Cardiovascular disease profile Heart disease Background This chapter of the Cardiovascular disease profiles focuses on coronary heart disease (CHD) and heart failure and is produced by the National Cardiovascular Intelligence Network (NCVIN). The profiles are available for each clinical commissioning group (CCG) in. Each profile is made up of five chapters which look at risk factors, coronary heart disease (CHD) and heart failure, diabetes, kidney disease and stroke. This profile compares the CCG with data for, a group of similar CCGs and the South West Coast strategic clinical network (). Key facts Comparator CCGs Key information August 214 The total population of NHS Wiltshire CCG is 477, and 9,5 of these people are aged 65 and over, a higher proportion than across as a whole. In the CCG, 2.% of people live in the most deprived fifth of areas in. In 212/13 there were 15,612 people who had been diagnosed with CHD in. Based upon Health Survey for results applied to this CCG, the total number of CHD cases diagnosed is likely to be around 22,5. Coronary heart disease prevalence 3.3% 3.3% 3.4% 3.3% Early mortality (under years) rates from coronary heart disease are significantly lower than the national rate and they have decreased by 5% since 22. Heart failure prevalence Estimated prevalence of CHD CHD early mortality (rate per 1,).8%.7%.8%.7% 4.6% 4.5% 5.% 4.6% 35.6 _ 34.8 42.4 Getting treatment quickly is important in emergency treatment of serious heart attack, where the coronary artery is blocked. For these patients in 212/13, the median time to primary PCI treatment from a call for help was 124 minutes in Bath, Gloucestershire, Swindon and Wiltshire area team. This is higher than (112 minutes). PCI is a procedure used to treat the narrowed or obstructed coronary arteries of the heart. Produced by the National Cardiovascular Intelligence Network (NCVIN) PHE publications gateway number 21413 Crown copyright 214 www.gov.uk/phe www.ncvin.org.uk Page 1
Heart disease August 214 Prevalence Prevalence is the number of people in a given population with a particular condition at a point in time. The diagnosed prevalence of CHD and heart failure is calculated from the returns submitted to the Health and Social Care Information Centre (HSCIC) as part of the Quality and Outcomes Framework (QOF) by each GP practice. Diagnosed prevalance is the number of all patients who are on a practice's CHD or heart failure register on the 31 March in a given financial year. Practice returns are combined to calculate a prevalence rate for the local CCG. The estimated prevalence of CHD is taken from the East of Public Health Observatory modelled estimates in 211 for people aged 16 and older, based on diagnosed CHD estimates of the general population. The model was developed using data from the 23-24 Health Surveys for and takes into account age, sex, ethnicity, smoking status and deprivation. Coronary heart disease and heart failure prevalence, 212/13 (percentage) Heart failure prevalence Coronary heart disease prevalence.8.55 3.3 3.34.7.79 3.3 3.95.8.76 th East Coast 3.4 3.67.7.71 3.3 2.31 1 2 3 4 5 6. 1. 2. 3. 4. 5. Source: Quality and Outcomes Framework (QOF), 212/13, Copyright % 214, re-used with the permission of the Health and Social Care Information Centre. All rights reserved Variation by general practice coronary heart disease prevalence, 212/13 (percentage) Diagnosed CHD prevalence (QOF) CCG diagnosed CHD prevalence 1% 8% 6% 4% 2% % (practices censored at 1%) Crown copyright 214 www.gov.uk/phe www.ncvin.org.uk Page 2
Heart disease August 214 Care processes and treatment indicators There are five QOF CHD treatment indicators which describe the management of CHD in primary care. The graphs below and on the next page present achievement against four of the six QOF CHD clinical indicators for the CCG as a whole and for the practices within the CCG. Patients with coronary heart disease in whom the last blood pressure reading (measured in the preceding 15 months) is 15/9 or less CHD-6, 212/13 (percentage).43.18.2. 88.5 8.1 88. 9.1 88.2.1 8.7 1 2 3 88.1 4 5 6 7 8 9 1 9.2 % 1 2 3 4 5 6 7 8 9 1 Variation by general practice for CHD-6, 212/13 (percentage) CCG optimal treatment 1 5 Patients with coronary heart disease whose last measured total cholesterol is 5 mmol/l or less (CHD-8), 212/13 (percentage) Patients with coronary heart disease whose last measured total cholesterol is 5 mmol/l or less CHD-8, 212/13 (percentage) 72.4 72.2 72.3 72.5.1 1 2 3 4 5 6 7 8 9 1 1 % 2 3 4 5 6 7 8 9 1 Variation by general practice for CHD-8, 212/13 (percentage) Optimal treatment Non optimal treatment Exceptions CCG optimal treatment 1 5 16.3 17.8 17.1 18. Crown copyright 214 www.gov.uk/phe www.ncvin.org.uk Page 3
Heart disease August 214 Care processes and treatment indicators Patients with CHD with a record in the preceding 15 months that aspirin, an alternative anti-platelet therapy or an anti-coagulant is being taken (CHD-9), 212/13 (percentage) Backgr 9.2 ound 9.6 91.3 6.1.1 1 2 3 9.7 4 5 6 7 8 9 1 6.6 1 % 2 3 4 5 6 7 8 9 1 Variation by general practice for CHD-9, 212/13 (percentage) 7.3 6.7 Optimal treatment Non optimal treatment Exceptions CCG optimal treatment 1 5 Patients with a history of heart attack on or after 1 April 211 currently treated with an ACE-I, aspirin or an alternative anti-platelet therapy, beta-blocker and statin CHD-14, 212/13 (percentage) 66.3 8.1 66. 8.8 64.3 8.5.1 68. 9.1 1 2 3 4 5 6 7 8 9 1 1 % 2 3 4 5 6 7 8 9 1 Variation by general practice for CHD-14, 212/13 (percentage) Optimal treatment Non optimal treatment Exceptions CCG optimal treatment 1 5 Crown copyright 214 www.gov.uk/phe www.ncvin.org.uk Page 4
DSR per 1, DSR per 1, Heart disease August 214 Primary management of heart attack Specialist treatment, combined with cardiac rehabilitation, leads to better outcomes and optimal quality of life. Heart attack, or myocardial infarction, is part of the spectrum of conditions known as acute coronary syndromes (ACS). This term includes serious heart attack where the coronary artery is blocked, for which emergency treatment is required to restore blood flow through the arteries quickly. Primary percutaneous coronary intervention (primary PCI), if performed in a timely fashion, is the recommended treatment for these patients - referred to as ST elevated MI (STEMI). The Myocardial Ischaemia National Audit Project (MINAP audit) recorded 4 patients in the Bath, Gloucestershire, Swindon and Wiltshire area team who received primary PCI in 212/13. 45.6% of eligible patients patients received primary angioplasty within 12 minutes of calling for help (call-to-balloon) including those admitted directly or transferred to a Heart Attack Centre. Primary PCI median time to treatment from calling for help, for STEMI patients, 212/13 Bath, Gloucestershire, Swindon and Wiltshire area team 124 112 2 4 6 8 1 12 14 Source: MINAP 212/13 Time in minutes Management - hospital admissions In 212/13 the emergency admission rate for CHD, in was 5 for every 1, people in the population (2,453 admissions). This is significantly lower than (5.1 per 1,). In 212/13 the emergency admission rate for heart failure all persons, in was 19.8 per 1, (522 admissions). This is significantly lower than. The emergency admission rate for heart failure in has decreased by 7% between 22/3 and 212/13. Coronary heart disease Heart failure 8 6 4 3 4 2 2 1 Year Year Source: Hospital Episode Statistics (HES), 212/13, Copyright 214, Re used with the permission of The Health and Social Care Information Centre. All rights reserved Crown copyright 214 www.gov.uk/phe www.ncvin.org.uk Page 5
Heart disease August 214 Heart failure - deaths at home The National Institute for Health and Care Excellence (NICE) have identified the need for palliative care in heart failure. Around 4% will die within a year of diagnosis and the quality of life may well be poorer than with other illnesses. Most people would prefer to die at home if there is sufficient support. Proportion of deaths from heart failure that occur at home or place of residence, 211-212 (percentage) 38.4 61.6 58.5 1 2 3 4 5 6 7 8 9 1 Source: Office of National Statistics (ONS) mortality data 212 Early mortality from CHD, 22-212 (rate per 1, people) 18 16 14 12 Directly standardised rate per (1, people) 1 8 6 4 2 22 23 24 26 27 28 29 21 211 212 Source: ONS mortality data 212 Year The Public Health Outcomes Framework includes an objective for reducing numbers of people dying prematurely. One of the indicators for this objective is mortality under from cardiovascular disease and CHD is the largest contributor for cardiovascular disease (45%). In 212, the early mortality rate for CHD in was 35.6 per 1,. This is a decrease of 5% since 22, which is similar to the change. In, the mortality rate has decreased by 51% over the same 1 years. The rates in the South West Coast strategic clinical network has decreased by 52% over the same time period. NCVIN - links to other sources of key heart data NICOR heart audits British Heart Foundation heartstats www.ucl.ac.uk/nicor/audits www.bhf.org.uk/research/heart-statistics.aspx A list of references for each chapter is given in the indicator guide for the profiles. Crown copyright 214 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.. To view this licence, visit OGL or email psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to ncvin@phe.gov.uk www.gov.uk/phe www.ncvin.org.uk Page 6