Cardiovascular Disease in Dorset where are we now & where to - - PowerPoint PPT Presentation

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Cardiovascular Disease in Dorset where are we now & where to - - PowerPoint PPT Presentation

Nov 08, 2022 253 likes •424 views

Cardiovascular Disease in Dorset where are we now & where to from here? Dorset Health & WellBeing Board November 2014 Dr Craig Wakeham Dorset CCG Chair CVD Clinical Commissioning Programme Dr David Phillips Director of Public

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SLIDE 1

Cardiovascular Disease in Dorset …where are we now & where to from here?

Dorset Health & WellBeing Board November 2014 Dr Craig Wakeham Dorset CCG – Chair CVD Clinical Commissioning Programme Dr David Phillips Director of Public Health

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SLIDE 2

Outline of this Session

  • 1. What is CVD and why we might be interested
  • 2. Introduction to the natural history of CVD
  • 3. What outcomes are we interested in?
  • 4. What do we know about key outcomes locally

and nationally?

  • 5. What is the significance of these findings?
  • 6. How might we address this together?
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SLIDE 3

Cardiovascular Disease – what is it?

Progressive blockage of blood vessels reducing blood flow to key organs, for example:

BRAIN

  • [mini] Stroke
  • Dementia [some forms]

HEART

  • Angina & Heart attack
  • Heart failure

Blood Vessel Disease

  • Big vessels – e.g. aortic aneurysm
  • Smaller vessels – e.g. gangrene
  • Other organs – e.g. kidneys

But SAME Risk Factors SAME Disease Process

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SLIDE 4

Why are we interested?

  • Number One cause of early death
  • Health & WellBeing Strategy priority
  • It develops over many years giving us plenty of
  • pportunity to do something
  • Much of it is preventable
  • We know what the factors are and what works
  • Rates & risks vary considerably across

localities

  • Important time trends
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SLIDE 5

Male Premature Death Rates from CVD Bournemouth and Dorset 2001 - 2013

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SLIDE 6

20 40 60 80 100

Female CVD mortality (< 75)

England Dorset

50 100 150 200 250

Male CVD mortality (< 75)

England Dorset

CVD premature death rates Dorset 2001-13 Men & Women

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SLIDE 7
  • 15%
  • 10%
  • 5%

0% 5% 10% 15% 2001 - 03 2003 - 05 2005 - 07 2007 - 09 2009 - 11 2011 - 13

Year-to-year change in Female CVD mortality (under 75)

England Dorset

Increase Decrease

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SLIDE 8
  • 15%
  • 10%
  • 5%

0% 5% 10% 15% 2001 - 03 2003 - 05 2005 - 07 2007 - 09 2009 - 11 2011 - 13

Year-to-year change in Male CVD mortality (under 75)

England Dorset

Increase Decrease

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SLIDE 9
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SLIDE 10

50 100 150 200 250

Early Male CVD mortality projections (under 75) England Dorset

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SLIDE 11

Manage Risk

General population At-risk individuals and groups CVD patients

A Framework for CVD

Prevent Modifiable Risks developing Prevent Complications Further Events

End- stage

Acute Care

Modified from A Tonkin, Atherosclerosis and Heart Disease, 2003

Population-wide strategies Treat high risk not high risk factor levels Implement effective treatments

Inequalities

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SLIDE 12

How do we define ‘normal’ and why does it matter?

Modified from A. Rogers

Hypertension Hyperchol- esterolaemia Obesity

Disease burden DALYs

BP (mmHg) Cholesterol (mmol/l) BMI

1,000 2,000 3,000 4,000 5,000 6,000 7,000

100 120 140 160 180 200

1000 2000 3000 4000

3.8 4.4 5.1 5.7 6.3 7.0 7.6

1000 2000 3000

20 23 26 29 32 35 38 41 44

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SLIDE 13

Cardiovascular Disease Life Course

Birth childhood adults

  • lder age

parents Death Social status / environment (e.g. air quality) Diet: healthy eating, cholesterol, salt, alcohol Lack of physical activity Smoking Obesity Diabetes / High BP Maternal risk factors, e.g. smoking Angina / Heart Attack / Stroke

Good antenatal care

Hospital / GP care Healthchecks and follow up

Active transport / access to open spaces

GP management

  • f diabetes / BP

Rehab and social care

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SLIDE 14

Progress Managing CVD in Dorset

Birth childhood adults

  • lder age

parents Death

Good antenatal care Hospital / GP care Healthchecks and follow up Active transport / access to open spaces GP management of diabetes / BP Rehab and social care

Control of ↑ BP Prevalence of ↑ BP NHS Healthchecks Excess weight in adults Patients with CHD cholesterol < 5 Heart failure / death at home Binge drinking Childhood

  • besity

Time to treatment for AMI Smoking prevalence Patients with CHD BP < 150/90 Smoking in pregnancy Children walk / bike to school

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SLIDE 15
  • 80000
  • 60000
  • 40000
  • 20000
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Reasons for the fall in coronary heart disease deaths in England & Wales 1981-2000

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SLIDE 16

Where to from here?

  • Existing Opportunities:
  • Better Together
  • NHS Five year plan - prevention
  • Clinical Services Review – outcomes/systems

focus

  • District health improvement plans
  • Thoughts & Next Steps…….