Leicester Joint Strategic Needs Assessment (JSNA). Health and social care needs associated with cardiovascular disease, 2016.
Cardiovascular diseases are a group of disorders of the heart and blood vessels 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.
Who’s at risk and why?
In England, cardiovascular disease (CVD) is the most common cause of death, accounting for around one third of all deaths and a significant cause of morbidity in the population.
CVD is more likely with increasing age; in men, rather than women; in those with a family history, particularly when close relatives are affected; in certain ethnic groups, such as South Asian or Black minorities; in populations with high socio-economic deprivation, in poor housing or with low educational attainment.
Modifiable risk factors for cardiovascular disease include unhealthy diet, physical inactivity, overweight and obesity, tobacco use, excessive alcohol consumption, and stress.
The level of need in the population
Nearly 10,000 people in Leicester have been diagnosed with chronic heart disease (CHD), over 45,000 with hypertension and around 4,600 with stroke/transient ischaemic attack (TIA).
Nationally, CVD accounts for a third of all deaths, and a quarter of premature deaths (under 75 years). In 2014, there were 684 deaths from CVD in Leicester, around 28% of all deaths. CVD is the major contributor to the adverse life expectancy gap between Leicester and England, accounting for 26% of the life expectancy gap in males and 44% in females.
Of all deaths from CVD in Leicester, around half are from coronary heart disease (CHD) and a quarter from strokes. CVD mortality rates in Leicester have improved over the past 10 years, showing a reduction of 32%. However, this has not been as great as the England-wide reduction of 39%. There is variation in CVD mortality across Leicester. Areas with higher rates of CVD deaths correspond to areas of high deprivation, and to South Asian communities in the east of Leicester.
In 2013/14, there were over 13,000 hospital admissions due to CVD in Leicester. Of these, around a third of admissions were planned and the remainder were unplanned (emergency admissions).
There are nearly 10,000 patients currently diagnosed with CHD on GP registers in Leicester, equivalent to 3.25% of the adult population, with around 800 emergency hospital stays (and patients discharged) for CHD in 2014/15. In 2014, there were 368 deaths in Leicester from CHD, with 146 of these in under 75 year olds.
in Leicester, there are around 4,600 people recorded on GP registers who would have had a stroke or transient ischaemic attacks (TIAs), which is equivalent to around 1.2% of the adult population. Modelled estimates of prevalence suggest a nearly 2% prevalence rate in Leicester’s adult population.
Local emergency hospital admission rates for stroke are equivalent to around 450 emergency hospital stays per year. Stroke mortality in Leicester has fallen by 40% over the last 10 years.
In Leicester, there are over 45,000 people recorded on GP registers with diagnosed hypertension, nearly 12% of the population. Modelled estimates of prevalence suggest nearly 26% of Leicester’s adult population could have high blood pressure, leaving a large gap between this and the currently observed numbers. In 2014, there were 34 deaths in Leicester in 2014, with hypertension indicated as the underlying cause.
Current services in relation to need
CVD is addressed on 3 levels - prevention, through better management of risk factors and identifying people at risk early, achieved through patient and clinical education programmes and promotion and prevention campaigns; ascertainment, occurring primarily via the NHS Health Checks programme; and management, where the majority of estimated spend on CVD is on hospital care.
There is also an Integrated Cardiovascular Service, to reduce the rate of premature mortality from CVD through developing capability within primary care to detect, diagnose and treat adult patients who are at higher risk of Atrial Fibrillation and Heart Failure.
More detailed information can be found in the full Cardiovascular Diseases section downloadable below.
Projected services use and outcomes in 3-5 years and 5-10 years
In Leicester, in those aged 16 years and over in 2015, for hypertension, there is a recorded prevalence of 14.9% and a modelled prevalence of 26.6%; for coronary heart disease, there is a recorded prevalence of 3.3% and a modelled prevalence of 5.1%; and for stroke, there is a recorded prevalence of 1.5% and a modelled prevalence of 2.1%. The modelled estimates are higher than the recorded prevalence, suggesting that a proportion of cases may still be undiagnosed.
Unmet needs and service gaps
There are clear inequalities in CVD health outcomes between different population groups in Leicester, linked to ethnicity and deprivation and a more nuanced understanding of unmet need in affected groups is necessary.
The continued reliance on secondary healthcare to deliver a large proportion of care for CVD patients, indicates a possible need for more integrated pathways of care and diagnostic and therapeutic shift to the community.
There is also an identified gap between estimated prevalence and rate of recorded diagnosis and, in seeking to address this, services need a robust approach to earlier detection, diagnosis and treatment (of both established disease and any modifiable risk factors).
Recommendations for consideration by commissioners
Recommendations for commissioners include development of a shared preventative strategy; establishing a joint approach to early detection; closing the inequality gap through better understanding of need and appropriate action by commissioners and providers; and further improvements in CVD care and prevention provided in the community.