Health Awareness - Q3 2024

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An exclusive edition of Health Awareness with special features on

Cardiovascular Health | Innovations in Pain Management | Understanding Dementia

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What is a cardiac rehabilitation programme and who should attend?

Cardiovascular Health Pages 02 - 04

Attending a cardiac rehabilitation programme is essential to recovery and will minimise the risk of future heart problems.

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ardiac 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.

WRITTEN BY Heather Probert President, British Association for Cardiovascular Prevention & Rehabilitation

Paid for by British Association for Cardiovascular Prevention & Rehabilitation Find out more at bacpr.org

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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.

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edical 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.

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.

WRITTEN BY Professor Bryan Williams Chief Scientific and Medical Officer at the British Heart Foundation

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

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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.

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ecycling 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.

WRITTEN BY Andrea Baer Programmes and Community Development Specialist, Arrhythmia Alliance

WRITTEN BY Trudie Lobban MBE Founder And Trustee, Arrhythmia Alliance

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

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.

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

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.

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INTERVIEW WITH Dr Robert Smith Consultant Interventional Cardiologist, Royal Brompton and Harefield Hospital, part of Guy’s and St Thomas’ NHS Foundation Trust

WRITTEN BY Tony Greenway

here’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

READ MORE AT HEALTHAWARENESS.CO.UK

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.”

Find out more at guysandstthomas specialistcare.co.uk

Paid for by Royal Brompton and Harefield

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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.

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t’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.

Find out more at nihr.ac.uk

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

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.”

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Modernising obesity care by enhancing education for physicians

Disease, National Institute for Health and Care Research (NIHR).

Obesity is an escalating epidemic impacting hundreds of millions worldwide. Its prevalence has increased dramatically in recent decades among adults, children and adolescents.

O WRITTEN BY Ellen Jenner Associate Director Clinical Strategy, Medscape

besity 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

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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.

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

Paid for by National Institute for Health and Care Research

treatment landscape. Healthcare providers must be kept informed of the latest clinical advances to elevate patient care in this evolving field.

Paid for by Medscape

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.

Find out more at www.medscape. org/cardiology

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Understanding Dementia

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Survey highlights widespread 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.

D WRITTEN BY Paola Barbarino CEO, Alzheimer’s Disease International

ementia is now the seventh leading cause of death Stigma impacts dementia patients and caregivers globally and the leading cause of death in the These misconceptions have real-world consequences. A United Kingdom. Currently, over 55 million people concerning 88% of people living with dementia report worldwide are living with dementia, a number experiencing discrimination. Due to the fear of stigma, expected to rise to 78 million by 2030. On average, someone 29% of those living with the condition avoid or discontinue develops the condition every three seconds. close personal relationships, and 31% steer clear of social Despite its prevalence, many people situations because they worry about living with dementia still face significant others’ reactions.

Due to the fear stigma and discrimination due to Caregivers are also significantly widespread misconceptions and a lack impacted.

Around 43% have stopped of stigma, 29% of of understanding about what dementia inviting friends over out of concern for those living with actually is. how they might treat their loved one, and almost half have declined invitations to the condition avoid World Alzheimer Report 2024 visit friends or family. or discontinue Today, Alzheimer’s Disease International published the 2024 World Alzheimer Make an impact on World Alzheimer’s Month close personal Report: Global Changes in Attitudes to Each September, Alzheimer’s Disease relationships.

Dementia. This report presents findings International organises the global from our recent survey of over 40,000 awareness campaign, World Alzheimer’s people, including those living with Month. The theme for 2024 is dementia, caregivers, healthcare practitioners and members #TimeToActOnDementia and #TimeToActOnAlzheimers, of the general public across 166 countries and territories. focused on addressing the stigma and misunderstanding The results were both enlightening and concerning. that is clearly so prevalent.

The report reveals that 65% of healthcare practitioners and Throughout the month, we encourage everyone to take 80% of the general public mistakenly consider dementia to be action to improve dementia awareness worldwide — whether a normal part of ageing. Even more troubling, between 29% on social media, through memory walks or simply in daily (in high-income countries) and 32% (in low and conversations. Together, we can make a difference. 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.

Caring for your loved one with the same compassion you do Dementia Care

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Accelerating research into vascular dementia A new centre will find treatments for vascular dementia and help build a future of healthy brain ageing.

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he 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.

INTERVIEW WITH Prof David Attwell Director, BHF-UK DRI Centre for Vascular Dementia Research, UK Dementia Research Institute WRITTEN BY Kate Sharma Paid for by UK Dementia Research Institute

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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.

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hen 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.

WRITTEN BY Andrew Pike Head of Policy, Campaigns and Public Affairs, Dementia UK

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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.

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t 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.

WRITTEN BY Christopher Stokes President and General Manager Lilly UK, Ireland & Northern Europe

Paid for by Lilly UK

PP-LN-GB-0087 August 2024

A biomarker diagnosis provides clarity for people Call for enhanced Alzheimer’s care and their loved ones while also unlocking access Currently, there are significant barriers to timely to research opportunities now and scientific detection, accurate diagnosis and appropriate innovations in the future. Currently, people with treatment. That’s why we’re calling on the new dementia are waiting up to two years for a diagnosis4 Government to deliver its manifesto commitment — with one in three never receiving one at all.1 to put Britain at the forefront of transforming As a first step, urgent improvement is required so treatment for dementia. that the NHS has the right pathway and infrastructure Our long-standing dedication to Alzheimer’s in place to adopt the newest medical advances. disease is driven by our commitment to improving Currently, England has fewer MRI scanners than lives. Alzheimer’s disease, the most common comparable countries, and only 2% of people in the type of dementia,1 is a debilitating and fatal UK can access advanced diagnostic tests like PET neurodegenerative disease that robs people of their scans or lumbar punctures on the NHS.5 2,3 memories, independence, relationships and futures.

While innovative blood-based biomarker tests, It has a devastating impact that relentlessly increases which have the potential to revolutionise early as it progresses. diagnosis, are being trialled in the UK,5 the availability We are proud to make a difference to people affected of existing infrastructure and tests should be rapidly by the disease not only through expanded. To make this a reality, our research but also through our we are working with leading NHS Urgent improvement commitment to support our local partners across England to enable communities.

Cerebrospinal Fluid Biomarkers is required so that (CSF) testing to be further adopted the NHS has the Alzheimer’s awareness and in clinical practice. community service right pathway and September is World Alzheimer’s Timely action needed for Alzheimer’s infrastructure in place Month, a time dedicated At Lilly, we envision a future to raising awareness and where, within 10 years, timely to adopt the newest challenging the stigma that detection, accurate diagnosis, medical advances. persists around the disease. appropriate treatment and September also marks Lilly’s ultimately prevention will annual Global Day of Service be a reality for people with (GDOS), a day when all employees globally have the Alzheimer’s disease. To realise this, the NHS and chance to volunteer in their communities. Since Government must act now to make Alzheimer’s 2008, GDOS has enabled us to collaborate with disease a political priority and develop a patient leading high-impact organisations, helping us to pathway that supports healthcare systems to adapt drive meaningful progress in addressing community for the benefit of people today and tomorrow. needs.

References Our UK GDOS this year is focused on charities that 1. NHS England (2024). Primary Care Dementia Data, June 2024. Available at: support people living with Alzheimer’s disease, their https://digital.nhs.uk/data-and-information/publications/statistical/primary-caredementia-data/june-2024#:~:text=487%2C432%20patients%20had%20a%20 carers and their loved ones. As such, our team will recorded,patients%20since%2031%20May%202024.&text=65.0%25%20of%20 volunteer across the country to support the vital work patients%20aged%2065,64.8%25%20on%2031%20May%202024. [Accessed of these organisations, extending the reach of our July 2024] 2. EBC and EFPIA (2023). ‘RETHINKING Alzheimer’s disease: Detection 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.

READ MORE AT HEALTHAWARENESS.CO.UK

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]

Find out more at lilly.com/uk

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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).

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ementia 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.

WRITTEN BY Mark MacDonald Associate Director of Evidence, Policy and Influencing, Alzheimer’s Society

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.

Learn more at alzheimers.org.uk

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INTERVIEW WITH Dr Zeke Steer Founder and CEO, Milbotix WRITTEN BY Tony Greenway

Dementia prevention How AI-enabled socks can measure measures you can take to emotional distress in protect brain health today dementia patients Learn how promoting lifelong brain health could be a game-changer for dementia prevention.

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.

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family crisis prompted Dr Zeke Steer to create an innovative wearable technology that detects distress in people living with dementia.

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 AI socks to detect distress early a biological reason for favouring socks “My great-grandmother was over a wristband. One of our sensors diagnosed with dementia,” he measures a sweat response called says. “Her aggressive and agitated electrodermal activity. The soles behaviour became very challenging of the feet have among the highest and my family were eventually left densities of sweat glands on the with no option but body.” to place her in a care Dr Steer is founder home.” and CEO of digital One of our sensors This agitation and health company measures a sweat aggression were the Milbotix. Milbotix is result of pain, anxiety funded by Alzheimer’s response called and confusion linked Society through electrodermal to the dementia. A the Accelerator particular challenge programme, with UK activity. for caregivers is Dementia Research recognising signs of Institute among its distress — especially in people with collaborators. The socks are intended communication difficulties — before for use by families, domiciliary carers they manifest into something more and care home staff and are now in serious. care home trials.

Dr Steer’s research at the Bristol “Following the painful experience Robotics Laboratory led to the design with my great grandmother, I’d like to of AI-enabled socks fitted with sensors see SmartSocks helping people living that measure pulse, temperature, with dementia thrive in whatever place sweat and motion. Caregivers are they call home. The next version of the alerted to the wearer’s distress, product will measure vital signs, track enabling timely care interventions. digital biomarkers of disease and help prevent falls,” says Dr Steer.

Sensors pick up stress signals from sweat glands Contact Milbotix if you’re interested in piloting Socks might not be the most obvious SmartSocks in your service. wearable dementia technology, but

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WRITTEN BY Henry Simmons Chief Executive, Alzheimer Scotland

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here 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.

Take a five-minute brain health quiz: brainhealth.scot/ brainhealthplan

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.

Find out more at milbotix.com

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Only together can we tackle chronic pain

Innovations in Pain Management Pages 10 - 12

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.

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s 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.

Visit versusarthritis.org/research to learn more.

WRITTEN BY Lucy Donaldson Director For Research & Health Intelligence, Versus Arthritis

Paid for by Versus Arthritis

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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.

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ain becomes chronic after three months when Former vice-chair of BPS patient committee Louise tissue healing has usually been completed.

Trewern recalls: “I lived with unexplained pain for Moderate to severe disabling chronic years, leading to high-dose opioid prescriptions. pain affects around 8 million adults in the I transformed my life by tapering off opioids and UK, disrupting lives of individuals, families and managing my pain through activity, diet and sleep.” communities. Back pain is the leading cause of disability, costing Psychological approaches Medicines may UK taxpayers an estimated £10 NICE recommends psychological billion annually. Our approach therapies, such as acceptance and relieve many to managing chronic pain must commitment therapy (ACT) or types of pain but change. cognitive behavioural therapy (CBT) in managing chronic pain for people work best when Medicines have limited effect on aged 16 years and over. ACT improves combined with chronic pain quality of life by enhancing sleep Pain is processed in the and reducing pain and psychological regular activity. nervous system through many distress. These therapies can be mechanisms, but most medicines provided by trained professionals target only one. Medicines may through the NHS or privately. relieve many types of pain but work best when BPS honorary member Pete Moore moved from combined with regular activity, exercise or enjoyable relying on medicines to self-management after activities. Some types of pain may not respond to attending a Pain Management Programme in 1996. medicines or only for short periods.

Since then, he has not needed to take medicines.

Opioids like codeine, morphine and tramadol cause “Empower patients to understand their pain and long-term issues such as constipation, itching, weight then take up self-management strategies,” Moore gain, low sex drive and breathing difficulties. For any advocates. concerns, your care team or pharmacist can advise on maximising benefits and managing side effects.

Find out more at britishpainsociety.org 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.

WRITTEN BY Professor Roger Knaggs BSc BMedSci PhD EDPM FHEA FFRPS FRPharmS FFPMRCA, Professor of Pain Management at the University of Nottingham and Specialist Pharmacist, Primary Integrated Community Services and President of the British Pain Society

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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.

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uch 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.

INTERVIEW WITH Dr Hartley Atkinson Managing Director, AFT Pharmaceuticals Ltd WRITTEN BY Tony Greenway

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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.”

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 Playing a part in reducing opioid use in 2019.1 Too many people are using opioids to manage Dr Hartley believes this pain relief — which has been everyday moderate pain such as headaches, available in UK pharmacies for around a toothache, sore throat and sprains; yet year — could play a role in helping to combat Our studies have shown sustained long-term use of these drugs the opioid crisis. “Doctors will still need to that relief is around increases the likelihood of addiction. consider giving their patients combinations 80% stronger than “Studies have shown that 10% or more of of multiple painkillers,” he says. “But having paracetamol alone and patients who are discharged from hospital access to an additional strength analgesic on opioids are still using them three months gives them options, which is what they have around 30% stronger later,2 and that’s just not appropriate,” says been asking for. It can minimise the amount than ibuprofen alone.

Dr Atkinson. of time that a patient spends on opioids — or help them avoid opioids altogether.”

Faster pain relief References Part of the answer is to give healthcare professionals 1. Roberts, A.O. and Richards, G.C. (2023) ‘Is England facing an opioid epidemic?’, British and patients a range of different pain relief options. For 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 example, Dr Atkinson’s company has created a specific, after hospital stay: A systematic review’, Drugs, 80(10), pp. 989-1004. https://doi.org/10.1007/ over-the-counter, codeine-free analgesic, which combines s40265-020-01294-z.

500mg of paracetamol and 150mg of ibuprofen (both 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. non-opioids) per tablet.

4. Daniels, S.E., et al. (2018) ‘Analgesic efficacy of an acetaminophen/ibuprofen fixed-dose “We found that combining paracetamol and ibuprofen combination in moderate to severe postoperative dental pain: a randomized, double-blind, in these ratios produces a very good level of pain relief,” parallel-group, placebo-controlled trial’, Clinical Therapeutics, 40(10), pp. 1765-1776. 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.

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ealthcare professionals routinely monitor four measurable vital signs: (1) body temperature; (2) pulse rate; (3) respiration rate (rate of breathing); and (4) blood pressure.

WRITTEN BY Roland Watson Chair, Pain UK (CIO)

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

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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,

Scan the QR code to find out more.

This article is for informational purposes only.

For professional medical advice, consult your GP.

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.

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.

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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.

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ngoing research reveals biases, stereotypes and disparities in pain management contributing to the unequal identification and treatment of women’s pain.

INTERVIEW WITH Dr Bill Laughey Senior Medical Scientist, Reckitt WRITTEN BY Bethany Cooper

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.

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Nurofen is the manufacturer of Nurofen 200mg tablets. For short-term, mild to moderate pain. Contains ibuprofen. Always read the label. RKT-M-68879

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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.”

Scan the QR code to download your Pain Pass

Reference 1. Gender Pain Gap Index Report. Year 1. September 2022.

2. Gender Pain Gap Index Report. Year 2. November 2023.

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