The Silent Symptoms of Heart Disease: Why Prevention Starts in Our Communities

September 29, 2026

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By Helfie Population Health Lead, Christelle Kelley BSc (hons), MSc, RN

At the end of the hospital bed

I have one of the best jobs in medicine. After many years as a nurse and then Advanced Nurse Practitioner, I now get to work at both ends of the scale at once — still seeing patients face to face in clinic, and also helping shape how we care for people at population level, across countries, with the reach that technology and AI now make possible. A decade of these wonderful years was spent in acute cardiology, caring for patients who had experienced acute cardiovascular events: heart attacks, cardiac arrests, strokes, heart failure. As my years in that unit progressed, I became increasingly aware of a missing puzzle piece. By the time I was standing at the end of that hospital bed, the patient was already far along a much bigger journey that had brought them to hospital — a journey on which there had been so many opportunities to prevent their cardiac event, or at least reduce its severity.

The Silent Killer

One of the most significant factors that we screen for is hypertension (high blood pressure). It’s often called the Silent Killer, because in some individuals it rarely announces itself until it has already contributed significantly to the development of heart disease. High blood pressure, however, isn’t the only silent symptom of heart disease. The other silent symptoms are out in our communities – poverty, poor housing, loneliness, depression, anxiety, inadequate diets or exercise, lack of green space and more. These symptoms are not silent because they make no sound. They are silent because they are less heard in the narrative of heart disease. They often sit outside of a short consultation, outside of the diagnosis and often outside of the treatment plan, given that these factors are so enormous to tackle.

Only half the story

Across health systems, however, we know that when we neglect to take these factors into consideration, our understanding of risk is less accurate creating further inequalities in access to treatment or prevention. It’s a crucial part of the story. We are starting to tackle this with flagship projects in many health systems, focussing on place level care. In the UK integrated neighbourhood teams integrate clinical, social and voluntary services around specific communities with increasing success. This is why the neighbourhood approach to health matters — not just clinics and hospitals, but teams working within communities who can see, name, and begin to address these wider determinants of health in their own right. But recognition at system level is only half the story. The people whose lives are shaped by these determinants of health need to be able to see them too — not to solve them alone, which is neither fair nor realistic, but to recognise which of these puzzle pieces affect them most, and what kind of help might make a difference. When people can see their own picture clearly, and health systems are ready to meet them where they are, support becomes something both sides are ready for — not something offered too late, or missed altogether.

The moment has gone

Where hypertension and its community counterparts are sometimes silent, the other symptoms of heart disease are not silent at all —but they do often pass us by. They are often missed opportunities. The chest tightness on a walk uphill. The breathlessness climbing stairs that didn’t used to be a problem. The palpitations at 3am that have settled by morning. These symptoms are loud enough, in the moment. But by the time we book an appointment or by the time one is offered in a stretched health system, the moment has gone. We tell ourselves it was the glass of wine, a stressful week or simply part of getting older. The symptom may be dismissed or find its way further down the to do list, not because it didn’t matter, but because our care is built around a moment in time — an appointment, a check-up, a single reading — while the body moves continuously, in the background of ordinary life.

Technology as a steward

What silence and fleeting moments both point to is complexity — not just the complexity of the body, but of systems, of government, of housing and income, and of human behaviour and choice. None of these exist in isolation, picked up in separate appointments or siloed services. They are all part of the same journey, for a person and for the community they belong to. Prevention is a systems and community challenge, not just a personal-responsibility one — and preventing heart disease means navigating that complexity together, in the moment someone is ready and motivated to engage.

This is where technology can act as a steward — a quiet, constant presence that listens for all of these things at once: the wider conditions someone lives in, the question someone has at the moment that they have it, the change in a vital sign at the moment a symptom appears. It can weave these fragments into a single story, for the individual and for the community around them, and use that story to bring the right person to the right clinician sooner, help clinicians reach more patients at the right time, and help health systems see risk before it becomes a crisis.

The heart doesn’t work alone

In my many years nursing hearts, I also learned that the heart doesn’t work alone. It is in constant conversation with the rest of the body and mind – its work is shaped by our hormones, our lungs, our kidneys and more, all working together. The heart is not the beating centre in isolation – and neither are we, or our health systems or our technologies. Tackling heart disease is a work of symbiosis — of finding people rather than waiting for them, and helping them want to be found. That’s the work I get to do now – working across all these moving parts, to make a difference. That’s why I have one of the best jobs in medicine.

Sources

Kimenai DM, Pirondini L, Gregson J, et al. Socioeconomic deprivation: an important, largely unrecognized risk factor in primary prevention of cardiovascular disease. Circulation. 2022;146(3):240–248. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060042
NHS Cornwall and Isles of Scilly. NHS Cornwall and Isles of Scilly integrated neighbourhood teams. Accessed 9 October 2026. https://cios.icb.nhs.uk/ica/nhs-cornwall-and-isles-of-scilly-integrated-neighbourhood-teams/
World Health Organization. Determinants of health. Published 4 October 2024. https://www.who.int/news-room/questions-and-answers/item/determinants-of-health

By Helfie Population Health Lead, Christelle Kelley BSc (hons), MSc, RN

At the end of the hospital bed

I have one of the best jobs in medicine. After many years as a nurse and then Advanced Nurse Practitioner, I now get to work at both ends of the scale at once — still seeing patients face to face in clinic, and also helping shape how we care for people at population level, across countries, with the reach that technology and AI now make possible. A decade of these wonderful years was spent in acute cardiology, caring for patients who had experienced acute cardiovascular events: heart attacks, cardiac arrests, strokes, heart failure. As my years in that unit progressed, I became increasingly aware of a missing puzzle piece. By the time I was standing at the end of that hospital bed, the patient was already far along a much bigger journey that had brought them to hospital — a journey on which there had been so many opportunities to prevent their cardiac event, or at least reduce its severity.

The Silent Killer

One of the most significant factors that we screen for is hypertension (high blood pressure). It’s often called the Silent Killer, because in some individuals it rarely announces itself until it has already contributed significantly to the development of heart disease. High blood pressure, however, isn’t the only silent symptom of heart disease. The other silent symptoms are out in our communities – poverty, poor housing, loneliness, depression, anxiety, inadequate diets or exercise, lack of green space and more. These symptoms are not silent because they make no sound. They are silent because they are less heard in the narrative of heart disease. They often sit outside of a short consultation, outside of the diagnosis and often outside of the treatment plan, given that these factors are so enormous to tackle.

Only half the story

Across health systems, however, we know that when we neglect to take these factors into consideration, our understanding of risk is less accurate creating further inequalities in access to treatment or prevention. It’s a crucial part of the story. We are starting to tackle this with flagship projects in many health systems, focussing on place level care. In the UK integrated neighbourhood teams integrate clinical, social and voluntary services around specific communities with increasing success. This is why the neighbourhood approach to health matters — not just clinics and hospitals, but teams working within communities who can see, name, and begin to address these wider determinants of health in their own right. But recognition at system level is only half the story. The people whose lives are shaped by these determinants of health need to be able to see them too — not to solve them alone, which is neither fair nor realistic, but to recognise which of these puzzle pieces affect them most, and what kind of help might make a difference. When people can see their own picture clearly, and health systems are ready to meet them where they are, support becomes something both sides are ready for — not something offered too late, or missed altogether.

The moment has gone

Where hypertension and its community counterparts are sometimes silent, the other symptoms of heart disease are not silent at all —but they do often pass us by. They are often missed opportunities. The chest tightness on a walk uphill. The breathlessness climbing stairs that didn’t used to be a problem. The palpitations at 3am that have settled by morning. These symptoms are loud enough, in the moment. But by the time we book an appointment or by the time one is offered in a stretched health system, the moment has gone. We tell ourselves it was the glass of wine, a stressful week or simply part of getting older. The symptom may be dismissed or find its way further down the to do list, not because it didn’t matter, but because our care is built around a moment in time — an appointment, a check-up, a single reading — while the body moves continuously, in the background of ordinary life.

Technology as a steward

What silence and fleeting moments both point to is complexity — not just the complexity of the body, but of systems, of government, of housing and income, and of human behaviour and choice. None of these exist in isolation, picked up in separate appointments or siloed services. They are all part of the same journey, for a person and for the community they belong to. Prevention is a systems and community challenge, not just a personal-responsibility one — and preventing heart disease means navigating that complexity together, in the moment someone is ready and motivated to engage.

This is where technology can act as a steward — a quiet, constant presence that listens for all of these things at once: the wider conditions someone lives in, the question someone has at the moment that they have it, the change in a vital sign at the moment a symptom appears. It can weave these fragments into a single story, for the individual and for the community around them, and use that story to bring the right person to the right clinician sooner, help clinicians reach more patients at the right time, and help health systems see risk before it becomes a crisis.

The heart doesn’t work alone

In my many years nursing hearts, I also learned that the heart doesn’t work alone. It is in constant conversation with the rest of the body and mind – its work is shaped by our hormones, our lungs, our kidneys and more, all working together. The heart is not the beating centre in isolation – and neither are we, or our health systems or our technologies. Tackling heart disease is a work of symbiosis — of finding people rather than waiting for them, and helping them want to be found. That’s the work I get to do now – working across all these moving parts, to make a difference. That’s why I have one of the best jobs in medicine.

Sources

Kimenai DM, Pirondini L, Gregson J, et al. Socioeconomic deprivation: an important, largely unrecognized risk factor in primary prevention of cardiovascular disease. Circulation. 2022;146(3):240–248. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.060042
NHS Cornwall and Isles of Scilly. NHS Cornwall and Isles of Scilly integrated neighbourhood teams. Accessed 9 October 2026. https://cios.icb.nhs.uk/ica/nhs-cornwall-and-isles-of-scilly-integrated-neighbourhood-teams/
World Health Organization. Determinants of health. Published 4 October 2024. https://www.who.int/news-room/questions-and-answers/item/determinants-of-health

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