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
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?
Cardiovascular Disease – what is it? Progressive blockage of blood vessels reducing blood flow to key organs, for example: BRAIN o [mini] Stroke o Dementia [some forms] HEART o Angina & Heart attack o Heart failure Blood Vessel Disease o Big vessels – e.g. aortic aneurysm o Smaller vessels – e.g. gangrene o Other organs – e.g. kidneys But SAME Risk Factors ������� ���������������������������� SAME Disease Process ����������������������������������
Why are we interested? • Number One cause of early death • Health & WellBeing Strategy priority • It develops over many years giving us plenty of opportunity 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
Male Premature Death Rates from CVD Bournemouth and Dorset 2001 - 2013
CVD premature death rates Dorset 2001-13 Men & Women 100 250 Female CVD mortality (< 75) Male CVD mortality (< 75) England 80 200 England Dorset Dorset 60 150 100 40 50 20 0 0
Year-to-year change in Female CVD mortality (under 75) 2001 - 03 2003 - 05 2005 - 07 2007 - 09 2009 - 11 2011 - 13 15% England Dorset 10% 5% Increase 0% Decrease -5% -10% -15%
Year-to-year change in Male CVD mortality (under 75) 2001 - 03 2003 - 05 2005 - 07 2007 - 09 2009 - 11 2011 - 13 15% England Dorset 10% 5% Increase 0% Decrease -5% -10% -15%
250 Early Male CVD mortality projections (under 75) 200 England Dorset 150 100 50 0
A Framework for CVD Manage Risk Prevent Modifiable Prevent Acute Care Risks developing Complications Further Events At-risk General individuals CVD End- population and patients stage groups Inequalities Implement effective Population-wide Treat high risk treatments strategies not high risk factor levels Modified from A Tonkin, Atherosclerosis and Heart Disease, 2003
How do we define ‘normal’ and why does it matter? BP (mmHg) Cholesterol (mmol/l) BMI Obesity Disease burden DALYs Hypertension 7,000 Hyperchol- 4000 esterolaemia 3000 6,000 5,000 3000 2000 4,000 2000 3,000 1000 2,000 1000 1,000 0 0 0 20 23 26 29 32 35 38 41 44 100 120 140 160 180 200 3.8 4.4 5.1 5.7 6.3 7.0 7.6 Modified from A. Rogers
Cardiovascular Disease Life Course Social status / Lack of Diet: healthy eating, environment physical cholesterol, salt, alcohol (e.g. air activity quality) Angina / Smoking Maternal Heart Attack risk factors, Diabetes / / Stroke Obesity e.g. smoking High BP Birth Death parents childhood adults older age Active transport / access to open GP management Rehab and spaces of diabetes / BP social care Good Hospital antenatal Healthchecks care / GP care and follow up
Progress Managing CVD in Dorset Prevalence of ↑ BP Excess weight in Patients with CHD adults cholesterol < 5 NHS Healthchecks Time to treatment Children Smoking in Patients with for AMI walk / bike to pregnancy CHD BP school Binge drinking < 150/90 Heart failure / death at Childhood Smoking home Control of obesity prevalence ↑ BP Birth Death parents childhood adults older age Active transport / GP management of Rehab and access to open social care diabetes / BP spaces Good antenatal Hospital / Healthchecks and care GP care follow up
Reasons for the fall in coronary heart disease deaths in England & Wales 1981-2000 ����������������������� �������������������������� �� 0 !�������������������������"�� #������$�����%�����$�������� �� ��������������������&'�� ()����* & �� -20000 +��$������$� &,� -$����.����/��������&,� �����������������&��� 0����)�����������& �� -40000 1�/���������������������)����&�� 0����)�����������������������&��� ������� (/�*����������*����� & � ������������ -60000 -80000 !�"! ���� 2��$��+�����$���3��+�.���$$�+���/$������ ��� ����,�,� ����&'�
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 … ….
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