Ageing Well - Health
Stroke & CVD
Introduction
Stroke is a serious potentially life threatening condition that occurs when part of the blood supply to the brain is interrupted. Urgent treatment is required as it is a medical emergency.
There are two main causes of stroke:
Ischaemic – where the blood supply is stopped due to a blood clot
Haemorrhagic – where a weak blood vessel in the brain bursts
There is a related condition called a Transient Ischaemic Attack (TIA) which occurs when the blood supply is temporarily interrupted. This can last up to 24 hours and should also be treated as an emergency as it could lead to a full stroke.
Strokes can be prevented by:
Eating a healthy diet
Exercising regularly
Following the recommended alcohol consumption guidelines
Not smoking
Medical conditions that increase your risk of stroke include:
High blood pressure
Diabetes
Atrial Fibrillation
High cholesterol
There are clear health inequalities associated with stroke with those people in lower socioeconomic groups at a higher risk of having a stroke.
Stroke is one of the biggest causes of death in the UK and is a significant cause of disability.
Main Issues
Hartlepool’s stroke prevalence, as captured by the Quality Outcomes Framework (QOF), has remained largely stable between 2012/13 and 2017/18, moving no more than 0.1% in any single year.
Throughout this period Hartlepool has remained no more than 0.2% higher than the England average. Hartlepool’s prevalence rate in 2017/18 was the 3rd lowest in the north east region, and is below the regional average.
However, Hartlepool’s under 75 mortality rate from strokes has increased year on year for the last four years.
In 2011/13 the under 75 mortality rate from stroke for Hartlepool was 16.5 per 100,000, by 2015/17 this had risen to 20.3 per 100,000, while in the same period the England average fell from 14.2 per 100,000 to 13.1 per 100,000. While the gap in 2011/13 between Hartlepool and the England average was 2.3 per 100,000 in 2015/17 this 7.2 per 100,000, a more than threefold increase. If the mortality rate is split by gender, then the under 75 mortality rate for males has, like Hartlepool as a whole, increased has increased year on year for the last four years.
The Hartlepool male under 75 mortality rate from stroke has increased from 21.4 per 100,000 in 2011/13 to 27.8 per 100,000 in 2015/17. This is an increase of 29.9%. During the same period the England average has fallen from 16.3 per 100,000 to 14.9 per 100,000. The Hartlepool rate in 2015/17 was 86% larger than the England average.
For females, however, the rate has followed a different pattern.
Unlike both the overall rate and the male rate, the female rate has remained statistically similar to the England average. The female rate has not seen continuous year on year increases, with the rate fallen from 15.1 per 100,000 in 13/15 to 12.8 in 14/16, a fall of 15.2%.
Hartlepool’s under 75 mortality rate from all cardiovascular diseases in 2015/17 of 95.7 per 100,000 population was the second highest in the north east.
Hartlepool’s rate is worse than both the regional and England averages, though there is a large gap between the Hartlepool rate and that of the highest in the region. Hartlepool’s rate had seen year on year declines for 11 consecutive years from 2001/03 to 2012/14, falling from 190.3 per 100,000 population to 90.1 per 100,000. This decline was at a faster rate than the England average and saw the gap between Hartlepool and England fall from 52.3 per 100,000 to 14.4 per 100,000. However, since 2013/15 Hartlepool’s rate has begun to rise, while the England average has continued to fall. The gap between Hartlepool and England in 2015/17 had increased back up to 23.2 per 100,000.
When this is examined along gender lines, then Hartlepool’s male under 75 mortality rate for all cardiovascular diseases is still the 2nd highest in the north east, and the 17th highest in England, but the female rate is only the 7th highest in the north east and is outside the top 40 highest rates in England.
When the focus moves to just those cardiovascular disease deaths considered preventable, Hartlepool’s rate of 54.3 per 100,000 population is only the 6th highest rate in the north east, and is statistically similar to the England average.
Hartlepool’s recent trend for preventable deaths from cardiovascular diseases has continued to fall for the past 13 years, with Hartlepool’s rate being statistically similar to England for eight of the last nine years.
Hospital admissions from alcohol related cardiovascular disease has increased by 42.9% in nine years, from 1,043 per 100,000 population to 1,490 per 100,000.
The 2017/18 rate for Hartlepool is an 8% increase on the previous year, which is after a period of four years where the increase had slowed to no more than 3% in any single year. Hartlepool’s rate was the 4th highest in the north east and the 20th highest in England.
Current services
Prevention, early detection and treatment of CVD can help patients live longer, healthier lives. Too many people are still living with undetected, high-risk conditions such as high blood pressure, raised cholesterol, and atrial fibrillation (AF). We must utilise all opportunities to work with partners to ensure that people are able to access services that will allow them to prevent and detect health conditions, and upon diagnosis ensure that conditions are managed and optimised effectively. We must support Primary and Community care to case find and treat people with the 3 key high-risk conditions described above (AF, Hypertension, and FH). In tackling the CVD agenda, there is an ambition to Prevent 150,000 heart attacks and strokes.
CVD management is available across all parts of the current health system but the CCG has recognised within its plans the need to focus on this key area. Current ongoing projects include:
AF Optimisation and Detection Programme
16 month project designed to optimise management of patients identified as having or at risk of AF. Scheme available to all participating GP practices in the Southern Collaborative to include; identification of patients from clinical systems, clinically led appointment to risk assess, educate and prescribe optimal medication and an educational programme for Primary and Secondary care clinicians.
Hypertension Detection and Optimisation Programme
Data analysis, audit and education programme aimed at improving the quality of primary care for this condition.
Hypercholesterolemia Programme
Data analysis and communication plan with all Primary Care to ensure patients are detected and are referred into a specialist Lipids clinic if found to have a cholesterol of 7.5mmol or more. These patients will be risk assessed and cascade testing offered to ensure this is prevented in future generations.
Future Intentions
Cardiac Rehabilitation
Review of Cardiac Rehabilitation services and aim to increase referral and uptake of cardiac rehabilitation during 2021/22.
Heart Failure
Pilot schemes in 2020-22 to increase access to echocardiography, improve investigation of those with breathlessness and early detection of heart failure and valve disease.
AF Optimisation and Detection Programme
CVDPREVENT audit will also be used in 2020.
