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National service frameworks and strategies

NSF for coronary heart disease

If you are at risk of developing coronary heart disease (CHD), or already have it, the national service framework (NSF) for CHD (PDF, 324kb) has marked a huge turning point in the quality, effectiveness and fairness of the care you receive in the NHS.

Launched in 2000, the NSF was a 10-year strategy to reduce CHD and stroke-related deaths by 40% by March 2010. This target was met five years ahead of schedule.

Based on clear evidence, the NSF sets out formal standards of care that local health communities are expected to achieve. The framework helps NHS organisations focus on treatments proven to be the most clinically effective and that represent the best value for money.

The NSF also promotes regional networking across health communities and encourages health professionals, such as GPs, nurses, hospital doctors and social care professionals, to work more closely in multi-disciplinary teams. This means patients benefit from integrated healthcare based on their needs rather than on professional or organisational boundaries.


The NSF for CHD has helped raise standards for the detection, treatment and management of all heart disease. The NSF's focus in the treatment of heart disease has delivered improvements in most areas of cardiac services.

March 2010 did not mark the end of the NSF. Much of what was set in the framework is as relevant now as it was 12 years ago. However, an evaluation as to why there has been such excellent progress in some areas but not in others is needed. Cardiac rehabilitation and the treatment of heart failure, for example, are areas that have developed more slowly than others and we need to understand why.

The NHS has changed a lot since the national service framework for CHD was first published. Working practices in cardiology and patient expectations have changed and technology has advanced. However, there is still room for improvement and the NHS will need to continue to focus on improving quality and productivity.

NHS Health Checks

Vascular disease (heart disease, stroke, diabetes and kidney disease), affects the lives of more than four million people and kills 170,000 in the UK every year. These conditions also account for more than half of the mortality gap between the rich and poor. Modelling work undertaken by the Department of Health has found that offering NHS health checks to all people between 40 and 74, and recalling people every five or 10 years, would be a cost-effective and clinically beneficial programme.

Health checks assess people’s risks to heart disease, stroke, kidney disease and diabetes and are based on straightforward questions and measurements such as age, sex, family history, height, weight, as well as blood pressure. They also include a simple blood test to measure cholesterol.

Everyone will receive a personal assessment, setting out the person’s level of risk and exactly what they can do to reduce it. For those at low risk, this might be no more than general advice on how to stay healthy. Others may join a weight management programme or a stop smoking service. Those at the highest risk might also require preventive medication with statins or blood pressure treatment.

Primary care trusts (PCTs) began delivering NHS Health Checks in 2009 and 2010. The NHS Health Check Programme has the potential to detect at least 20,000 cases of diabetes or kidney disease earlier, allowing individuals to be better managed and improve quality of life. It could also prevent over 4,000 people a year from developing diabetes and 1,600 heart attacks and strokes.

Cutting the risk of CHD

Smoking, obesity and a physically inactive lifestyle are among the top risk factors for developing CHD. In 2009, around 14% of deaths from circulatory diseases were linked to smoking. That's why the NSF has driven forward major developments in prevention. These include:

Local NHS Stop Smoking Services

With the help of local NHS stop-smoking services, smokers are up to four times more likely to successfully quit, compared to unassisted (‘cold turkey’) quitting. For more information visit the NHS Smokefree website.


The Change4Life campaign was launched in 2009. This is part of a strategy to help reduce obesity, which can lead to coronary heart disease, and to help people maintain a healthy weight. Aimed at families, it promotes messages around healthy eating and being more active.

More support to be physically active

The Department of Health promotes all types of physical activity such as walking, cycling, swimming, dancing or heavy gardening. Work with your health professional to come up with a physical activity plan that matches your abilities. If your condition stops you from meeting the minimum of 150 minutes of moderate activity a week (guidelines for physical activity for adults), then try to do as much as you can. What is important is that you avoid being inactive. 

If you are not sure what type of exercise is right for you, try one of our getting started guides on:


Faster diagnosis and treatment

Whether you develop any symptoms, experience a heart attack or are living with coronary heart disease (CHD), you will now get the lifesaving care and treatment you need much faster. 

  • If you develop CHD symptoms, you may be directed to one of a network of Rapid Access Chest Pain Clinics (RACPC) set up specifically to assess patients within two weeks of reporting symptoms to their GP.
  • Or you may be diagnosed in your GP surgery without having to visit hospital. GP surgeries and primary care trusts (PCTs) are increasingly investing in the skills and equipment to diagnose CHD in community settings.
  • If you do have an emergency and need an ambulance, emergency response time targets mean help is more likely to arrive within eight minutes of your call.
  • Ambulance crews are also being trained to administer neccessary drugs on site.
  • If you do need surgery, your maximum wait should be three months and you will be offered a choice of two hospitals for this surgery. Also read our guide to waiting times and information about choosing a hospital.

Cardiac rehabilitation

A 2005 review by what is now the Care Quality Commission showed that there are some aspects of cardiac rehabilitation that needed further improvements. Together, the Vascular Programme and the NHS Improvement - Cardiac Network aim to spread good practice and improve the quantity and quality of the rehabilitation provided.

The National Audit of Cardiac Rehabilitation (NACR) has addressed the need to achieve better information about services provided and their use by patients. There is now emphasis across England to provide stronger evidence on quality and effectiveness and to encourage local areas to appraise and improve their provision of cardiac rehabilitation.


Also read the information about how to recover from a heart attack.

Improving quality of life

Because of the UK's ageing population and the increasingly effective care for people who have heart attacks, more and more people are living with heart failure. With no cure for this progressive condition, the NSF places particular emphasis on helping people live longer, more independent and active lives.

  • Growing numbers of specialist heart failure nurses are helping people with heart failure to live fuller, longer lives, retain independence in their own homes, and reduce the likelihood of a hospital admission.
  • Many people getting help and support through the Expert Patient Programme, now a mainstream service run by primary care trusts. The programme is aimed at people with long-term conditions and helps individuals to manage and cope with their condition on a daily basis.

Growing with the times

In March 2005, strategies for arrhythmias and sudden cardiac death were added to the NSF. Arrhythmias (irregular heart beats) affect more than 700,000 people and cause up to 400 sudden, unexplained cardiac deaths a year.

Since the first publication of the NSF for CHD, there have been significant improvements in the technology and clinical skills that enhance care for people with heart conditions. The new additions to the NSF aim to ensure that people with arrhythmias quickly receive an assessment and effective treatment. It also aims to ensure that when sudden, unexpected cardiac death occurs, NHS services have systems in place to identify family members at risk and provide personally tailored, sensitive and expert support.


The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Harriet Sauce said on 16 October 2011

Anyone know who the author of this is?!

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Page last reviewed: 20/06/2012

Next review due: 20/06/2014

CHD key facts

Coronary heart disease (CHD) is a preventable disease. It kills more than 110,000 people in England every year.

The death rate from heart disease and other circulatory diseases for under 75s in England has fallen by 41% since 1999 to 2001.

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Media last reviewed: 21/10/2013

Next review due: 21/10/2015