Cardiovascular disease (CVD)

Introduction

Cardiovascular diseases are a group of disorders of the heart and blood vessels and are mainly caused by blockages that prevent blood from flowing to the heart, brain and other parts of the body.  The Quality Outcomes Framework 2014/15 (NHS Digital, accessed 31 May 2016) shows that the main types of CVD are: coronary heart disease (CHD), stroke and high blood pressure (hypertension).

Most premature deaths from CVD are preventable, and hospital admissions represent a burden to health and care services.

CVD increases in prevalance with age. With an ageing population and the current rising levels of obesity and diabetes in the UK, investment in primary prevention is essential in reducing premature deaths (mortality) and ill health (morbidity) from CVD in the population as a whole and reducing the cost burden on health and care services.

Key inequalities and risk factors

A number of health inequalities exist:

• Gender – Men are significantly at higher risk of mortality from CVD than women.
• Ethnicity – Incidence rates of stroke are higher in the black population (even after adjusting for social class, age and sex). Death rates from CVD are approximately 50% higher than average among South Asian groups.
• Age – CVD increases in prevalence with age and support tends to be focussed on the older stroke survivors with the experience of care and outcomes in younger victims and more active stroke survivors being less understood and supported.
• Deprivation – Premature death rates from CVD are up to six times higher among lower socioeconomic groups than among more affluent groups. Whilst deaths from CVD have fallen, the decline has been smaller in more deprived communities. CHD and stroke were all highest in the lowest socio-economic group and lowest in the highest socio-economic group where there are links to poor health literacy affecting access to and take up of preventative services and healthier lifestyle choices, e.g. smoking and healthier eating.

NHS Choices lists a number of risk factors associated with CVD that include:

• high blood pressure (hypertension)
• smoking
• high blood cholesterol
• diabetes
• lack of exercise
• being overweight or obese
• family history of heart disease
• ethnic background

Many of the above risk factors are linked. This means that if a person has one risk factor, they are likely to have others. CVD is also linked to a range of heart conditions, and good self-care, regulation and management can avoid unnecessary primary care intervention.

In addition, people with co-occurring high depressive symptoms and cardiometabolic abnormalities (such as cardiovascular disease) have an increased risk of developing type 2 diabetes.

Facts, figures and trends

Cardiovascular diseases are a group of disorders of the heart and blood vessels (World Health Organisation) and include:

• coronary heart disease: disease of the blood vessels supplying the heart muscle
• cerebrovascular disease: disease of the blood vessels supplying the brain
• peripheral arterial disease: disease of blood vessels supplying the arms and legs
• rheumatic heart disease: damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria
• congenital heart disease: malformations of heart structure existing at birth
• deep vein thrombosis and pulmonary embolism: blood clots in the leg veins, which can dislodge and move to the heart and lungs

Coronary heart disease (CHD) is the single most common cause of premature death in the UK.

Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason is a build-up of fatty deposits on the inner walls of the blood vessels. Strokes can be caused by bleeding from a blood vessel in the brain or by blood clots.

According to research by NICE, CVD is increasingly common after the age of 60, but rare below the age of 30.

The Quality and Outcomes Framework 2014/15 (NHS Digital, Accessed 31 May 2015) measures the percentage of people registered with each GP Practice in England who are recorded as having specific diseases. The percentage of patients with cardio vascular diseases recorded on practice disease registers in the Bracknell Forest and Ascot CCG area with CVD is as follows:

Hypertension is the most prevalent cardiovascular condition in the Bracknell Forest and Ascot CCG area, followed by coronary heart disease (CHD). Prevalence is lower in the CCG area compared to England, but mirrors the national picture across all cardiovascular diseases.

Raw data is available from the Public Health Profiles, NHS Health Check data and Cardiovascular Profiles, however, please note due to data collection changes in 2011, comparisons with previous years should be made with caution.

Not all people will be aware they have or have been diagnosed with specific conditions. The percentage of people in the population expected to have a specific condition have been estimated by studying the risk factors for developing the condition amongst those with a known diagnosis. The more present these risk factors are in the population, the higher the percentage estimates will be. These modelled estimates by the Berkshire Public Health Team and can be compared to QOF figures to determine the level of unidentified need in the population as follows:

Mortality from CVD in people aged less than 75

Cardiovascular disease (CVD) is one of the major causes of death in under 75s in England. The mortality rate from CVD is measured by the Public Health Outcomes Framework. In Bracknell Forest, the mortality rate is 60.5 people aged under 75 per 100,000 population:

However, most premature deaths from CVD among people aged less than 75 are preventable, that is, deaths could have been prevented if determinants of ill health and underlying causes could have been identified or avoided. The Public Health Outcomes Framework records the rate in 2012-14 for people in Bracknell Forest as 40.2 people under 75 per 100,000 population:

Generally, the rate is historically below the south east and England averages for both measures.

The rate of mortality and preventable mortality from CVD has fallen consistently over the last decade. However, when broken down by gender, the 2014/15 mortality rate in Bracknell Forest for females is 37.5 per 100,000 population and the mortality rate for males is 84.3 per 100,000 population. Again, whilst similar to the south east and England averages, this shows significantly more men dying from cardiovascular disease.

In Bracknell Forest, deaths from heart disease per 100,000 population aged 35 years and over attributable to smoking are lower but statistically similar to the England average:

Mortality data for individual Bracknell Forest wards calculated by the Berkshire Public Health Team shows that Priestwood and Garth ward has the highest mortality rate and Warfield Harvest Ride has the lowest mortality rate in the borough for all CVD.  This information should be read alongside the ward profiles for each area.

Prevention

The risk of developing CVD is influenced by our diet and physical activity since childhood. Our risk as adults is determined by a wider range of factors:

Claire D’Cruz (2013)

Most deaths caused by cardiovascular disease are premature and could easily be prevented. NICE guidance recommends a range of lifestyle changes for prevention including:

• stopping smoking
• eating a healthy diet
• reaching and maintaining a healthy weight
• increasing physical activity
• reducing alcohol consumption

These are echoed by the NHS Choices website along with advice for parents and carers to consider for their children with regard to fat, salt, sugar and exercise. The Government Eatwell guide is a colourful tool which families may find helpful.

NHS Health Checks

Health Checks are for patients between the ages of 40 and 74 who will be invited (once every five years) to have a check to assess, raise awareness and support them to manage their risk of cardiovascular disease.

Modelling suggests that high uptake will lead to substantial reductions in premature mortality and local authorities have a legal duty to make arrangements to provide the NHS Health Check programme to 100% of the eligible population over a five year period and to achieve continuous improvement in uptake.

The percentage of people the eligible population in the Bracknell Forest and Ascot CCG area, aged 40 – 74 years:

• offered  an NHS Health Check per financial year has improved from 14.3% in 2013/14 to 19.3% in 2014/15 which compares favourably with the 19.7% England average
• in receipt of an NHS Health Check per financial year has also improved from 10.5% in 2013/14 to 12.3% in 2014/15 which exceeds the 9.6% England average

Hospital Admissions

As most premature deaths from CVD are preventable, hospital admissions represent a burden to health and care services.

Coronary heart disease

Admissions for CHD per 100,000 people of all ages in the Bracknell Forest CCG area has fallen between 2003 and 2014. Recent figures show the rate is below the England average. There were 135,904  recorded deaths due to diseases of the circulatory system in England and Wales in 2014.

Stroke

Between 2004 and 2014, the rate of hospital admissions for stroke has only been above the national average on four occasions.  However, recent rates have fallen below the national average every other year. There were 15,570 recorded deaths due to stroke in England and Wales in 2014.

Local services and support

There are a range of services within Bracknell Forest that can deliver or support intermediate care functions. The main service is the Community Response and Reablement Team, which delivers intermediate care in people’s homes and own communities as well as in the local bed based service in the Bridgewell Centre. Services such as community hospitals, Rapid Access Community Services, Community Health Clinics, specialist nurses, GP services, district nursing, physiotherapists and social care teams also have a role in intermediate care.

The 2016 Stroke Services Review with Bracknell Forest and Ascot CCG is a review and assessment of the type and quality of care and treatment received by people affected by stroke in order to improve chances of survival and recovery.

Want to know more?

Bridging the gaps: Tackling inequalities in cardiovascular disease (Heart UK, 2013) – a comprehensive review and assessment of evidence, policy, legislation regard CVD as one of the conditions most strongly associated with health inequalities.

Cardiovascular Disease Outcomes Strategy – Improving outcomes for those with or at risk of developing Cardiovascular Disease (Department of Health, 2013) – government strategy setting standards for prevention, diagnosis, treatment and management of CVD, and improving intelligence, monitoring and research into CVD to enable risk stratification to identify families or individuals at high risk.

Community Response and Reablement Team (Bracknell Forest Council) – information about intermediate care in people’s homes and communities, such as community hospitals, Rapid Access Community Services, Community Health Clinics, specialist nurses, GP services, district nursing, physiotherapists and social care teams also have a role in intermediate care.

Health matters: getting every adult active every day (Public Health England, 2016) – summary facts and figures, descriptions of  physical activity and how benefits extend beyond physical health to include mental wellbeing, and how it can be used in a number of care pathways for cancers, diabetes, dementia, cardiovascular disease, falls and hip fractures.

Hypertension in adults (NICE 2013, updated 2015) – quality standard providing specific, concise quality statements, measures and audience descriptors to provide the public, health and social care professionals, commissioners and service providers with definitions of high-quality care. Covers the management of primary hypertension in adults, including diagnosis and investigations, treatment to reduce risk of cardiovascular disease, monitoring of treatment efficacy, and specialist referral.

Joint Commissioning Strategy for Intermediate Care 2015-2018 (Bracknell Forest Council, 2015) – sets out the commissioning priorities for intermediate care based on an evidence review of national policy and research and the views of local people, service providers and commissioners.

Stroke in adults (NICE, 2010 updated 2016) – guidance which covers diagnosis and initial management, acute-phase care, rehabilitation and long-term management of stroke in adults (aged over 16 years).

Stroke rehabilitation in adults (NICE, 2013) – evidence-based advice on the care of adults and young people aged 16 years and older who have had a stroke with continuing impairment, activity limitation or participation restriction

This page was created on 27 February 2014 and updated on 21 June 2016.

Cite this page:

Bracknell Forest Council. (2016). JSNA – Cardiovascular disease. Available at: jsna.bracknell-forest.gov.uk/living-working-well/health-conditions/cardiovascular-disease (Accessed: dd Mmmm yyyy)

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