Cardiac and vascular disease urgently needs a strategy that goes further and wider than the current framework and improves access to high quality services for far more people.

No-one working in health could miss the fact that heart disease has been a priority issue over the past decade. Politicians, health policy makers and NHS managers have given the UK's biggest killer the attention it deserves. The national service framework for coronary heart disease translated this concern into action by taking a root and branch approach to improving prevention, treatment and care of people who have or are at risk of coronary heart disease.

And the plan has worked. Deaths due to heart disease have fallen by more than 40 per cent - an impressive five years earlier than the framework planned for. Waiting times for heart surgery are down. Numbers of consultant cardiologists are up.

Prevention is also improving, with tobacco control measures helping to cut the number of smokers. And incentives encouraging GPs to prescribe statins - and the availability of these drugs over the counter - mean millions of people are at lower risk of furred arteries.

The government has rightly taken credit for these major achievements. The Department of Health has been happy with progress, sounding a possibly premature victory cry in its 2004 progress report Winning the War on Heart Disease.

But the cardiovascular community is worried. The service framework was published in 2000, so it is fast approaching its sell by date of early 2010 but there are as yet no confirmed plans to replace it.

A lot has been achieved but there is still a lot to do. The death rate may be down, but cardiac and vascular conditions remain the leading cause of death in the UK. And the numbers of people living with these diseases are set to increase as effective treatments and surgery enabling people to survive heart attacks and strokes mean they need ongoing care. The ageing population will only add to this.

The cardiovascular community wants more. Not a replica of the current framework but a plan that goes further and wider, covering not just heart disease but embracing related conditions such as stroke, diabetes, chronic kidney disease, transient ischaemic attacks (mini strokes) and peripheral vascular disease (affecting the blood vessels in the legs and arms). Joined up thinking is crucial because of the many common risk factors across cardiac and vascular disease.

We believe it makes sense to develop a new strategy for cardiac and vascular disease that recognises links and make recommendations to achieve progress across all these conditions.

There are clearly items remaining on the to-do list from the framework that should go straight into the new plan. Rehabilitation can make all the difference between someone who has had a heart attack or stroke getting back to the activities they enjoyed before they became ill or being limited by ongoing disability.

Wider strategy

The framework promised cardiac rehabilitation would be available to 85 per cent of heart patients by 2002, but a recent national audit of cardiac rehabilitation warned that around 60 per cent of the patients who need it are denied the chance of taking part and many programmes are unable to meet clinical guideline standards. A new strategy needs to draw on the experience gained, setting out what excellence looks like and providing the resources needed.

End of life care is an area that needs more work. Huge progress has been made in improving the care of people dying with cancer. But people dying of cardiac and vascular conditions often miss out on specialised palliative care.

Concern is so great that the cardiovascular community has come up with an unprecedented response and a recommended plan of its own. Destination 2020: a plan for cardiac and vascular health - a voluntary sector vision for change - will be launched later this month.

These recommendations have been developed by the Cardiac and Vascular Coalition: 41 voluntary and professional organisations with an interest in promoting cardiac and vascular health in England. They represent the voices of patients, carers and health professionals - experts with an understanding of how to tackle cardiovascular disease on the front line.

Parts of the DH whisper that developing a new strategy across all cardiovascular diseases is a Herculean task. Yet politicians across all political parties have met and engaged with the coalition project and our vision for change. We are confident politicians and health policy makers will listen and act on our recommendations, which serve the interests of millions of patients.

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