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 27 th Nov 2014

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 2 determinants based approach to CVD prevention in England. BHF 2008 Cardio & Vascular Coalition Modelling the UK burden of Cardiovascular Disease to 2020

CVD mortality CVD mortality for aged <75 200 is going down 150 Deaths per 100 000 100 London 50 Haringey 0 2002 - 04 2003 - 05 2004 - 06 2005 - 07 2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13 2002-4 2011-13 PHOF 4.04ii Under 75 mortality rate from cardiovascular diseases (Persons) All persons, Haringey and London 2002/4-2010/12 (three year average) 3 Source: Public Health England (based on ONS source data)

CVD mortality more prevalent London - Female in men but down by more than Haringey - Female half in ten years London - Male Haringey - Male 250 200 Deaths per 100 000 115.3 150 100 50 59.2 0 2002 - 04 2003 - 05 2004 - 06 2005 - 07 2006 - 08 2007 - 09 2008 - 10 2009 - 11 2010 - 12 2011 - 13 2002-4 2011-13 PHOF 4.04ii Under 75 mortality rate from cardiovascular diseases, Haringey and London 2002/4-2010/12 (three year average) 4 Source: Public Health England (based on ONS source data)

CVD deaths in men more prevalent in the most deprived area of Haringey 200 150 Deaths per 100 000 100 50 Haringey - Female Haringey - Male 0 Decile 1 Decile 2 Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Most deprived Least deprived Under 75 mortality rate from cardiovascular diseases by deprivation decile, (Male/Female), Haringey 2010/12 (three year average) 5 Source: analysis by Haringey Public Health (based on ONS source data)

CVD is a major cause of inequalities in life expectancy 100% <28 days, 8% External causes, 8% Digestive diseases, External causes, 10% 10% Digestive diseases, 5% Other causes, 11% percentage of total Other causes, 25% Cancer, 14% Cancer, 6% Respiratory diseases, 23% Respiratory diseases, 32% Circulatory diseases 34% Circulatory diseases 14% 0% Male Female 6 Chart showing the key underlying causes that contribute to gap in life expectancy between poorest and affluent areas (deprivation quintiles), Haringey 2010-12 From: Segmenting tool, PHE, 2014

Diagnosed and estimated prevalence of heart disease More than half undetected 4% Haringey London 4% 1.9% * 1.3% 3% 5,439 Undiagnosed 3% percentage Total CHD prevalence in 2% 2.1% Haringey 2% 1.6% Comparator 10,200 Diagnosed 1% Diagnosed 4,761 CCGS Haringey 1% 0% Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. 7 * Percentages refer to proportion of the total registered population

Prevalence of stroke or TIAs Half of strokes or TIA attacks undiagnosed 3% 3% Diagnosed + undiagnosed prevalence 2% Haringey London in Haringey totals at percentage 2% 0.9% 0.6% * Undiagnosed 2,442 4,908 1% Diagnosed 1.00% 0.80% Diagnosed 1% 2,466 0% Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. 8 * Percentages refer to proportion of the total Haringey population

Prevalence of chronic kidney disease Number of residents receiving renal replacement therapy up by nearly half from 2007 5% London 5% 2.0% Haringey 4% Diagnosed + undiagnosed 4% 1.8% prevalence in Haringey * 3% Undiagnosed totals at 4016 percentage 3% 2.60% 2% 8255 1.90% 2% Diagnosed Diagnosed 4239 1% 1% 0% Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. 9 * Percentages refer to proportion of the total Haringey population aged 18 +

Prevalence of diabetes Those with diabetes 49% more likely to have a heart Diabetes makes up 11.6% attack of the CCG prescribing budget, over £3.2 million in 9% Haringey London Haringey 8% 7% 2.0% 1.6% Diagnosed + undiagnosed 6% * Undiagnosed prevalence in Haringey 2,849 5.80% 5.80% 5% percentage totals at 4% 16,200 3% Diagnosed Diagnosed 13,351 2% 1% 0% Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. 10 * Percentages refer to proportion of the total population 17+

Hospital admissions CHD and Heart failure 11

Main risk factors for CVD Blood High pressure cholesterol Main life style risk factors for CVD 12 Source: Attributable risk from NHS Atlas of risk (Last accessed March 2014).

Hypertension prevalence 1 in 10 of Haringey’s registered population diagnosed hypertensive (2012/13) 25% Haringey London Although proportionally similar to other areas, diagnosed + 20% undiagnosed prevalence in * Undiagnosed 11.1% 10.2% 15% Haringey totals at percentage 10% 11.10% 62,759 10.6% Prevalence (diagnosed) 5% 0% Source: NCVIN CVD Profiles 2014 – data from QOF 2012/13. 13 * Percentages refer to proportion of the total Haringey population aged 18 +

Smoking and drinking prevalence is high 1 in 5 1 in 5 Smoke Binge drink (2012) (2009 synthetic estimates) Haringey England London 20.10% 20% 19.7% 20.7 % 20.8 % 19.4 % Haringey London England Haringey London England 14 Source: PHE (from PHOF 2014 August) Source: Active People Survey, Sports England (from PHOF 2014 August)

Obesity is becoming the norm Over Nearly 1 in 4 2 in 3 Inactive Overweight (2013) (2013) 63.8% 59% 57.3% 28.9% 28.4% Haringey London England 27.3% Haringey London England 15 Source: PHE (from PHOF 2014 May) Source: Active People Survey, Sports England (from PHOF 2014 May)

Examples of wider factors increasing risk of CVD Income which brings Work and stress – low access to healthy reward high job strain foods etc. (Hynek et al. Bell et al 2013) Social isolation Low increases the educational risk of CHD attainment and Stroke (Steptoe et.al, 2013, Shankar et.al. 2011) Transport that facilitates physical activity 16 Determinants of health (1992) Dahlgren and Whitehead; With PHE 2014, From evidence into action

The NHS Health Checks Programme 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. 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. To be effective the programme needs to be seen as a pathway from  risk assessment through to risk management. 17

Overview of lifestyle programmes in Haringey NHS and community Active for Life Health checks Healthy walks Alcohol IBA Health trainers Stop Smoking services Community health champions Active with ease 18

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

What can the CCG do about CVD? Support the redesign of a cardiac rehab programme that is line with  BACPR standards Work with Public Health to improve monitoring and outcomes from  Health Checks 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 Promote benefits of healthy life styles through NHS health checks  and improve referral to lifestyle behavioural programmes Support adult and childhood obesity pathways, former of which is  currently being updated Promote prevention early in childhood  20