9: Coronary heart disease

Contacts

Preface

Contents

List of Tables
List of Figures

Abbreviations

Main Body

1: Boundaries and Populations
2: Inequalities and Deprivation
3: Ethnicity and Health
4: Environmental Hazards
5: Health related behaviour
    of young people
6: Accidents
7: Cancer
8: Teeth and fluoridation
9: Coronary Heart Disease
10: Communicable diseases

Appendices

"Coronary heart disease results from the reduction or complete obstruction of the blood flow through the coronary arteries by narrowing of the arteries (atheroscleriosis) and/or a blood clot (thrombus). There is evidence that if CHD is properly managed, progression of the disease can be slowed down and possibly reversed in some people. If untreated, it is progressive and will lead to death either from a heart attack (acute myocardial infarction) or from heart failure." (Department of Health, 1999)

The NSF defines four conditions, which will be considered within this chapter:

• Chest pain (angina pectoris)
• Heart attack (acute myocardial infarction)
• Irregular heart beat (arrhythmia)
• Heart failure.

9.1    Hospital admissions for Coronary Heart Disease (March 1991- April 1997)

The following graphs (figure 9.1) present the directly age sex standardised rates of admissions (to European population) for the four conditions of the NSF by health authority. The data for each graph are presented in Tables 9.1 to 9.4. The data source for hospital admissions is the West Midlands Hospital Episode Statistics (WM HES).

ICD9 to ICD10 conversion

The NHS updated ICD9 with ICD10 in April 1995. Guidance issued by the NHS Centre for Coding and Classification warns that the degree of direct equivalence between ICD9 and ICD10 is small. This means that absolute continuity is not always possible. Therefore, any change in trend at that time should not be regarded as a real change without further local investigation. In addition, it is not unusual to see declines in trends caused by local confusion in the application of the new classification.

Figure 9.1 The age sex standardised rate per 100,000 population for admissions for the NSF Conditions by Health Authority (1990/1-1997/8)
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Table 9.1 Age sex standardised rates per 100,000 population for admission for Heart Failure by Health Authority (March 1991 - April 1997).

Table 9.2 Age sex standardised rates per 100,000 population for admission for AMI by Health Authority (March 1991- April 1997).

Table 9.3 Age sex standardised rates per 100,000 population for admission for Irregular Heart Beat by Health Authority (March 1991- April 1997). 

Table 9.4 Age sex standardised rates per 100,000 population for admission for Chest Pain by Health Authority (March 1991- April 1997).

9.2    Mortality from Coronary Heart Disease

The change over the last ten years in the mortality from CHD is plotted on the following figure (Figure 9.2) by health authority. The mortality counts are taken from the ONS Public Health Mortality files.

The following graphs present the annual age-sex standardised admission rate by health authority. The rates have been standardised to the European Standard Population.

Figure 9.2 The age sex standardised rates per 100,000 population for deaths from CHD by Health Authority (1988-1997)
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Table 9.5 The directly age sex standardised rates per 100,000 population for deaths From CHD by Health Authority (1998-1997) < 65 years.

Table 9.6 The directly age sex standardised rates per 100,000 population for deaths from CHD by Health Authority (1988-1997) for the all ages.

9.3    Mortality and hospital admissions due to CHD by PCG

To reflect the new geography maps showing the crude rates of admissions and mortality have also been produced by PCG. Due to the lack of available responsible populations and of an up to date age-sex breakdown of the resident populations, crude rates have been produced to account for differences in the magnitude of the populations.

For the mortality rates five years of data have been aggregated together to account for annual fluctuations in the pattern of mortality. To allocate deaths to PCGs, the patient's postcode had to be used.

The admission rates were calculated using the 1996/7 HES data set. However, in this instance it was possible to use the GP Practice code to allocate patients to their appropriate PCG. It was not possible to calculate more recent rates as the Department of Health did not record practice code in the data for 1997/8.

Figure 9.3 Crude Mortality rates per 100,000 population from Coronary Heart Disease by PCG.

Figure 9.4 Admissions for Heart disease by PCG rate per 100,000 population

9.4    Variations in Trust activity

Variations in trust performance are reported in terms of finished consultant episodes (FCE), admissions and average length of stay. The average length of stay refers to the length of the admission.

The data are presented for the last complete year of HES data available at the time of publication which is 1997/8 and is for all patients seen at the units regardless of area of residence.

Table 9.7 Hospital admissions for Chest Pain by West Midlands Trust (March 1997- April 1998)

REFERENCES

Department of Health. National Service Framework on Coronary Heart Disease - Emerging Findings Report. 1998.

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