Hull Public Health 

The Deep, Hull The Guildhall, Hull King William Statue, Market Place, Hull City Hall, Hull Spurn Lightship, The Marina, Hull

 

 

Cardiovascular Disease (CVD) or Circulatory Disease


Documents

The main documents providing information on cardiovascular or circulatory diseases, are as follows:

JSNA
Hull JSNA Toolkit: All Circulatory Diseases
Hull JSNA Toolkit: Coronary Heart Disease
Hull JSNA Toolkit: Stroke
Hull JSNA Toolkit: Other Circulatory Diseases
Coronary Heart Disease Equity Audit completed September 2005
Stroke Equity Audit completed September 2011
Hypertension Equity Audit completed February 2011

Other documents which include information on cardiovascular disease, mainly related to mortality, are as follows:

JSNA Hull Atlas
Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here)
Public Health Outcomes Framework Summary
Longer Lives Briefing Report
Director of Public Health Annual Reports

There are topic-specific Hull JSNA Toolkit reports on all types of cardiovascular disease, coronary heart disease (CHD), stroke and transient ischaemic attack (TIA), as well as other circulatory diseases including heart failure, atrial fibrillation, hypertension and abdominal aortic aneurysm. Information is presented on risk factors, prevalence, inpatient admissions and mortality where information is available and numbers are sufficiently large. Modelled prevalence is compared with diagnosed prevalence at practice level, and admission rates and mortality rates are compared among deprivation quintiles.

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Background

There are three main types of circulatory (cardiovascular) disease: coronary heart disease (CHD), cerebrovascular disease and peripheral vascular disease. Cardiovascular disease is usually caused by a build-up of fatty deposits on the walls of the arteries. The fatty deposits, called atheroma, are made up of cholesterol and other waste substances. The build up of atheroma on the walls of the arteries makes the arteries narrower and restricts the flow of blood. This process is called atherosclerosis. CHD is caused by the narrowing of one or more of the coronary arteries, which can result in angina, heart attack or heart failure. Cerebrovasular disease (stroke and transient ischaemic attack (TIA)) results from disease of the arteries in the brain. The most common cause of a stroke is due to an artery in the brain becoming blocked by a blood clot which is usually formed over some atheroma. A TIA is a disorder caused by temporary lack of blood supply to a part of the brain. Peripheral vascular disease is also a disease resulting from narrowing of the arteries due to atheroma, but arteries other than those in the heart or brain (generally in the leg).

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10-year Risk of Cardiovascular Event

Definitions of the risk of a 10-year cardiovascular event is given within the Glossary document.

The local Healthy Heart Study involved collecting information on age, gender, blood pressure, cholesterol, smoking status and whether or not the person had diabetes or not. The information was collated into a score (probability) relating to the '10-year risk of a cardiovascular event'. Further information is given in Hull JSNA Toolkit: Coronary Heart Disease.

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Abdominal Aortic Aneurysm

Screening, risk factors and mortality information is given in Hull JSNA Toolkit: Other Circulatory Diseases.

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Angiography

Angiography is an investigation of coronary heart disease (CHD) undertaken to assess whether one of two common treatments are necessary: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Angiography rates are given within Hull JSNA Toolkit: Coronary Heart Disease and Coronary Heart Disease Equity Audit, as well as in relation to deprivation. Information is given at ward level in the JSNA Hull Atlas.

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Atrial Fibrillation

The prevalence and modelled prevalence for each general practice, and inpatient admissions are given in Hull JSNA Toolkit: Other Circulatory Diseases. The prevalence and inpatient admission rate are also given in relation to deprivation, as well as information on expenditure.

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Coronary Artery Bypass Graft

Angiography is an investigation of coronary heart disease (CHD) undertaken to assess whether one of two common treatments are necessary: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Whilst specific patients may be more suitable to either PCI or CABG, for most patients both treatments are equally effective and the choice of treatment depends on available resources and/or clinician preference. However, generally PCI is becoming more common as it is does not involve open surgery as CABG does. Overall treatment (revascularisation) rates are given within Hull JSNA Toolkit: Coronary Heart Disease and Coronary Heart Disease Equity Audit for PCI and CABG combined rather than examining PCI rates and CABG rates separately. The rates of revascularisation are also given in relation to deprivation. Information is given at ward level in the JSNA Hull Atlas.

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Coronary Heart Disease

Hull JSNA Toolkit: Coronary Heart Disease gives information on coronary heart disease (CHD) in relation to risk factors, prevalence, modelled prevalence, inpatient admissions and mortality. Hospital admission and mortality information is also presented by deprivation. Expenditure is also detailed within Hull JSNA Toolkit: Coronary Heart Disease.

There are also specific programme budgeting and marginal analysis reports for CHD which examines expenditure in relation to outcomes for Hull and compares these with other comparator areas:

PBMA CHD 2009/10
PBMA CHD 2008/09
PBMA CHD 2007/08

Information on influenza vaccination uptake among those on the CHD register is also given within Hull JSNA Toolkit: Coronary Heart Disease.

More detailed information is available on CHD within the CHD Equity Audit completed September 2005.

The Projecting Older People Population Information (POPPI) System provides population projections for people aged 65+ years for 2011, 2015, 2020, 2025 and 2030. It provides estimates of the number of people aged 65+ years in Hull are predicted to have had a heart attack. These estimates are available in Hull JSNA Toolkit: Coronary Heart Disease and Hull JSNA Toolkit: Older People.

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Expenditure and Programme Budgeting

Expenditure and Programme Budgeting is given in the disease-specific Hull JSNA Toolkit reports for the main diseases including cardiovascular disease.

Programme Budgeting is a well-established technique for assessing investment in health programmes rather than services. It can provide an overall view of how Hull PCT expenditure (from Department of Health Programme Budgeting information) and health outcomes compare with other PCT's in England, and to identify programmes that may require further investigation. Quadrant charts are given in the topic-specific Hull JSNA Toolkit reports which plot expenditure and outcomes (in standardised units) for different disease areas.

There are also specific programme budgeting and marginal analysis reports for CHD and stroke which examines expenditure in relation to outcomes for Hull and compares these with other comparator areas:

PBMA CHD 2009/10
PBMA Stroke 2009/10
PBMA CHD 2008/09
PBMA Stroke 2008/09
PBMA CHD 2007/08
PBMA Stroke 2007/08

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Health Equity Audit

The Coronary Heart Disease Equity Audit was completed September 2005 and the Stroke Equity Audit was completed during September 2011. These documents provide information on risk factors, prevalence, inpatient admissions and mortality. This information is examined in relation to age, gender and deprivation to assess potential inequalities that might exist among these groups. The documents also examined potential programmes that could reduce health inequalities.

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Heart Failure

The prevalence and modelled prevalence for each general practice, and inpatient admissions are given in Hull JSNA Toolkit: Other Circulatory Diseases. The prevalence and inpatient admission rate are also given in relation to deprivation.

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Hypertension

The prevalence and modelled prevalence for each general practice is given in Hull JSNA Toolkit: Other Circulatory Diseases, as well as prevalence in relation to deprivation.

The Hypertension Equity Audit which was completed February 2011 examines hypertension in more detail in relation to potential inequity.

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Influenza Vaccination

As well as offering influenza vaccinations for those aged 65 and over, it is also recommended that influenza vaccinations are offered for particular 'at risk' groups such as patients on the QOF disease registers for diabetes mellitus, CHD, stroke and chronic obstructive pulmonary disease. Uptake rates for the influenza vaccination for these 'at risk' groups for Hull are given within Hull JSNA Toolkit: Diabetes, Hull JSNA Toolkit: Coronary Heart Disease, Hull JSNA Toolkit: Stroke and Hull JSNA Toolkit: Chronic Obstructive Pulmonary Disease.

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Inpatient Admissions

The number of inpatient admissions for the main types of cardiovascular diseases are given in Hull JSNA Toolkit: All Circulatory Diseases, which also has the inpatient admissions rate for all cardiovascular diseases combined, as well as the elective and non-elective admission rates by ward and by general practice. Admission rates are also examined in relation to deprivation.

The number of inpatient admissions and admission rate for coronary heart disease, stroke are given in Hull JSNA Toolkit: Coronary Heart Disease and Hull JSNA Toolkit: Stroke respectively, as well as the elective and non-elective admission rates by ward and by general practice. Admission rates are also examined in relation to deprivation.

The number of inpatient admissions and admission rate for heart failure and atrial fibrilation are given in Hull JSNA Toolkit: Other Circulatory Diseases by Area Committee Area. Admission rates are also examined in relation to deprivation.

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Longer Lives

Higher tier local authorities were also ranked on premature mortality rates from cardiovascular disease as part of Public Health England's Longer Lives project. Details are given in the Longer Lives Briefing Report.

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Mortality

Mortality rates and mortality rates by deprivation are given for all circulatory disease combined, CHD and stroke in Hull JSNA Toolkit: All Circulatory Diseases, Hull JSNA Toolkit: Coronary Heart Disease and Hull JSNA Toolkit: Stroke respectively. The number of deaths from each of the main types of cardiovascular disease is given within the causes of death section of Hull JSNA Toolkit: Mortality.

The mortality rates are also displayed, by ward, within the JSNA Hull Atlas.

Cardiovascular, CHD and stroke mortality rates have also been presented in the Director of Public Health Annual Reports.

Premature mortality rates for 2006-08 were also examined for the four of the five national deprivation quintiles (not examined for least deprived quintile as so numbers in least deprived quintile too small for Hull) for Hull in relation to other comparable areas. This data is not readily available and analysis was completed with the assistance of the Yorkshire and Humber Public Health Observatory, who hold a copy of the national mortality file and have commissioned the Office for National Statistics (ONS) to produce the LLSOA population estimates. The summary of this analysis for CHD and stroke is given in Hull JSNA Toolkit: Coronary Heart Disease and Hull JSNA Toolkit: Stroke respectively.

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NHS Health Check

Screening for cardiovascular disease or risk factors for cardiovascular disease is a key feature of the NHS Health Check. There are two indicators relating to the NHS Health Check Programme within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. The indicators are the percentage of Health Checks offered out of the eligible population and the percentage of Health Checks completed out of those offered health checks.

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Percutaneous Coronary Intervention (PCI)

Angiography is an investigation of coronary heart disease (CHD) undertaken to assess whether one of two common treatments are necessary: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Whilst specific patients may be more suitable to either PCI or CABG, for most patients both treatments are equally effective and the choice of treatment depends on available resources and/or clinician preference. However, generally PCI is becoming more common as it is does not involve open surgery as CABG does. Overall treatment (revascularisation) rates are given within Hull JSNA Toolkit: Coronary Heart Diseaseand Coronary Heart Disease Equity Audit for PCI and CABG combined rather than examining PCI rates and CABG rates separately. The rates of revascularisation are also given in relation to deprivation.

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Prevalence

As part of the Quality and Outcomes Framework (QOF), practices need to have registers of patients who have had a diagnosis of specific diseases. More information about QOF is given in the topic-specific Hull JSNA Toolkit reports and Glossary. The QOF general practice disease registers cover a range of medical conditions and diseases including coronary heart disease (CHD), stroke and transient ischaemic attack (TIA), heart failure, atrial fibrillation and hypertension, and the prevalence of these diseases are reported within Hull JSNA Toolkit: Coronary Heart Disease, Hull JSNA Toolkit: Stroke, Hull JSNA Toolkit: Other Circulatory Diseases as well as in Hull JSNA Toolkit: All Circulatory Diseases. These are also presented by deprivation.

Some of the issues associated with comparing prevalence figures over all the Hull practices are discussed within the General Practice Comparator Groupings, topic-specific Hull JSNA Toolkit reports and Glossary, with more detailed information within the Why QOF Differs Among Practices report. Details of grouping practices into eight groups for benchmarking are given in the General Practice Comparator Groupings.

This actual diagnosed prevalence is compared with modelled prevalence estimates. These modelled estimates and the difference between the modelled estimates and the numbers diagnosed at practice level are given within the  topic-specific Hull JSNA Toolkit reports. A modelled or synthetic estimate is only as good as the model and as good as the underlying data from which the model is produced. A full discussion of the Problem of Synthetic Estimates is available, and it is also discussed within the topic-specific Hull JSNA Toolkit reportsand Glossary.

The Projecting Older People Population Information (POPPI) System provides population projections for people aged 65+ years for 2011, 2015, 2020, 2025 and 2030. It provides estimates of the number of people aged 65+ years in Hull are predicted to have had a heart attack or stroke. These estimates are available in Hull JSNA Toolkit: Coronary Heart Disease and Hull JSNA Toolkit: Stroke, as well as in Hull JSNA Toolkit: Older People.

The prevalence of behavioural and lifestyle risk factors is summarised within Hull JSNA Toolkit: Smoking, Hull JSNA Toolkit: Alcohol Consumption, Hull JSNA Toolkit: Diet, Hull JSNA Toolkit: Exercise and Hull JSNA Toolkit: Overweight and Obesity, with more detailed information in the Adult and Young People Health and Lifestyle Survey reports (see Prevalence for more information).

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Public Health Outcomes Framework

Premature (under 75 years) mortality rate from cardiovascular disease and the mortality rate from cardiovascular disease which is considered preventable are both indicators within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. This information is also displayed within the JSNA Hull Atlas.

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Revascularisation

Angiography is an investigation of coronary heart disease (CHD) undertaken to assess whether one of two common treatments are necessary: percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Whilst specific patients may be more suitable to either PCI or CABG, for most patients both treatments are equally effective and the choice of treatment depends on available resources and/or clinician preference. However, generally PCI is becoming more common as it is does not involve open surgery as CABG does. Overall treatment (revascularisation) rates are given within JSNA Toolkit: Coronary Heart Disease and the Coronary Heart Disease Equity Audit for PCI and CABG combined rather than examining PCI rates and CABG rates separately. The rates of revascularisation are also given in relation to deprivation. Elective and non-elective admission for CHD are also given within JSNA Toolkit: Coronary Heart Disease.

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Risk Factors

Risk factors for cardiovascular disease are discussed within Hull JSNA Toolkit: All Circulatory Diseases, Hull JSNA Toolkit: Coronary Heart Disease, Hull JSNA Toolkit: Stroke and Hull JSNA Toolkit: Other Circulatory Diseases as well the individual equity audits (Coronary Heart Disease Equity Audit, Stroke Equity Audit and Hypertension Equity Audit).

The prevalence of behavioural and lifestyle risk factors is summarised within Hull JSNA Toolkit: Smoking, Hull JSNA Toolkit: Alcohol Consumption, Hull JSNA Toolkit: Diet, Hull JSNA Toolkit: Exercise and Hull JSNA Toolkit: Overweight and Obesity, with more detailed information in the Adult and Young People Health and Lifestyle Survey reports (see Prevalence for more information).

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Screening

Screening for cardiovascular disease or risk factors for cardiovascular disease is a key feature of the NHS Health Check. There are two indicators relating to the NHS Health Check Programme within Public Health Outcomes Framework and further analysis is given within the Public Health Outcomes Framework Main Report (to open this report on a particular PHOF indicator, click here) and Public Health Outcomes Framework Summary. The indicators are the percentage of Health Checks offered out of the eligible population and the percentage of Health Checks completed out of those offered health checks.

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Social Marketing

Social marketing research was completed in Hull during September 2009 to assess knowledge and perceptions of stroke amongst the general public. The conclusions are given in Hull JSNA Toolkit: Stroke.

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Stroke

Information is given related to risk factors, prevalence, modelled prevalence, inpatient admissions and mortality is given within Hull JSNA Toolkit: Stroke. Hospital admission and mortality information is also presented by deprivation. Expenditure is also detailed within Hull JSNA Toolkit: Stroke.

There are also specific programme budgeting and marginal analysis reports for stroke which examine expenditure in relation to outcomes for Hull and compares these with other comparator areas:

PBMA Stroke 2009/10
PBMA Stroke 2008/09
PBMA Stroke 2007/08

Social marketing research was completed in Hull during September 2009 to assess knowledge and perceptions of stroke and Transient Ischaemic Attack (TIA) amongst the general public. The conclusions are given in Hull JSNA Toolkit: Stroke.

Information on influenza vaccination uptake among those on the stroke and transient ischaemic attack register is also given within Hull JSNA Toolkit: Stroke.

More detailed information is available on stroke within the Stroke Equity Audit completed September 2011.

The Projecting Older People Population Information (POPPI) System provides population projections for people aged 65+ years for 2011, 2015, 2020, 2025 and 2030. It provides estimates of the number of people aged 65+ years in Hull are predicted to have had a stroke. These estimates are available in Hull JSNA Toolkit: Stroke and Hull JSNA Toolkit: Older People.

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Transient Ischaemic Attack (TIA)

Information for stroke and transient ischaemic attack is given related to risk factors, prevalence, modelled prevalence, inpatient admissions and mortality is given within Hull JSNA Toolkit: Stroke. Hospital admission and mortality information is also presented by deprivation.

Social marketing research was completed in Hull during September 2009 to assess knowledge and perceptions of stroke and TIA amongst the general public. The conclusions are given in Hull JSNA Toolkit: Stroke.

Information on influenza vaccination uptake among those on the stroke and transient ischaemic attack register is also given within Hull JSNA Toolkit: Stroke.

Further information on TIA is available within the Stroke Equity Audit which was completed September 2011.

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