Cardiovascular disease

Cardiovascular disease (CVD) is a general term that describes a disease of the heart or blood vessels. This group of diseases incudes coronary heart disease, heart failure, stroke as well as peripheral artery disease and aortic disease. Aortic aneurysms are discussed in greater detail in the chapter ‘non-cancer screening’. Chronic kidney disease and diabetes are related conditions as they share risk factors with CVD and are associated with a greater risk of CVD.

Cardiovascular disease causes more than a quarter of all deaths in the UK, or around 155,000 deaths each year - an average of 425 people each day or one every three minutes. Around 41,000 people under the age of 75 in the UK die from CVD each year and there are an estimated 7 million people living with cardiovascular disease in the UK.

The cost to the UK of premature death, lost productivity, hospital treatment and prescriptions relating to CVD is estimated at £19 billion each year. Healthcare costs alone total an estimated £8 billion.

(Source: BHF Cardiovascular Disease Statistics 2015)

What do we know?

Risk factors for cardiovascular disease include those that cannot be modified for example age, gender, family history and ethnicity as well as factors that can be modified for example lifestylefactors.

Lifestyle risk factors for cardiovascular disease overlap with risk factors for many other non-communicable diseases such as diabetes, cancer and chronic lung disease. They include poor diet, physical inactivity, smoking and excess alcohol. These risk factors are also known to cluster and are associated with socioeconomic status.

Despite still being the leading cause of death, deaths from cardiovascular disease in England have in fact almost halved since 1990 (Source: Global Burden of Disease Study). This reduction in deaths is not due to a reduction in disease prevalence, but rather because treatment of CVD has improved significantly. This is particularly true for coronary heart disease. In fact, the number of operations to treat coronary heart disease have increased tenfold over the last three decades (Source: Townsend et al 2014).

Facts, Figures, Trends

Risk factors

Obesity & Inactivity

Using modelled estimates from the Health Survey for England, it is estimated that 25.7% of the adult population in Slough are obese compared with 23% in England and 21.1% in South East. (NOO, PHE, 2015). New data on physical inactivity in adults shows that Slough is now ranked 95th with 53.5% not meeting the national guidelines.

In Slough the prevalence of obesity among children entering school in reception is now in line with the national average at 9.8% (2014/15) and at age 10 – 11 years remains statistically above national rates at 24.2%.These figures relate to children with Slough postcodes rather than schools with Slough postcodes (Source: National Child Measurement Programme 2014/15).

Smoking

It is estimated that 19.9% of the population in Slough smoke (Integrated Household Survey IHS). This is lower than the estimated proportion in England (20.7%) and higher than Thames Valley (18.0%). The rate of smoking related deaths is 298 per 100,000. This represents 136 deaths per year. Estimated levels of adult smoking are worse than the England average but have fallen from 22% to 19% (Health Profile, 2015).

Increasing and high risk drinking (combined)

It is estimated that 18.9% of the population in Slough have increasing or high risk drinking behaviour (General Household Survey). This is lower than England (22.3%) and lower than Thames Valley (23.3%).

Hypertension

Hypertension is both a risk factor for further cardiovascular disease as well as being classified as a condition in itself. Over 10% of patients registered with GPs in Slough have been classified as having high blood pressure (hypertension) . This is approximately half the number of people in Slough estimated to be living with high blood pressure.

Disease prevalence

Figure 1 illustrates the prevalence of recorded cardiovascular diseases in Slough compared with the National figures. It is important to note that looking at the numbers of people currently being treated for a disease does not show the true prevalence of the disease or impact on a population’s health. There will also be many people who have a disease or condition that are not aware of it and have not been diagnosed.

In fact, while 10% of the population of Slough are recorded by their GP as having high blood pressure (hypertension), it is estimated that the true prevalence in Slough 19.5%. This suggests that half the people with hypertension in Slough have not been identified.

Figure 1. Recorded prevalence of Cardiovascular diseases in Slough (2013/14)

Figure 1

Outcomes

Following national trends, deaths due to cardiovascular disease in Slough are also falling. Figure 2 illustrates the change in CVD deaths over the last 10 years.

Although falling, the death rate in Slough remains higher than the national average as well as similarly deprived local authorities. In fact, Slough is ranked 32nd out of 326 district and unitary authorities in England for rates of premature (under 75) cardiovascular deaths

Figure 2. Cardiovascular Mortality in Slough from 2001-2013


Figure2

National & Local Strategies (Current best practices)

The Cardiovascular Disease Outcomes Strategy (2013) identifies for commissioners and providers of health (including public health) and care services the ten key actions that will make a difference in improving outcomes for CVD patients, in line with the NHS, Public Health and Adult Social Care Outcomes Frameworks. These include:

  • Managing CVD as a single family of diseases
  • Improving prevention and risk management
  • Improving case finding in primary care and better identification of high risk
  • Better early management and secondary prevention in the community
  • Improving acute and chronic care
  • Improving end of life care
  • Improving intelligence, monitoring and research and support commisioning

These actions build on continuing implementation of the National Service Frameworks for coronary heart disease, diabetes and renal services and the Stroke Strategy. The Strategy also outlines evidence-based interventions and their potential costs for each activity area. Additional useful analyses can be found through NHS Englands Commissioning for Value packs.

The NICE Guidance PH25: Cardiovascular disease prevention provides both recommendations for national policy as well as recommendations for local practice. Practice recommendations include actions on providing a sustainable regional CVD prevention programme.

Local Activity

  • NHS Health Check
    HS Health Checks is a national scheme that targets people aged 40 to 74 to assess, and then help reduce their risk of chronic diseases including cardiovascular diseases by offering tailored advice.
  • Berkshire East Healthy Hearts
    Healthy Hearts is a programme that works with those at high risk of cardiovascular disease, as identified though the NHS Health Check programme, to provide a structured diet and exercise programme.
  • NHS Diabetes Prevention Programme (in development for 2016)
    The National Diabetes Prevention Programme seeks to identify those at high risk of developing diabetes and provide a 9 month intensive structured diet and exercise programme.
  • Integrated Cardiac Prevention Programme
    Work is underway to design an integrated cardiac prevention programme that works alongside the existing risk-reduction programmes (NHS healthchecks, NHS diabetes prevention programme, Healthy Hearts) to provide both a primary prevention service, as well as a cardiac rehabilitation programme which will act as a secondary prevention service.

What is this telling us?

Despite significant improvements in the treatment of cardiovascular disease, and resulting reductions in mortality; the number of people in Slough at risk of or currently being treated for cardiovascular diseases continues to rise. Prevention, therefore, is a priority.

There is scope to review the current provision of various preventative programmes to align services and prevent duplication of efforts. Work is already underway on this, as well as the design of an integrated community cardiac rehabilitation programme.

What are the key inequalities?

  • Deprivation
    Risk factors for cardiovascular disease including poor diet and smoking are known to be associated with socioeconomic deprivation. Mortality from cardiovascular disease is similarly associated with deprivation with the rate of death in the most deprived decile in England being 73% higher than in the least deprived decile.
  • Gender
    The mortality rate from cardiovascular disease in males in Slough is over double that of females. This reflects the trend nationally.
    (Source: Fingertips Public Health Outcomes Framework)
  • Mental Health
    People with mental health problems have a much higher incidence of CVD, and poorer outcomes. Depression has been associated with a four-fold increase in the risk of cardiovascular disease, even when other factors are controlled.
    (Source: The Cardiovascular Disease Outcomes Strategy (2013)
  • Ethnicity
    South Asian men are more likely to develop CHD at younger age, and have higher rates of myocardial infarction. In the UK, mortality from IHD in both South Asian men and women is 1.5 times that of the general population. (Source: Chaturvedi et al 2003) The proportion of the population in Slough which is from black and minority ethnic groups is estimated to be 54.3% (Source: Census, 2011).

What are the unmet needs/ service gaps?

  • There remains a need for greater primary prevention of cardiovascular disease through risk factor reduction in the population
  • Locally accessible cardiac rehabilitation in the community is needed – the business case for this service is currently in development
  • Reducing inequalities by targeting hard-to-reach groups remains a priorty

Recommendations for consideration by other key organisations:

  • Promotion of local and national healthy lifestyle programmes and campaigns including:
    • Get Active Slough
    • Smoke Free Berkshire
    • Healthy Hearts
    • Change4Life
  • Implementation and integration of the National Diabetes Prevention Programme
  • Development and integration of a community cardiac rehabilitation service