
There are some pre-determined aspects, such as age and genetic characteristics, that may put us at increased risk. However, there are many steps we can take to safeguard our brain health and delay or prevent certain types of dementia. These include:
• Regular exercise
• Staying connected with other people
• Reducing risks such as alcohol and smoking
• Managing stress
• Keeping on top of existing medical conditions (eg. diabetes, high blood pressure)
Tool for tailored brain health tips
We developed an interactive online quiz called ‘My Brain Health Plan’. It walks users through a series of questions about their lifestyle and habits, generating evidence-based suggestions and personalised tips.
Empowering people to protect brain health
In 2023, we opened the UK’s first walk-in Brain Health Service and Clinic within our Brain Health and Dementia Resource Centre in Aberdeen. A multi-agency project between the Scottish Government, NHS Grampian and Alzheimer Scotland, this dedicated space enables people to recognise their risk of diseases that can lead to dementia. Making small changes now can pave the way for significant improvements in the future.
INTERVIEW WITH Dr Zeke Steer Founder and CEO, Milbotix
WRITTEN BY Tony Greenway
WRITTEN BY Henry Simmons Chief Executive, Alzheimer Scotland
Only together can we tackle chronic pain
Chronic pain is life-changing for people with arthritis and other musculoskeletal conditions. Teamwork and listening to people with lived experience is the path forward to beating chronic pain.
As the UK’s largest dedicated funder of arthritis research, Versus Arthritis is helping to bring together the expertise needed to push back on pain.
Chronic pain’s societal impact
Chronic pain colours everything and prevents people from living a full life and, for some, from earning a living. It’s one of the main reasons people see their GP. It affects up to 28 million people (43%) in the UK alone. The impact of chronic pain on wider society is significant.
It is the most difficult problem for many people with arthritis, which is why we took the lead in 2019, bringing together experts in pain, people with arthritis, healthcare professionals and researchers to create a research roadmap. This was a turning point in honing in on what scientific, clinical and patient-support advances needed to be made and led us to develop the Advanced Pain Discovery Platform (APDP) initiative.
Pain research initiative
The APDP is a five-year, £24 million initiative funded by Versus Arthritis in partnership with the UK Research and Innovation Strategic Priorities fund, with additional funding coming from Eli Lilly and the Medical Research Foundation.
The APDP brings together pain scientists from across the UK to take on the challenge of chronic pain. The funded APDP projects in the UK include lab-based science, biopsychosocial research and data platforms, all involving people with lived experience of pain. Being guided by those who know what it means to live in pain is central to making progress.
Since 2010, we have also funded and supported the Pain Centre Versus Arthritis at the University of Nottingham, which places great emphasis on ensuring patients’ insights are fully embedded in its chronic pain research.
Seeking voices for research
Given the critical role of real-life experiences, we are seeking more people to help us shape future research. It’s through collective action that advances will be made to transform the lives of people living in the shadow of chronic pain.
Innovations in Pain Management
Chronic pain relief requires a personalised approach
Chronic pain impacts 20% of the population. We need to shift from medical treatments to holistic, supported self-management approaches.
Pain becomes chronic after three months when tissue healing has usually been completed. Moderate to severe disabling chronic pain affects around 8 million adults in the UK, disrupting lives of individuals, families and communities. Back pain is the leading cause of disability, costing UK taxpayers an estimated £10 billion annually. Our approach to managing chronic pain must change.
Medicines have limited effect on chronic pain
Pain is processed in the nervous system through many mechanisms, but most medicines target only one. Medicines may relieve many types of pain but work best when combined with regular activity, exercise or enjoyable activities. Some types of pain may not respond to medicines or only for short periods.
Former vice-chair of BPS patient committee Louise Trewern recalls: “I lived with unexplained pain for years, leading to high-dose opioid prescriptions. I transformed my life by tapering off opioids and managing my pain through activity, diet and sleep.”
Medicines may relieve many types of pain but work best when combined with regular activity.
Opioids like codeine, morphine and tramadol cause long-term issues such as constipation, itching, weight gain, low sex drive and breathing difficulties. For any concerns, your care team or pharmacist can advise on maximising benefits and managing side effects.
National survey on chronic pain
The 2024 British Pain Society (BPS) national survey on chronic pain found that 87% of patients were prescribed pain medicines, primarily opioids. Approximately 86% had taken these medicines for over two years, and 77% reported benefits. However, 67% experienced side effects, and worryingly, 69% had not been informed about long-term risks.
Psychological approaches NICE recommends psychological therapies, such as acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT) in managing chronic pain for people aged 16 years and over. ACT improves quality of life by enhancing sleep and reducing pain and psychological distress. These therapies can be provided by trained professionals through the NHS or privately.
BPS honorary member Pete Moore moved from relying on medicines to self-management after attending a Pain Management Programme in 1996. Since then, he has not needed to take medicines. “Empower patients to understand their pain and then take up self-management strategies,” Moore advocates.
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Why new medications are needed to reduce the UK’s opioid dependence
Codeine-free over-the-counter analgesics — which combine paracetamol and ibuprofen — can offer patients a faster pain-relief option and may help reduce opioid dependence.
Much has been written about the scourge of opioid addiction in recent years. Yet, in the UK, there’s a temptation to think that this issue only affects other countries. That’s just not the case, insists Dr Hartley Atkinson, Managing Director, AFT Pharmaceuticals.
Opioid epidemic affects the UK
According to one study in the British Journal of Pain, the UK had the world’s highest rate of opioid consumption in 2019.1 Too many people are using opioids to manage everyday moderate pain such as headaches, toothache, sore throat and sprains; yet sustained long-term use of these drugs increases the likelihood of addiction.
“Studies have shown that 10% or more of patients who are discharged from hospital on opioids are still using them three months later,2 and that’s just not appropriate,” says Dr Atkinson.
Faster pain relief
combined with paracetamol boosts pain relief by only 5% compared to paracetamol alone.3 “Our studies have shown that relief is around 80% stronger than paracetamol alone and around 30% stronger than ibuprofen alone.4 Combining paracetamol and ibuprofen also offers faster pain relief. We discovered the medication produces meaningful pain relief in about 42 minutes, whereas simply taking ibuprofen on its own takes around an hour to produce the same effect.”
Playing a part in reducing opioid use
Our studies have shown that relief is around 80% stronger than paracetamol alone and around 30% stronger than ibuprofen alone.
Part of the answer is to give healthcare professionals and patients a range of different pain relief options. For example, Dr Atkinson’s company has created a specific, over-the-counter, codeine-free analgesic, which combines 500mg of paracetamol and 150mg of ibuprofen (both non-opioids) per tablet.
“We found that combining paracetamol and ibuprofen in these ratios produces a very good level of pain relief,” reveals Dr Atkinson. A clinical study has indicated codeine
Why pain should be recognised as a vital sign — and how it will help patients
Pain should be a vital sign. Learn why it’s crucial for healthcare to prioritise pain assessment, ensuring better patient care and comprehensive health monitoring.
Healthcare professionals routinely monitor four measurable vital signs: (1) body temperature; (2) pulse rate; (3) respiration rate (rate of breathing); and (4) blood pressure.
Assessing pain as a vital sign
Currently, pain is not considered to be ‘vital.’ It cannot be measured. Yet, in ‘UK Pain Messages 2024’, the British Pain Society states:
• Approximately 8 million adults report moderate to severely disabling pain.
• Around 43% of adults (almost 28 million people) live with a degree of chronic pain.
• In older age groups, the rates are higher, with up to 62% of those aged
Dr Hartley believes this pain relief — which has been available in UK pharmacies for around a year — could play a role in helping to combat the opioid crisis. “Doctors will still need to consider giving their patients combinations of multiple painkillers,” he says. “But having access to an additional strength analgesic gives them options, which is what they have been asking for. It can minimise the amount of time that a patient spends on opioids — or help them avoid opioids altogether.”
References
1. Roberts, A.O. and Richards, G.C. (2023) ‘Is England facing an opioid epidemic?’, British Journal of Pain, 17(3), pp. 320-324. doi:10.1177/20494637231160684.
2. Arwi, G.A. and Schug, S.A. (2020) ‘Potential for harm associated with discharge opioids after hospital stay: A systematic review’, Drugs, 80(10), pp. 989-1004. https://doi.org/10.1007/ s40265-020-01294-z.
3. De Craen, A.J.M., et al. (1996) ‘Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone: a systematic review’, BMJ, 313, pp. 321-325.
4. Daniels, S.E., et al. (2018) ‘Analgesic efficacy of an acetaminophen/ibuprofen fixed-dose combination in moderate to severe postoperative dental pain: a randomized, double-blind, parallel-group, placebo-controlled trial’, Clinical Therapeutics, 40(10), pp. 1765-1776.
making it a routine part of patient evaluations.
4.Patient-centred approach: Encourage open communication with patients about their pain, ensuring that their experiences are validated and addressed.
5. Patient-centred language: Understand that patients use a wide range of words to describe their pain. It might ‘ache,’ ‘burning’ or ‘over-sensitivity’ — and they may deny ‘pain.’
6. Regular audits and feedback: Conduct regular audits to ensure pain is being assessed and treated effectively, providing feedback and making necessary adjustments to improve care.
75 and over reporting chronic pain symptoms.
Steps to elevate pain as a vital sign
1. Standardise assessment tools: Implement consistent, validated pain assessment tools and pain scales across all healthcare settings to ensure that pain, like other vital signs, is regularly monitored.
2. Education and training: Educate healthcare professionals on the importance of pain assessment and management, including recognising different types of pain and understanding appropriate treatment options.
3. Policy integration: Incorporate pain assessment protocols into clinical guidelines and hospital policies,
7. Balanced pain management: Combine pain assessment with strategies to prevent overreliance on opioids, using a multidisciplinary approach to pain management.
Value in promoting pain awareness
Viewing pain as a vital sign encourages healthcare providers to assess pain, which improves patient care. Pain is a critical indicator of underlying conditions. Neglecting it can lead to unnecessary suffering and delayed treatment.
As a vital sign, clinicians will have to consider it as an integral part of patients’ overall health, ensuring that it is monitored and managed. This approach ensures patients — not just the condition — receive treatment.
WRITTEN BY Roland Watson Chair, Pain UK (CIO)
INTERVIEW WITH Dr Hartley Atkinson Managing Director, AFT Pharmaceuticals Ltd
WRITTEN BY Tony Greenway
Why women’s pain is underestimated and how awareness of the gender pain gap can help
The gender pain gap (GPG) highlights disparities in how pain is perceived, treated and managed between genders and shines a spotlight on the need for better women’s healthcare.
Ongoing research reveals biases, stereotypes and disparities in pain management contributing to the unequal identification and treatment of women’s pain.
What is the gender pain gap?
The gender pain gap refers to the phenomenon in which pain in women is more poorly understood and more mistreated compared to men’s pain due to systemic gaps and biases. Dr Bill Laughey, Senior Medical Scientist at Reckitt, explains: “Women actually experience pain more frequently than men, which on average is more disruptive to their lives. Yet, unfortunately, we — as a society — don’t take pain in women as seriously.”
Nurofen’s mission is to help women receive a timely diagnosis, ensuring that they are treated fairly and their pain is validated. “We want a more compassionate society. We want to help close the gap for good,” adds Dr Laughey.
Gender Pain Gap Index Report
According to Nurofen’s Gender Pain Gap Index Report, one in four women versus one in six men felt that, generally, no one took their pain seriously.1 More concerningly, only 47% of women surveyed received a diagnosis for their pain within 11 months, compared with 66% of men.2 This might prevent women from seeking appropriate pain treatment. When adding issues such as menstrual pain or gynaecological concerns, which can be uncomfortable to discuss, the need for change becomes more urgent.
Pain Pass enhances patient dialogue
The report also highlights that women find it challenging to talk about their pain. In fact, one-fifth (20%) of women want more resources to aid better conversations between them and their healthcare professionals.2 Recognising this need, Nurofen created a Pain Pass tool for patients, available for free.
“We’ve developed a Pain Pass tool in collaboration with leading pain specialists to help empower and equip women to get the right support, diagnosis and treatment for their pain,” says Dr Laughey. The Pain Pass is available online or as a pocket-sized foldaway. To date, it has been distributed in over 2,300 GP surgeries and is available in high street pharmacies.
“The Pain Pass is essentially a pain diary, to empower women and enable better conversations with healthcare professionals. It provides a pain tracking calendar and provides adjectives to help describe pain, such as numbing, dull or aching pain,” says Dr Laughey. “Feedback has been extremely positive. We encourage patients to use the tool as a resource to advocate for themselves and improve treatment plans for pain.” Scan the QR code on this page to download your Pain Pass.
Dr Laughey insists: “We urge women to download the pain pass tool and use it as a resource to advocate for themselves. By sharing your experiences and openly discussing your pain, we can help to raise awareness of the gender pain gap to fight for change.”
Collaboration as key to change
“We know we can’t address this change alone, so we are partnering with academic institutions such as Oxford University and The University of Manchester to advance research into the gender pain gap,” Dr Laughey continues.
“We have created a free Gender Pain Gap training programme for healthcare professionals, leveraging insights from research carried out with leading women’s health charity Wellbeing of Women. We are excited to announce that over two-thirds of Superdrug’s pharmacists, pharmacy assistants and nurses have completed the training,” he adds.
Campaigning to close the gap
“We see our campaign as being aligned with what the UK Government is hoping to do in terms of improving women’s health — by driving education initiatives, supporting medical research into women’s health and attending professional conferences,” says Dr Laughey. “By sharing experiences and openly discussing pain, we can help to raise awareness of the gender pain gap to fight for change.”
Paid for by Nurofen
INTERVIEW WITH Dr Bill Laughey Senior Medical Scientist, Reckitt
WRITTEN BY
Bethany Cooper
Nurofen is the manufacturer of Nurofen 200mg tablets. For short-term, mild to moderate pain. Contains ibuprofen. Always