Cardiovascular disease profile

Cardiovascular disease profile Cardiovascular risk factors March 2015 Background This chapter of the Cardiovascular disease profiles focuses on risk factors for cardiovascular disease and is produced by the National Cardiovascular Intelligence Network (NCVIN). The profiles are available for each clinical commissioning group (CCG) in. Each profile is made up of five chapters which look at risk factors, coronary heart disease (CHD), diabetes, kidney disease and stroke. This profile compares the CCG with data for, a group of similar CCGs and the East of strategic clinical network. Lifestyle and behavioural risk factors (such as smoking, physical inactivity, poor diet and obesity) reflect an individual s circumstances and choices. There are also a number of risk factors for cardiovascular disease (CVD) which are not dependant on how people behave but on biological and social aspects of their lives, such as age, sex, ethnicity and deprivation. In addition, physical risk factors (including hypertension) reflect changes to body systems that are also reversible or preventable in their early stages but may require medical treatment. Key facts Population aged 65 and over Estimated smoking prevalence Current smokers offered support and treatment 16.5% 16.9% 84.3% Comparator CCGs 18.1% 18.7% 17.3% 84.5% 18.5% 19.1% 83.3% 17.3% 84.3% Key information The resident population of NHS East and North Hertfordshire CCG is 546,500 and 90,500 of these people are aged 65 and over, a lower proportion than across as a whole. In NHS East and North Hertfordshire CCG, 1.4% of people live in the most deprived fifth of areas in. In 2013 it was estimated that 16.9% of adults in NHS East and North Hertfordshire CCG smoked. In 2013 it was estimated that 61.8% of adults in NHS East and North Hertfordshire CCG were classified as overweight or obese. In 2014 there were 77,000 people diagnosed with hypertension in NHS East and North Hertfordshire CCG. This was lower than the expected number and 10.9% of adults could have hypertension that has not been diagnosed. In 2013/14 the NHS Health Check was offered to 12.8% of the eligible population of NHS East and North Hertfordshire CCG. Of those people offered a NHS Health Check, 65.3% received a NHS Health Check. Observed prevalence of hypertension 13.2% 13.7% 14.1% 13.7% Expected prevalence of hypertension 24.2% 24.6% 25.0% 24.7% Produced by the National Cardiovascular Intelligence Network (NCVIN) PHE publications gateway number 2014714 Crown copyright 2015 www.gov.uk/phe www.ncvin.org.uk Page 1

Quantifying non-behavioural risk factors The prevalence of CVD increases with age, which is important in the light of an ageing population. In 2013 the proportion of people aged 65 and over in was 16.5% which is lower than across as a whole, where 17.3% of the population were aged 65 and over. Age profile and population projections, 2013 (percentage) Deprivation, 2010 (percentage) 90+ 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Women Men 2013 2035 8% 6% 4% 2% 0% 2% 4% 6% 8% Source: 2013 Mid-year population estimates 1.4 12.2 21.9 25.7 38.8 People from a more deprived background are at greater risk of CVD than the general population. In, 1.4% of the population are in the most deprived national quintile and 38.8% of the population in the least deprived. 45 40 35 30 25 20 15 10 5 0 Most deprived Source: IMD 2010 Least deprived Minority ethnic groups, 2011 (percentage) Asian Black Mixed Other 7.8 4.7 3.5 2.8 2.3 2.3 1.0 0.6 Source: ONS 2011 0 10 20 30 40 50 60 70 Ethnic group (Percentage) has become more ethnically diverse with rising numbers of people identifying with minority ethnic groups in the 2011 Census. The relationship between ethnic group and CVD prevalence is complex. For example, the risk of stroke is higher in south Asian, African or Caribbean populations living in. In an estimated 10.4% of the population are from black, Asian, mixed or other groups, compared to 14.6% across. Crown copyright 2015 www.gov.uk/phe www.ncvin.org.uk Page 2

Behavioural risk factors - prevalence A number of common risk factors are recognised as increasing the likelihood of individuals developing CVD. These include smoking, obesity, physical inactivity, poor nutrition and drinking too much alcohol. Smoking prevalence, 2013/14 (percentage) 16.9 17.3 18.5 19.1 0 5 10 15 20 25 30 35 40 45 50 Smoking prevalence (percentage) Source: Quality and Outcomes Framework (QOF), 2013/14 In 2013 it was estimated that 16.9% of adults in smoked. Excess weight in adults, 2012 (percentage) 61.8 64.2 65.2 63.8 0 10 20 30 40 50 60 70 80 90 100 Excess weight prevalence (percentage) Source: Active people survey, Sport, 2012 In 2013 it was estimated that 61.8% of adults in were classified as overweight or obese. Physical inactivity, 2013 (percentage) 25.0 26.3 26.7 28.3 0 5 10 15 20 25 30 35 40 45 50 Source: Active people survey, Sport, 2013 Prevalence of physical inactivity (percentage) In 2013 it was estimated that 25.0% of adults in were classified as inactive. Healthy eating (estimated proportion of adults who consume 5 or more portions of fruit or veg per day), 2006-08 (percentage) 31.5 30.9 30.3 28.7 0 5 10 15 20 25 30 35 40 45 50 Prevalence of 5 a day (percentage) Source: Model-based estimates (based on invidual level data from the Health Survey for ), 2006-08 In 2006-08 it was estimated that 31.5% of adults in ate five or more portions of fruit and vegetables a day. Crown copyright 2015 www.gov.uk/phe www.ncvin.org.uk Page 3

Binge drinking, 2007/08 (percentage) 19.4 19.4 18.2 This 20.1 chapter 0 of 5 10 15 20 25 30 35 40 45 50 Binge drinking prevalence (percentage) Source: Model-based estimates (based on individual level data from the Health Survey for ), 2007/08 In 2007/08 it was estimated that 19.4% of adults in engaged in binge drinking. Hypertension - prevalence Blood pressure measurements indicate the pressure which the circulating blood puts on the walls of blood vessels. Blood pressure is measured in millimetres of mercury (mmhg) and is usually written as the systolic blood pressure/diastolic blood pressure. Blood pressure measurements are on a continuous scale and therefore there is no specific point at which normotension (normal blood pressure) becomes hypertension (high blood pressure). However, a blood pressure of 140/90 mmhg or greater is usually used to indicate hypertension because persistent levels of blood pressure above this start to be associated with increased risks of cardiovascular events. For the purpose of the Quality and Outcomes Framework (QOF), hypertension is defined as a blood pressure measurement of 150/90. Hypertension is important because when uncontrolled it is a major risk factor for stroke, heart attack, heart failure, aneurysms and chronic kidney disease. In 2014 there were 76,504 people on GP lists in with diagnosed hypertension. This equated to 13.2% of the population registered with a GP. However, it was estimated the expected prevalence of hypertension in the CCG was 24.2%, meaning that 10.9% or 63,000 adults could have hypertension that has not been diagnosed. Diagnosed and estimated prevalence of hypertension, 2013/14 (percentage) Observed hypertension prevalence Expected hypertension prevalence 13.2 8.8 24.2 15.6 13.7 Comparator 12.1 CCGs 24.6 21.6 14.1 14.0 25.0 25.0 13.7 24.7 13.7 24.6 0 5 10 15 20 25 30 Hypertension (percentage ) 0 Source: QOF, 52013/14 10 15 20 25 30 Variation by general practice of diagnosed hypertension prevalence, 2013/14 (percentage) Diagnosed hypertension prevalence CCG diagnosed hypertension prevalence Observed hypertension prevalence (percentage ) 20 10 0 Source: QOF 2013/14 (practices censored at 25%) Practices Crown copyright 2015 www.gov.uk/phe www.ncvin.org.uk Page 4

Care processes and treatment indicators The Quality and Outcomes Framework (QOF) rewards practices for the provision of quality care and helps to standardise improvements in the delivery of clinical care. The risk of developing cardiovascular disease can be reduced in patients with hypertension by careful management of blood pressure and other cardiovascular risk factors such as physical inactivity and smoking. The graphs below show achievement against QOF hypertension and primary prevention of cardiovascular disease clinical indicators for the CCG as a whole. Hypertension Patients with hypertension in whom the last blood pressure is 150/90 or less, HYP002, 2013/14 (percentage) 78.6 17.4 79.4 15.6 78.4 17.4 79.2 10Source: QOF 20 2013/14 30 0 40 10 50 20 60 30 70 40 80 50 90 60 100 70 80 90 100 In those patients with a new diagnosis of hypertension aged 30 or over and who have not attained the age of 75, recorded between the preceding 1 April to 31 March (excluding those with pre-existing CHD, diabetes, stroke and/or TIA), who have a recorded CVD risk assessment score (using an assessment tool agreed with the NHS CB) of 20% in the preceding 12 months who are currently treated with statins, PP001, 2013/14 (percentage) 66.0 5.7 62.8 4.3 62.6 8.6 64.0 6.0 0 10 20 30 40 50 60 70 80 90 100 Source: QOF 2013/14 10 20 30 40 50 60 70 80 90 100 The percentage of patients diagnosed with hypertension (diagnosed on or after 1 April 2009) who are given lifestyle advice in the preceding 12 months for: smoking cessation, safe alcohol consumption and healthy diet, PP002, 2013/14 (percentage). 77.9 18.7 79.1 17.1 74.6 21.2 79.0 17.4 Source: QOF 2013/14 0 10 20 30 40 50 60 70 80 90 100 10 20 30 40 50 60 70 80 90 100 Crown copyright 2015 www.gov.uk/phe www.ncvin.org.uk Page 5

Smoking QOF includes information on the percentage of patients with a smoking status recorded and whether those identified as smokers are offered support or treatment to stop smoking. Patients aged 15 years and over whose notes record smoking status in the preceding 24 months, SMOK001, 2013/14 (percentage) 85.5 85.1 85.6 85.6 Source: QOF 2013/14 0 10 20 30 40 50 60 70 80 90 100 10 20 30 40 50 60 70 80 90 100 14.1 14.5 14.0 14.0 Patients aged 15 years and over who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 24 months, SMOK004, 2013/14 (percentage) 84.3 14.8 84.5 14.3 83.3 15.5 84.3 14.7 Source: QOF 2013/14 0 10 20 30 40 50 60 70 80 90 100 NHS Health Check Programme The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions, will be invited once every five years to assess their risk of developing these conditions. They are given support and advice to help them reduce or manage that risk. In in 2013/14 an estimated 160,000 residents were eligible to be offered a Health Check. authorities offer the programme to all the eligible population over a five year period. During 2013/14, 12.8% of eligible residents were offered a Health Check, 65.3% of those offered received a Health Check. Proportion of eligible people who were offered and received a Health Check, 2013/14 (percentage) Percentage of eligible people offered check 12.8 65.3 17.2 47.0 19.8 52.6 18.4 49.0 Percentage of those offered a NHS Health check who received one 0 10 20 30 40 50 60 70 80 90 100 Source: NHS Health Check 2014, percentage uptake censored at 100% Percentage A list of references for each chapter is given in the indicator guide for the profiles. Crown copyright 2015 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.0. To view this licence, visit OGL or email psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquires should be sent to ncvin@phe.gov.uk www.gov.uk/phe www.ncvin.org.uk Page 6