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Cardiovascular Disease

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Introduction

Cardiovascular disease (CVD) affects more than 1 in 4 adults in England and is the second largest single risk factor for premature death and disability in the country. There have been huge gains over the past decades in terms of better treatment for CVD and improvements in lifestyle, but to ensure that there continues to be a reduction in the rate of premature mortality from CVD, there needs to be concerted action on both prevention and treatment.

Cardiovascular disease is defined as all the diseases of the heart and circulation including coronary heart disease (angina and heart attack), and stroke. Around one third of all deaths in the UK are due to these diseases.

Heart attacks and strokes are usually acute conditions and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason is a build-up of fatty deposits on the inner walls of the blood vessels. Strokes can be caused by bleeding from a blood vessel in the brain or by blood clots.

CVD becomes increasingly common in people over the age of 60 and is rare below the age of 30.

Facts and Figure

Prevalence of Cardiovascular Diseases

For further information regarding the source of NHS Quality and Outcomes Framework (QOF) prevalence data and its limitations please see Note on QOF Data.

Coronary heart disease is the most common type of heart disease and cause of heart attacks. The disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the arteries and reduces blood flow to the heart.

In 2019/20 7,799 people had been identified by NHS Blackpool CCG GP practices as living with Coronary Heart Disease (CHD).1 It is estimated that this accounts for only 70% of the total population in Blackpool living with CHD and there are likely to be approximately 3,350 people with undiagnosed CHD.2 

NHS Blackpool CCG is shown as a purple marker in Figure 1, with all other CCGs shown in blue. Figure 1 shows that 4.46% of NHS Blackpool CCG's registered population are recorded as living with CHD. Blackpool has a significantly higher prevalence of CHD than the average of English CCGs (3.1%).

Figure 1: CHD Prevalence Funnel Plot Analysis at CCG Level (2019/20 QOF)

Source: Quality Outcomes Framework (QOF)

Stroke is the loss of brain function due to a disturbance in the blood supply to the brain. Risk factors for stroke include old age, high blood pressure, previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, tobacco smoking and atrial fibrillation. High blood pressure is the most important modifiable risk factor of stroke.

In 2019/20, 4,122 people of all ages had been identified by NHS Blackpool CCG GP practices as having previously experienced a stroke or ischaemic attack.1  NHS Blackpool CCG is shown as a purple marker in Figure 2, with all other CCGs shown in blue. Figure 2 shows that 2.4% of NHS Blackpool CCG's registered population are recorded as having experienced a stroke or ischaemic attack. Blackpool has a significantly higher prevalence of stroke than the average of English CCGs (1.8)%.

For further summary data about stroke prevalence in Blackpool see PHE Stroke Profile.

Figure 2: Stroke and Ischaemic Attack Prevalence Funnel Plot Analysis at CCG Level (2019/20 QOF)

Source: Quality Outcomes Framework (QOF)

Hypertension is a chronic medical condition in which the blood pressure in the arteries is elevated. It affects approximately 22% of the population. Hypertension puts a strain on the heart, leading to hypertensive heart disease and coronary artery disease if not treated. Hypertension is also a major risk factor for stroke, aneurysms of the arteries (e.g. aortic aneurysm), and peripheral arterial disease and is a cause of chronic kidney disease. A moderately high arterial blood pressure is associated with a shortened life expectancy while mild elevation is not. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of health complications, although drug treatment is still often necessary in people for whom lifestyle changes are not enough or not effective.

In 2019/20, 31,823 people had been identified by NHS Blackpool CCG GP practices as living with hypertension.1 NHS Blackpool CCG is shown as a purple marker in Figure 3, with all other CCGs shown in blue. Figure 3 shows that 18.2% of NHS Blackpool CCG's registered population are recorded as living with hypertension. Blackpool has a significantly higher prevalence of CHD than the average of English CCGs (14.1%).

Public Health England estimates that the 31,823 identified by GP practices make up 76.3% of the overall number of people living with hypertension in Blackpool. This means that between approximately 9,900 people are estimated to be living with undiagnosed hypertension in Blackpool.2 

Figure 3: Hypertension Prevalence Funnel Plot Analysis at CCG Level (2019/20 QOF)

Source: Quality Outcomes Framework (QOF)

Mortality from Cardiovascular Diseases

There were 482 deaths from CVD across Blackpool in 2017-19 in people aged under 75. The directly standardised mortality rate (in this case per 100,000 population) is calculated to allow comparison between geographies of different population sizes and with different gender and age make ups. As displayed in Figure 4, Blackpool's mortality rate from circulatory diseases in those aged under 75 (121.6 per 100,000 pop.) is the highest in the country and more than 50% greater than that of England (69.8 per 100,000 pop.).

Figure 4: Funnel plot of mortality from all cardiovascular diseases, people aged under 75 years, 2017-19 - Lower Tier Local Authorities

CVD u75 mortality funnel 17-19Source: PHE, Public Health Outcomes Framework, Indicator E04a

Figure 5 shows the trend in mortality from cardiovascular diseases in those aged under 75, comparing Blackpool to the North West and England averages. Over the long term there has been a decrease in mortality from cardiovascular diseases both nationally and in Blackpool, although the mortality rate in Blackpool is significantly higher than both the national and regional rates. Whilst the national rate continues to reduce gradually, Blackpool's rate has been relatively steady in recent years, increasing slightly since 2014-16 and 2015-17.

Figure 5: Trend in CVD mortality - persons aged under 75 - 2001-03 to 2017-19

CVD mortality trend for under 75s shows gradual decline at national and regional level but flattening off and slight increase in BlackpoolSource: PHE, Public Health Outcomes Framework, Indicator E04a

Figure 6 shows the difference in male and female mortality for those aged under 75 years. Of the 482 deaths in 2017-19 in Blackpool, 68% were male and 32% female which is similar to the England average split.  However, it can clearly be seen that in Blackpool rates for both sexes are significantly higher than the national average.

Figure 6: Mortality from CVD, males and females aged under 75, 2017-19

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 Source: PHE, Public Health Outcomes Framework, Indicator E04a

Preventable mortality

The basic concept of preventable mortality is that deaths are considered preventable if, in the light of the understanding of the determinants of health at the time of death, all or most deaths from the underlying cause (subject to age limits if appropriate) could potentially be avoided by public health interventions in the broadest sense.

    • In 2017-19 in Blackpool, 196 (40.7%) of the deaths from cardiovascular disease in people aged under 75 are considered preventable
    • This is similar to the national average of 39.9%

Figure 7 shows mortality from coronary heart disease in people aged under 75 years for lower tier local authorities in England3. There were 295 deaths in 2015-17, a Blackpool rate of 73.6 per 100,000 pop, significantly higher than the England average of 37.1 per 100,000.

Figure 7: Funnel plot of mortality from coronary heart diseases, people aged under 75 years, 2017-19 - Lower Tier Local Authorities 

CHD u75 mortality funnel 17-19

Source: NHS Digital, Compendium: Mortality, 2021

Figure 8 shows mortality from stroke in people aged under 75 years for lower tier local authorities between 2017 and 2019. Across Blackpool there were around 75 deaths from stroke in people aged under 75 (data is rounded so values are approximate). The mortality rate from stroke in Blackpool for those aged under 75 is sigificantly higher than the national average over this period.

Figure 8: Funnel plot of mortality from stroke, people aged under 75 years, 2017-19 - Lower Tier Local Authorities3

Stroke u75 mortality funnel 17-19

Source: NHS Digital, Compendium: Mortality, 2021

Services

    • The Sentinel Stroke National Audit Programme (SSNAP) publishes national and local level findings on the organisation of stroke services, including acute care organisation, staffing and pathway at discharge. It reflects the organisation of stroke services as at July 2016 and gives a comprehensive picture of current services. Results for Blackpool Teaching Hospital show it meets 4 out of the 10 key indicators on stroke service organisation.

SSNAP Acute Organisational Audit 2016 for Blackpool Teaching Hospital NHS Foundation Trust   pdf  (270 KB)

    • PHE summary profiles on CHD and Stroke provide a broad understanding of how these conditions are treated and how Blackpool compares with other areas. They show the impact on the local population, identify emerging issues and aim to help improve services.

National and local strategies

    • The Blackpool CCG: CVD primary care intelligence pack uses GP practice data on prevention, detection and management across a range of cardiovascular conditions. It provides a narrative that explains the case for prevention and suggests actions, shows variation between local practices and between demographically similar clinical commissioning group (CCG) areas and identifies the number of undiagnosed and inadequately treated people in the local area.

Risk Factors

Risk factors for CVD include:

    • high blood pressure (hypertension)
    • smoking
    • high blood cholesterol
    • diabetes
    • lack of exercise
    • being overweight or obese
    • family history of heart disease
    • ethnic background

Many of the above risk factors are linked. This means that if you have one risk factor, you're more likely to have others.2


[1] PHE, National General Practice Profiles

[2] PHE, Hypertension Prevalence and Management, October 2020

[3] Note: Five local authorities omitted due to data quality.