Who are the “missing millions”? Making sense of the CVD Modern Service Framework

July’s Cardiovascular Disease Modern Service Framework set a clear ambition for the NHS: find the millions of people living with cardiovascular-kidney-metabolic risk who don’t yet know they are affected. Three weeks after publication, Lifeyear’s Co-founder and Chief Medical Officer, Dr Eleanor Wicks, set out on LinkedIn why the “missing millions” are harder to find than the headline suggests.

Dr Wicks argues the missing millions fall into three groups: people who are undiagnosed, people who are diagnosed but not treated to target, and people who are referred to care but never arrive. Citing Greater Manchester’s prevention programme, which identified more than 135,000 high-risk people and delivered over 73,000 enhanced cardiovascular reviews in a year, preventing an estimated 200 strokes and 180 heart attacks, she highlights that data infrastructure has to come before outreach, and that finding people without the capacity to treat them can do more harm than good.

The piece also points to inequity as central to the challenge: people in the most deprived communities develop cardiovascular disease earlier, are diagnosed later, and are four times more likely to die from it. For Dr Wicks, the second and third kinds of “missing”, found but not treated to target, or referred but never followed up, are exactly the gap Lifeyear’s remote care platform is built to close.

Read Dr Wicks’ full piece on LinkedIn.