Heart czar Roger Boyle has claimed the NHS could reach its long-term goal for cardiovascular disease, three or four years ahead of schedule, and said greater use of disease management would play a large role.

Addressing the Guidelines in Practice conference on implementing the new GMS contract in conjunction with key national service frameworks, Professor Boyle reiterated his proud claim that premature death rates due to heart disease had fallen 23% between 1995 and 2002.

If deaths continue to decline at this rate, the government's long-term goal of cutting by 40% premature deaths due to cardiovascular disease by 2010 could be reached several years earlier.

He was careful to demand no lapse into complacency in the health service after the national press magnified his claims when presenting the progress.

"I made the mistake of extrapolating this figure and said deaths in the under 65s might actually be a thing of the past within the next ten years - this caught the press' imagination."

He said: "When I got on South West trains to go to work I read a headline that I thought might nearly put me out of a job!", The Times heralding 'End of Heart Attack' and the Express reporting 'End to Heart Disease'.

The government admits that it is not sure about the exact reasons behind the sharp fall in deaths, and will be trying to ascertain which factors have been the most significant, but in the meantime Professor Boyle called for efforts to continue.

"The big downside is in an increase in reported hypertension. I am not sure if this is an actual rise or better recognition of the condition. Certainly, the rate of stroke does not seem to be declining as rapidly as the rate of heart disease, so I would make a plea for you to be very vigilant in regard to that."

Professor Boyle also added his voice to the growing debate around the idea of banning smoking in public places, and said a recent visit to Ireland had further convinced him that the UK should follow suit.

"We have got to convince our ministers that we should go down the same route, even it is simply in allowing local legislation to be passed in cities."

He added:  "I am working hard to persuade them that it not going to be denigrating to them in the polls to be a bit more direct."

Meanwhile, the heart czar said the increasing use of statins had undoubtedly played a part in reducing deaths, and said studies showed around 59% of high risk patients were now on statins, having risen from 20% to 30% in just a few years and comparing to approximately 35% in the US.

When asked about his thoughts on new research suggesting patients would benefit from very high doses of atorvastatin (Pfizer's Lipitor), he commented: "You have to be careful how you interpret these studies,adding: "That's why there is so much uncertainty about where we get the most cost-effective approach and that's why we have referred it to NICE."

He concluded:  "I think it's a big issue but it's not as important as the issue of compliance - if you are spending £2 million a day just to fill up people's bathroom cabinets it not a good use of NHS resources."

Disease management techniques adapted from US models are becoming increasingly important in the NHS agenda, something which Professor Boyle says will provide strong arguments for a shift in resourcing from secondary to primary care.

New areas of focus within the coronary heart disease national service framework include greater diagnosis and treatment of heart failure and an increase in ACE inhibitor prescribing for people with diabetes.

Meanwhile, a new consultation has been launched to add a chapter to the NSF to tackle heart arrhythmias which affect up to 700,000 people in the UK.

The severity of arrhythmias, a disturbance of the heart rhythm, ranges from a minor health inconvenience to a fatal rhythm disturbance, including sudden adult cardiac death syndrome (SADS) which kills around 400 people every year.

Three charities, STARS (Syncope Trust and Reflex Anoxic Seizures), SADS UK (Sudden Adult Death Syndrome) and CMA (Cardiomyopathy Association), teamed up with medical groups and industry to form the Arrhythmia Alliance.

For more information visit the website at: www.aaaw.org.uk

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