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Coronary Heart Disease and Stroke in Scotland
1 Coronary Heart Disease and Stroke in Scotland: Trends
1.1 In recent years, Scotland has seen a dramatic fall in the level of premature deaths from coronary heart disease and stroke - since 1995 mortality rates for CHD and stroke have fallen by more than a third. On a human level, over 3,000 fewer families lost a loved one to CHD or stroke last year than in 1995. There have also been significantly fewer people diagnosed with cardiovascular diseases and stroke. This is a considerable achievement of which Scotland should be proud.
1.2 Of course, Scotland started from a very high base, traditionally being dubbed "the Sick Man of Europe". Scotland certainly had the scope to improve, but other countries with lower levels of mortality have also seen a fall in the rates of CHD and stroke in recent times. This shows us that we can go further. On the one hand, Scotland is still playing catch-up, but on the other, we know that more improvement is possible.
1.3 The Scottish Executive has set tough targets. The public health White Paper:
"Towards a Healthier Scotland" set a target to halve the rate of death from cardiovascular diseases and stroke in those aged under 75 in the 15 years between 1995 and 2010. For CHD, the Scottish Executive has recently made the target even more stringent: the aim now is to have reduced deaths from CHD in those aged under 75 by 60%. These are tough targets that should not be underestimated. Scotland is presently on track to meet them - but only just.
Coronary Heart Disease
1.4 Chart 1 shows the improved mortality for CHD over the last 8 years and the reduction necessary to reach the target by 2010. The overall rate for men and women has fallen by 38% and this suggests that the target is achievable. However, the trend for men has shown a recent levelling out and action must be taken to address this.
Coronary Heart Disease for ages under 75 Age Standardised
(European Standard Population) Mortality rate per 100,000 population
Stroke
1.5 As for CHD there has been a consistent downward trend in stroke mortality in the under 75s. The overall rate for men and women has fallen by 34%. This trend also suggests that the target for 50% reduction by 2010 can be achieved.
Cerebrovascular Disease for ages under 75 Age Standardised
(European Standard Population) Mortality rate per 100,000 population
Hospital Admissions for CHD and Stroke
1.6 Despite the reduced prevalence of cardiovascular disease in Scotland, it is unlikely that this will lead to a reduction in hospital admissions. Partly, this is because although older people are at less risk of developing cardiovascular disease than they were ten years ago, there are now more older people in Scotland. In addition, we are seeing more people admitted to hospital for preventative treatment as technologies have improved. Much of this increased hospital activity is through scheduled care rather than through emergency admissions, and this is leading to more scope to manage patient journeys. Chronic Disease Management strategies will have an increasingly important role in future clinical practice.
1.7 The number of admissions due to stroke and stroke related disease has increased by 8% since 1995. Admissions for acute myocardial infarction (AMI) have declined since 1995 by 13% in the under 75 year age group, but have risen by 5% in those aged greater than 75. This overall reduction in heart attack admissions has been offset by an 18% increase in the number of admissions due to angina and chest pain.
1.8 It is likely that the fall in the number of patients presenting with an AMI is due to earlier investigation and treatment of angina. Research in this area has demonstrated that early intervention in patients with acute coronary syndromes results in fewer patients going on to have a major cardiac event.
1.9 More patients survive heart attacks now than in the past. This had led some clinicians to expect an increase in the number of people developing heart failure. However, current data does not indicate that mortality or hospital admissions due to heart failure are increasing.
Deprivation
"Deprivation takes many different forms in every known society. People can be said to be deprived if they lack the types of diet, clothing, housing, household facilities and fuel and environmental, educational, working and social conditions, activities and facilities which are customary, or at least widely encouraged and approved, in the societies to which they belong."
Health in Scotland 2002
1.10 It has long been accepted that there is a direct correlation between deprivation and ill health. People in the most deprived sections of society are more likely to develop cardiovascular disease and, when they do, they are likely to die sooner than their less deprived counterparts. This is true for both CHD and stroke, although the effect is even more pronounced for stroke.
Coronary Heart Disease for ages under 75 Age Standardised
(European Standard Population) Mortality rate per 100,000 population by deprivation quintile
Cerebrovascular Disease for ages under 75 Age Standardised
(European Standard Population) Mortality rate per 100,000 population by deprivation quintile
1.11 All sections of Scottish society have seen downward trends in cardiovascular mortality and the gap in mortality between the least deprived (Quintile 1) and the most deprived (Quintile 5) has narrowed. But the Scottish Executive is attaching increased importance on narrowing the gap further and included the specific commitment in
"Closing the Opportunity Gap, the Budget for 2003-06" to provide:
"a clear direction to NHS Boards to ensure resources are used to tackle inequalities, through addressing life circumstances, lifestyles and health priorities such as cancer, coronary heart disease and mental illness (much of which is preventable)"
1.12 The Executive has now set a specific target to reduce CHD mortality by 27% over 5 years for the most deprived communities.
Urban versus Rural Dimension
1.13 There is no significant difference in the mortality from CHD between urban and rural communities. Furthermore, the rate of decline between the most and least deprived in both urban and rural communities is similar. The reduction in stroke mortality, though real, has been less marked than the decline in CHD. It shows a similar pattern in rural and urban areas.
CHD mortality 3 year moving average
Cerebrovascular Disease mortality 3 year moving averages
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