Cardiovascular disease: Heart disease, stroke, chronic kidney - - PowerPoint PPT Presentation

Cardiovascular disease:

Heart disease, stroke, chronic kidney disease and diabetes

Haringey Public Health performance update CCG Governing Body meeting 27th Nov 2014

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Background



CVD is a major cause of death and differences in life expectancy across UK and Haringey - Who gets ill and who dies from CVD is socially patterned with those in the lower socioeconomic groups fairing worse



CVD risk factors also linked to social disadvantage: obesity, smoking, diet, drinking patterns and physical activity



Effective CVD prevention focuses on different life stages– e.g. pregnancy, early years through to older ages; and is proportionate to the social gradient and level of risk (Bell et al. 2012)

Ruth Bell, Jessica Allen, Ilaria Geddes, Peter Goldblatt and Michael Marmot (2012) A social determinants based approach to CVD prevention in England. BHF 2008 Cardio & Vascular Coalition Modelling the UK burden of Cardiovascular Disease to 2020

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50 100 150 200

2002 - 04 2003 - 05 2004 - 06 2005 - 07 2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13

Deaths per 100 000

PHOF 4.04ii Under 75 mortality rate from cardiovascular diseases (Persons) All persons, Haringey and London 2002/4-2010/12 (three year average)

London Haringey

CVD mortality

CVD mortality for aged <75 is going down

Source: Public Health England (based on ONS source data)

2002-4 2011-13

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59.2 115.3

50 100 150 200 250

2002 - 04 2003 - 05 2004 - 06 2005 - 07 2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13

Deaths per 100 000

PHOF 4.04ii Under 75 mortality rate from cardiovascular diseases, Haringey and London 2002/4-2010/12 (three year average)

London - Female Haringey - Female London - Male Haringey - Male

CVD mortality more prevalent in men but down by more than half in ten years

Source: Public Health England (based on ONS source data)

2002-4 2011-13

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50 100 150 200

Decile 1 Decile 2 Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8

Deaths per 100 000

Under 75 mortality rate from cardiovascular diseases by deprivation decile, (Male/Female), Haringey 2010/12 (three year average) Haringey - Female Haringey - Male

CVD deaths in men more prevalent in the most deprived area of Haringey

Source: analysis by Haringey Public Health (based on ONS source data)

Most deprived Least deprived

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Circulatory diseases

34%

Respiratory diseases, 23% Respiratory diseases, 32% Cancer, 14% Cancer, 6%

Other causes, 11% Other causes, 25%

Digestive diseases, 10% Digestive diseases, 5% External causes, 8% External causes, 10% <28 days, 8%

0% 100% Male Female percentage of total

CVD is a major cause of inequalities in life expectancy

From: Segmenting tool, PHE, 2014

Chart showing the key underlying causes that contribute to gap in life expectancy between poorest and affluent areas (deprivation quintiles), Haringey 2010-12

Circulatory diseases

14%

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Diagnosed and estimated prevalence of heart disease

More than half undetected

Diagnosed Haringey Comparator CCGS

1.6% 2.1% 1.9% 1.3% 0% 1% 1% 2% 2% 3% 3% 4% 4% percentage Undiagnosed Diagnosed

Total CHD prevalence in Haringey

10,200

5,439

4,761

Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. * Percentages refer to proportion of the total registered population

*

Haringey London

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0.80% 1.00% 0.9% 0.6% 0% 1% 1% 2% 2% 3% 3% percentage Undiagnosed Diagnosed

Prevalence of stroke or TIAs

Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. * Percentages refer to proportion of the total Haringey population

Diagnosed

Diagnosed + undiagnosed prevalence in Haringey totals at

4,908

Half of strokes or TIA attacks undiagnosed

Haringey London

2,442 2,466

*

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1.90% 2.60% 1.8% 2.0% 0% 1% 1% 2% 2% 3% 3% 4% 4% 5% 5% percentage Undiagnosed Diagnosed

Number of residents receiving renal replacement therapy up by nearly half from 2007

Prevalence of chronic kidney disease

Diagnosed

Diagnosed + undiagnosed prevalence in Haringey totals at

8255

Haringey London

Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. * Percentages refer to proportion of the total Haringey population aged 18 +

*

4239 4016

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5.80% 5.80% 1.6% 2.0% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% percentage Undiagnosed Diagnosed

Prevalence of diabetes

Diagnosed

Diagnosed + undiagnosed prevalence in Haringey totals at

16,200

Those with diabetes 49% more likely to have a heart attack

Diabetes makes up 11.6%

• f the CCG prescribing

budget, over £3.2 million in Haringey

13,351

Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. * Percentages refer to proportion of the total population 17+

2,849

Haringey London

*

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Hospital admissions CHD and Heart failure

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Main risk factors for CVD

Source: Attributable risk from NHS Atlas of risk (Last accessed March 2014).

Blood pressure High cholesterol

Main life style risk factors for CVD

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10.6% 11.10% 11.1% 10.2% 0% 5% 10% 15% 20% 25% percentage Undiagnosed Prevalence (diagnosed)

Hypertension prevalence

1 in 10

• f Haringey’s

registered population diagnosed hypertensive

(2012/13)

Although proportionally similar to other areas, diagnosed + undiagnosed prevalence in Haringey totals at

62,759

*

Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. * Percentages refer to proportion of the total Haringey population aged 18 +

Haringey London

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Smoking and drinking prevalence is high

Source: Active People Survey, Sports England (from PHOF 2014 August) Source: PHE (from PHOF 2014 August) 20.10% 19.7% 20% Haringey 20.7 % London 19.4% England 20.8%

1 in 5

Smoke

(2012)

1 in 5

Binge drink

(2009 synthetic estimates)

Haringey London England Haringey London England

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Obesity is becoming the norm

Source: Active People Survey, Sports England (from PHOF 2014 May) Source: PHE (from PHOF 2014 May)

Over

1 in 4

Inactive

(2013)

Nearly

2 in 3

Overweight

(2013)

27.3% 28.4% 28.9%

Haringey London England

59% 57.3% 63.8%

Haringey London England

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Examples of wider factors increasing risk of CVD

Transport that facilitates physical activity Income which brings access to healthy foods etc.

Social isolation increases the risk of CHD and Stroke

(Steptoe et.al, 2013, Shankar et.al. 2011)

Low educational attainment

Determinants of health (1992) Dahlgren and Whitehead; With PHE 2014, From evidence into action

Work and stress – low reward high job strain

(Hynek et al. Bell et al 2013)

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The NHS Health Checks Programme

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The NHS Health Checks programme is a national programme which comprises systematic assessment of cardiovascular risk factors in adults aged between 40-74 years with no known history of cardiovascular disease (CVD), stroke, diabetes mellitus or chronic kidney disease. The programme is primarily focused on the East of the borough.

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Through this programme GPs can refer their patients at high risk of CVD to numerous lifestyle management initiatives to support them in reducing their risk e.g Stop Smoking Services, Health Trainers etc.

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To be effective the programme needs to be seen as a pathway from risk assessment through to risk management.

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Active for Life NHS and community Health checks Health trainers Community health champions Alcohol IBA Active with ease Healthy walks Stop Smoking services

Overview of lifestyle programmes in Haringey

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NHS Health Checks Performance – Haringey

Year Offered to target population 20% Target Uptake by target population 75% Target Haringey London Haringey London 2011-12 26.2% 19% 34.6% 46% 2012-13 22.6% 20.6% 51.6% 45.2% 2013-14 19.3% 20.9% 45.1% 47.3%

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

Support the redesign of a cardiac rehab programme that is line with BACPR standards

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Work with Public Health to improve monitoring and outcomes from Health Checks

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Strengthen the patient pathways and interface between Acute, Primary care & community providers and increase uptake of patients from phase 2 -4 of the cardiac programme

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Promote benefits of healthy life styles through NHS health checks and improve referral to lifestyle behavioural programmes

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Support adult and childhood obesity pathways, former of which is currently being updated

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Promote prevention early in childhood

What can the CCG do about CVD?