Services for the prevention of cardiovascular disease
This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg45
2 An integrated approach to commissioning high-quality services for the prevention of cardiovascular disease
Figure 2 summarises the scope of this guide, which covers population-wide, community-level and individual approaches to cardiovascular disease prevention (see box 2 for definitions). Studies have shown that combining population, community and individual approaches can reduce cardiovascular disease mortality. Local Government Improvement and Development, the Department of Health and the Cardio and Vascular Coalition recognise that a combination of approaches is needed to ensure sustained lifestyle and behaviour change,,.
Box 2 Definitions of approaches
Population-wide approaches aim to change the risks from the social, economic, material and environmental factors that affect an entire population. This can be achieved through regulation, legislation, subsidy and taxation or rearranging the physical layout of communities.
Community-level approaches are targeted at groups of people who are at high risk of cardiovascular disease (for example a specific black and minority ethnic group or geographical area) and may include activities to change health behaviours among the group.
Individual approaches are interventions that give people direct encouragement to change their behaviour. This may involve providing information about the health risks of their current behaviour, offering advice or prescribing a treatment.
Commissioners should work with service providers to carry out baseline assessment of relevant NICE guidance (see box 1). This will enable commissioners to identify where recommendations from NICE guidance have been implemented and highlight areas for improvement. Commissioners are encouraged to ask providers to conduct regular clinical audits to monitor and improve the management of cardiovascular disease risk.
Figure 2 An integrated approach to cardiovascular disease prevention
 Capewell S, Graham H (2010) Will cardiovascular disease prevention widen health inequalities? PLOS Medicine 7: e1000320.
 British Heart Foundation (2009) Cardio and Vascular Coalition: Destination 2020. A plan for cardiac and vascular health. The voluntary sector vision for change. London: British Heart Foundation.
 Improvement and Development Agency (2009) Valuing Health: developing a business case for health improvement. London: Matrix Evidence.
 Department of Health (2011) Healthy lives, health people: a call to action on obesity in England. London: Department of Health