Cardiovascular Disease (CVD)

Headlines

  • Mortalities from Cardiovascular disease is rising in the district.
  • Rates of burden and mortality are rising in women
  • Inequality in both morbidity and mortality between richest and poorest is growing for those experiencing these diseases

The Population

Cardiovascular diseases are the main cause of death in the UK causing around a third of all deaths in England. Around 45% of all deaths from CVD are from coronary heart disease (CHD) and more than a quarter from stroke (28%). CHD is the most common cause of death in England and Wales (15% of all deaths).

The Burden

Mortality


Source: Public Health Outcomes Framework

The measures shown here are for those considered premature deaths, those aged under 75 account for around 18% of all deaths in Wakefield district per year.

Wakefield has consistently had significantly higher rates of premature mortality from cardiovascular diseases compared to the national average. This trend has been maintained since 2001 in the area from males and females.

In the most recent data available, the gap between Wakefield and the national average rate of death indicates a worsening situation for the area. This pattern has continued for the area, since the 2012-14 period mortalities for these aged under 75 from Cardiovascular disease has been on an upward trend.

There is a definite correlation between deprivation and CVD mortality. The priority neighborhoods have a mortality rate that is much higher than the Wakefield average (HI Gap Analysis, 2010).

The cost of total statin prescribing relative to the local population with CHD was lower compared to the national picture (CVD Profile, 2015).

Coronary Heart Disease

Source: Public Health Outcomes Framework

Levels of CHD appear to be higher on the east of the district, rather than by priority neighbourhoods. Statin prescribing is matching this pattern (HEA, 2010, CHD Equity Audit, 2013). This partly correlates with increasing levels of death from CVD in the east of the district in subsequent years

Recorded hypertension is relatively equal across the district with high levels in pockets of Knottingley, Fitzwilliam, Featherstone and Normanton. Levels of strokes are also equal across the district with pockets in Knottingley, Ackworth and Hemsworth where first shown in the HEA, 2010 the pattern has continued to the present with Hypertension remaining high in these communities.

Stroke & Transient Ischaemic Attacks

Source: Public Health Outcomes Framework

Stroke admissions continue to remain lower than the national average level for the district which has been the case since 2012/13.Hypetension an important risk factor for cardiovascular disease has been greater than the national level of around 13.7% for England compared to 15.3%

 

 

Source: NHS Digital HES data

Risk Factors

Diabetes in disease terms is strictly a disease of the endocrine system, however the manifestations of the disease are often cardiovascular diseases. Diabetes, excess weight, low physical activity and smoking are major risk factors for developing cardiovascular disease. For more information on Diabetes please click here.

Life style risk factors such as alcohol consumption, obesity and smoking are serious issues affecting CVD in Wakefield district. Alcohol consumption has continued to increase in the area, with the middle aged being the largest consumers of alcohol in the district. Admissions for cardiovascular diseases where alcohol is involved are increasing in the district. The adult population who are overweight is greater than the national average and total trend for excess weight in the population is growing. Over the last five years this proportion has been on an upward trend. On a slightly better note smoking, though still at higher level than national levels, has consistently been on a decreasing trend.

The Inequality

The burden of these diseases is unequally felt in the district, those in the more deprived areas are suffering these conditions at greater rates than their wealthy neighbours. The map below shows the community that have higher rates of admission from cardiovascular disease for all ages. These communities are the more deprived parts of the district. The CVD admissions rate chart above demonstrates the two most deprived deciles of the district have significantly higher rates of admissions when compared with the Wakefield average.

Source: NHS Digital HES data
The prevalence of all Cardiovascular diseases in the above model show clearly that people in the most deprived deciles of the district experience significantly higher levels of CVD’s

Source: NHS Digital HES data

  • In 2016/17 there were 7,764 people who have previously been diagnosed with a stroke in NHS Wakefield CCG.
  • In this CCG, 43.2% of stroke patients admitted who had a history of atrial fibrillation were not prescribed anticoagulation: this has be lower than the England rate (47.5%) admissions

Community Assets

Service Provision

  • The Mid Yorkshire Hospitals NHS Trust (MYHT) Hyperacute Stroke and TIA business case for the Acute Stroke Pathway was approved at the beginning of July 2011. This was developed by MYHT due to a need to bring the current stroke and TIA services in line with the regional Stroke Assurance Framework Indicators. The business case predominantly allowed the recruitment of 6 wte, Band 6 Stroke Assessment Nurses (SANs) to be available on a 24/7 basis. The role is to assess a suspected stroke patient in the emergency department, and take them through the hyperacute phase of the stroke pathway (imaging, thrombolysis and stroke unit). A limited service (12 hours, 5 days) has been in operation for around 12 months and has demonstrated a significant improvement in the quality of service patients experience when the SANs are on duty.
  • All the new nurses have now been recruited, and are undergoing a process of induction and training. A 7 day, 8am to 8pm service will start on November 1st, leading to a 24/7 stroke assessment service (including thrombolysis for eligible patients) from January, 2012. Additional therapy and radiology resources have also been identified to support the stroke pathway. In addition, the business case allows streamlining of the transient ischaemic attack (TIA) service over seven days to support a more rapid response to the higher risk patients.
  • MYHT stroke services will undergo an accreditation process as part of the Y&H Stroke Assurance Framework. The visit will take place at Pinderfields Hospital on December 12th, 2011. Accreditation is an important assurance process and will enable local stroke services to take part in regional telemedicine rotas for out of hours hyperacute and thrombolysis decision support.
  • There is now a stroke Early Supported Discharge Service within the Community Therapy team. This aims to take around 40% of stroke patients (those in the mild to moderate category) to continue their rehabilitation within their home environment. Evidence is clear that the medium and long term outcomes for this group of patients are better if they rehabilitate at home.
  • NHS Wakefield and Wakefield WMDC Family Services are currently working on a joint commission of services from the Stroke Association. This will provide support for patient and carer from hospital discharge, and will enable the achievement of identified patient goals in terms of community integration or return to work.
  • A pilot of an approach to the 6 month review of stroke survivors is underway in Wakefield, as part of a Y&H regional project to develop a template in SystmOne. The results of the pilot are expected towards the end of November, 2011 and roll out across the district is then anticipated.
  • The stroke prevention workstream is to engage with all GP practices in Wakefield around the stroke prevention agenda with particular emphasis on atrial fibrillation (AF) and transient ischaemic attack (TIA) and to implement the GRASP AF Tool in conjunction with offering information, support and education. This will in turn enable improved detection and increased awareness in AF and Warfarin management, supporting a reduction in the number of AF related Strokes in Wakefield district.
  • The workstream will also enable a targeted approach to increasing awareness of the signs and symptoms of TIA/Stroke amongst health care professionals and members of the public in Wakefield. Ultimately, the need is to ensure commissioning of an effective and evidence based service for TIA patients.

Publications

CVD Profile 2017

NHS Health Checks Equity Audit, 2013

NICE Guidance on Cardiovascular Diseases