cardiovascular disease pct health profile · cardiovascular disease health profile - bath &...

Contact Details: This report, interactive atlases and the accompanying glossary and technical appendix are available to download on the

SEPHO website - http://www.sepho.nhs.uk

There is a slightly lower proportion of stroke patients under 75 years discharged back to their usual place of residence

compared to the national picture.

Bath & North East Somerset lies within the boundaries of

the current Avon, Gloucestershire, Wiltshire &

Somerset Cardiac and Stroke Network (pictured right).

This information is also available for each cardiac and

stroke network, and as an interactive atlas.

This Cardiovascular Disease (CVD) Health Profile brings

together a wide range of data on cardiovascular disease

in each PCT area in the country and in associated Cardiac

& Stroke Networks. Its aim is to provide information to

health care professionals, commissioners and other

interested parties about CVD issues in their local

community, as an aid to planning and development.

Cardiovascular diseases are the main cause of death in

the UK causing around 147,300 deaths in England in

2010 (around a third of all deaths). Around 45% of all

deaths from CVD are from coronary heart disease (CHD)

and more than a quarter from stroke (27%). CHD is the

most common cause of death in England and Wales (15%

of all deaths in 2010).

For people having myocardial infarction reperfusion in 2010, the median time to primary angioplasty treatment from a

call for help was 126 minutes in Bath & North East Somerset, this is higher than in Prospering Smaller Towns and England

(115 and 113 respectively).

Early mortality rates from cardiovascular disease (< 75 years) are significantly lower than the national rate, and have

decreased by 55.9% since 1995.

Emergency admission rates for CHD are significantly lower than the national rates, but for stroke the local rate is similar

to the national rate.

The rates of angiography procedures are significantly lower than the national rate.

Using this method Bath & North East Somerset is classified as a member of the 'Prospering Smaller Towns' cluster.

The PCT is benchmarked against the national figure and Office for National Statistics (ONS) clusters. ONS clusters are based on 2001 census data. Two PCTs are

similar based on a comparison of a range socio-economic variables and demographic indicators.

Cardiovascular disease PCT health profile

Key messages

PCT boundaries

Bath & North East Somerset

© Crown Copyright. All rights reserved. DH 100020290 2012.Network boundaries

Benchmarking

Bath & North

East Somerset

North

Somerset

SwindonSouth

Gloucestershire

Bristol

Gloucestershire

Somerset

Wiltshire

Version 0.9

http://www.sepho.nhs.uk/

IndicatorLocal

ValueEng Avg Eng Low Eng High

1 52.3 64.7 36.2 118.4

2 45.7 40.9 22.1 58.6

3 19.9 22.1 0.0 33.5

4 21.9 24.1 0.0 30.7

5 4.0 4.1 1.9 7.3

6 13.6 17.5 11.4 27.2

7 0.60 0.59 0.31 0.82

8 0.45 0.44 0.30 0.53

9 198.2 225.9 145.3 399.0

10 82.6 85.7 58.2 172.7

11 6.0 9.3 0.0 17.3

12 70.3 77.3 56.7 97.5

13 47.8 59.2 17.9 98.8

14 202.4 272.0 121.3 533.9

15 109.2 136.6 93.7 231.1

Page 1: Contents & summary Indicators

: Demographic profile

Page 3: Lifestyle behaviours

Page 4: Quality and Outcomes Framework - exceptions & prevalence

Page 5: Quality and Outcomes Framework - performance

Page 6: Coronary heart disease emergency admission rates

Page 7: Heart failure emergency admission rates

Page 8: Myocardial Infarction management

Page 9: Angiography procedures

Page 10: Revascularisation procedures

Page 11: Revascularisation procedures by deprivation & valve surgery

Page 12: Cardiac procedures

Page 13: Stroke emergency admission rates

Page 14: Stroke and TIA management

Page 15: CVD mortality rates and contribution of CVD deaths

Page 16: CVD mortality rates and CVD mortality rates by quintile of relative deprivation

Page 17: Trends in mortality rates

Page 18: Programme budgeting expenditure

Obs/Exp Hypertension prevalence

% HF who die at usual place residence

Angiography rates

Revascularisation rates

CHD emergency admissions

Stroke emergency admissions

30 day mortality in STEMI

% stroke discharged to usual residence

Estimated % obese (16+)

4 week quitters per smokers (%)

% of long term conditions who smoke

Obs/Exp CHD prevalence

Cardiovascular disease health profile - Bath & North East Somerset

England Range

Cardiovascular mortality (under 75)

Stroke mortality

Estimated % smokers (16+)

Source: ONS mid year population estimates, 2007 Source: Calculated from ONS ethnic group population estimate, 2005Source: IMD2007 and ONS mid year population estimates, 2007

Cardio vascular disease Health ProfileHull PCT

Summary Indicators

Contents

Significantly Higher than England averageSignificantly Lower than England averageNot significantly different from England averageNo significance available 25th

HighestLowest

ONS clusteraverage

Englandaverage

Percentile 75th

1. Directly standardised rate per 100,000, 2010 under 75. 2. Directly standardised rate per 100,000, 2010, all ages. 3. Percentage estimate of smokers , 16+, 2006-08. 4. Percentage estimate of obese adults, 16+, 2006-08. 5. Quitters as a proportion (%) of estimated smokers, 2010/11. 6. Percentage of those registered with long-term conditions who smoke, 2010/11. 7. Ratio of 2010/11 CHD QOF disease registers to estimated prevalence in 2011. 8. Ratio of 2010/11 hypertension QOF disease registers to estimated prevalence in 2011. 9. Directly standardised rate per 100,000, 2010/11. 10. Directly standardised rate per 100,000, 2010/11. 11. Percentage, 2010. 12. % of all patients diagnosed with stroke under 75, 2010/11. 13. Percentage of deaths due to heart failure at their usual place of residence 2010. 14. Directly standardised rate per 100,000, 2010/11. 15. Directly standardised rate per 100,000, 2010/11.

Page 1 of 18

Age profile and population projections in Bath & North East Somerset

National deprivation structure (IMD 2010)

Ethnicity estimated in 2009

The proportion of the population in Bath &

North East Somerset which is from black and

minority ethnic groups is estimated to be

7.7%. South Asian men are more likely to

develop CHD at younger age, and have

higher rates of myocardial infarction. Black

people have the highest stroke mortality

rates.

The definition of BME used here excludes 'White

Irish' and 'White other' ethnic groups.

Bath & North East Somerset has 4.1% of its

population in the most deprived national

quintile and 42.9% of the population in the

least deprived quintile.

The population estimate of Bath & North East Somerset in

2010 was 179,700 and is projected to increase to 206,300 in

2030.


Age is a key factor in cardiovascular disease. The prevalence of

cardiovascular disease increases significantly after the age of

40 years.

The percentage of the population aged 40 yrs and over is

expected to increase from 23.2% to 24.2% for males and

decrease from 25.9% to 25.0% for females by 2030. This age

group in the Prospering Smaller Towns population is expected

to increase from 25.6% to 27.5% for males and increase from

28.3% to 29.7% for females. In England it is expected to

increase from 23.5% to 25.1% for males and increase from

25.8% to 26.8% for females.8% 6% 4% 2% 0% 2% 4% 6% 8%

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84

85+

Percentage

Age

Ban

ds

F 2030 F 2010 M 2030

M 2010 ENG M 2010 ENG F 2010

Demographic profile

Source: Office for National Statistics (ONS) 2010 MYE & 2008-based subnational population projections

0%10%20%30%40%50%60%70%80%90%

100%


Prospering Smaller Towns

England

% R

esi

de

nts

1 (Most deprived) 2 3 4 5 (Least deprived)

Source: IMD 2010 Department of Communities and Local Government (DCLG)

3.1% 2.4%3.5%

3.0%2.9%

6.1%1.5%

1.1%

2.9%

0%

2%

4%

6%

8%

10%

12%

14%



England

% B

ME

Black Asian Other

Source: ONS Resident Population Estimates by Ethnic Group, 2009

Page 2 of 18

Lifestyle estimates for adults

Smoking Binge Drinking Obesity

19.9% 23.2% 21.9%

20.1% 20.2% 23.6%

22.1% 20.0% 24.1%

Smoking

Binge drinking (2007-2008)

Adult obesity

Four week quitters as a proportion of estimated adult smokers, 2010/11


It is estimated that 23.2% of the population in Bath & North East Somerset binge drink. This is higher than England (20.0%)

and higher than Prospering Smaller Towns (20.2%).

Using synthetic estimates from the Health Survey for England it is estimated that 19.9% of the population in Bath & North East

Somerset smoke. This is lower than the estimated proportion in England (22.1%) and lower than Prospering Smaller Towns

(20.1%).



England

QOF data shows that the

percentage of patients with long-

term conditions who smoke in

Bath & North East Somerset was

13.6% in 2010/11. This is

significantly lower than the rate

in England (17.5%) and

significantly lower than the rate

in Prospering Smaller Towns

(15.6%).

Percent of patients registered with a GP with any combination of registered long-term conditions who

smoke, QOF 2010/11

It is estimated that 21.9% of the adult population in Bath & North East Somerset are obese. This is lower than England

(24.1%) and lower than Prospering Smaller Towns (23.6%).•

•

•

In 2010/11 4.0% (1,194) of adult

smokers in Bath & North East

Somerset quit using the NHS

Stop Smoking Services, a lower

percent than in England (4.1%)

and lower percent than in


(4.2%).

Lifestyle behaviours

17.5%

15.6%

13.6%

0% 5% 10% 15% 20% 25% 30%

England



Source: Modelled Estimates from Health Survey for England, 2006-08 - Binge drinking is for 2007-2008 only

Source: Quality and Outcomes Framework 2010/11

4.0% 4.2% 4.1%

0%

1%

2%

3%

4%

5%

6%

7%

8%



England

Pro

po

rtio

n Q

uit

tin

g

Source: Smoking cessation 2010/11 ONS Mid year population estimates 2010, Modelled Estimates from Health Survey for England, 2006-08

Page 3 of 18

PCT



England

Number and percentage of practices with high exception reporting rates

Atrial

fibrillation

Coronary

heart

disease

Heart

failure

Hyper-

tension

Stroke &

TIA

Practices

with any

high

exception

rates

Total

number of

practices

Bath & North East Somerset 2 1 1 2 2 2 2

Bath & North East Somerset 100.0% 50.0% 50.0% 100.0% 100.0% 100.0% 2Prospering Smaller Towns 22.0% 58.3% 31.8% 22.7% 41.7% 100.0% 132

England % 21.3% 47.1% 19.8% 15.0% 36.9% 85.7% 848

Observed (GP registered) prevalence in 2010/11 versus estimated prevalence in 2011

Coronary heart disease

Stroke

HypertensionThe observed prevalence for hypertension in

Bath & North East Somerset is 45.4% of the

estimated prevalence. This compares to 44.1%

for England and 44.7% for Prospering Smaller

Towns. The gap between recognised and

treated hypertension, and actual hypertension

levels in the community have been long

recognised.


5.4%

5.5%

6.4%

2010/11 EERGPs can exclude patients from the calculation of

measures in the Quality and Outcomes Framework, to

allow practices to pursue the quality improvement

agenda and not be penalised, where, for example,

patients do not attend for review, or where a

medication cannot be prescribed due to a

contraindication or side-effect. However, the number of

such exceptions varies substantially between practices.

In 2010/11, the exception rate in Bath & North East

Somerset was 5.4%. Within England, the exception rate

varied between 2.2% to 7.5% for individual PCTs.

The observed prevalence for stroke in Bath &

North East Somerset is 76.8% of the estimated

prevalence. This compares to 67.4% for England

and 72.3% for Prospering Smaller Towns.

The observed prevalence for CHD in Bath &

North East Somerset is 60.0% of the estimated

prevalence. This compares to 58.7% for England

and 61.8% for Prospering Smaller Towns.

GPs record information on whether their

patients have CHD or have a stroke. This

information is crude and does not consider

population structure. The estimated prevalence

is population structure adjusted, but is for the

16+ population, so does not match the all age

population of GP registers.

Quality and Outcomes Framework - exceptions

3.0

%

3.7

%

3.4

%

5.0

%

6.0

%

5.8

%

0%1%2%3%4%5%6%7%8%9%

Bath &North EastSomerset


England

Pre

vale

nce

1.8

%

1.9

%

1.7

%

2.4

%

2.7

%

2.5

%

0%

1%

2%

3%

4%



England

Pre

vale

nce

12

.8%

14

.5%

13

.5%

28

.3%

32.5

%

30.6

%

0%

10%

20%

30%

40%



England

Pre

vale

nce

Sources: Quality and Outcomes Framework 2010/11 and modelled estimates of prevalence, Eastern Region Public Health Observatory, December 2011

Observed Estimated

Quality and Outcomes Framework - prevalence

Page 4 of 18

2010/11

Significantly lower than England The same as England Significantly higher than England

Coronary heart disease Stroke

Bath &

North East

Somerset

Prospering

Smaller

Towns England

Bath &

North East

Somerset

Prospering

Smaller

Towns England

% newly diagnosed angina

patients referred for exercise

testing or assessment95.4 94.6 94.6

% stroke patients with a

record of blood pressure in

last 15 months96.9 96.9 96.8

% CHD patients with record of

blood pressure in last 15

months

98.2 97.8 97.8

% stroke patients whose

blood pressure was 150/90 or

less

87.7 88.8 88.6

% CHD patients in whom last

blood pressure reading was

150/90 or less89.8 90.3 90.2

% stroke patients with record

of cholesterol in last 15

months92.4 91.7 91.5

% CHD patients with a record of

total cholesterol in last 15

months

94.7 93.9 93.7

% stroke patients whose

cholesterol was 5mmol/l or

less

76.1 77.5 77.3

% CHD patients in whom last

cholesterol measurement was

5mmol/l or less82.3 82.4 82.1

% stroke patients immunised

preceding Sept-March89.4 89.9 89.6

% CHD patients taking aspirin,

an alternative anti-platelet

therapy or an anti-coagulant in

last 15 months94.6 93.4 93.5

% non-haemorrhagic/with

history of TIA stroke patients

taking anti-platelet agent/anti-

coagulant95.7 93.6 93.7

% CHD patients currently

treated with beta blocker 73.0 73.2 73.5

% new patients with a stroke

referred for further

investigation

89.8 90.0 89.8

% patients with history of

myocardial infarction currently

treated with ACE inhibitor or

angiotensin II antagonist

88.7 88.6 88.8

Atrial fibrillation% CHD patients immunised

against influenza in Sept-March

05 92.9 92.7 92.4

% atrial fibrillation patients

currently treated with anti-

coagulation drug therapy or

an anti-platelet therapy

94.6 93.4 93.6

Heart failure Hypertension% heart failure patients

diagnosed after 1st April 2006

with diagnosis confirmed by an

echocardiogram or specialist

assessment

97.2 95.8 95.8

% hypertension patients with

record of blood pressure in

last 9 months91.3 91.6 91.6

% patients with a current

diagnosis of heart failure due to

LVD currently treated with an

ACE inhibitor or angiotensin

receptor blocker

89.4 89.1 89.5

% hypertension patients (with

record in last 9 months) in

whom last blood pressure

was 150/90 or less77.5 79.4 79.3


Quality and Outcomes Framework - performance

Source: Quality and Outcomes Framework 2010/11

Page 5 of 18

CHD emergency admission rates (DSRs), for all ages, 2010/11

CHD emergency admission rates (DSRs) for all ages, by quintile of relative deprivation, 2010/11

Trend in CHD rates (DSRs), 2003/04 to 2010/11

The emergency admission rate for CHD in Bath

& North East Somerset has decreased by 27.9%

between 2003/04 and 2010/11.

In England it has decreased by 23.9% and in

Prospering Smaller Towns it has decreased by

12.5%.


In 2010/11 the emergency admission rate for

CHD, all persons, in Bath & North East Somerset

was 198.2 per 100,000 (535 admissions). This is

significantly lower than England (225.9 per

100,000) and lower than Prospering Smaller

Towns (206.5 per 100,000).

Male CHD emergency admission rates are

significantly higher than female CHD emergency

admission rates.

The emergency admission rates for persons who live in the most deprived areas of England are 2.1 times greater compared to persons

who live in the least deprived areas and 1.8 times greater in Prospering Smaller Towns.

The emergency admission

rate for CHD in 2010/11 for

persons living in the most

deprived areas of Bath &

North East Somerset was

231.1. This is 1.3 times

greater than emergency

admission rates for persons

living in the least deprived

areas of Bath & North East

Somerset (175.4).

Coronary heart disease emergency admission rates

0

100

200

300

400

500

600

700

800

Leastdeprived

Mostdeprived

DSR

pe

r 1

00

,00

0

PCT

0

100

200

300

400

500

600

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

DSR

pe

r 1

00

,00

0

Source: HES, The NHS Information Centre for health and social care, ONS, Department of Communities and Local Government (DCLG )

Source: HES, The NHS Information Centre for health and social care, ONS



England



England

27

6.0

12

7.7 19

8.22

81

.8

13

8.1 20

6.53

05

.3

15

3.7 22

5.9

0

100

200

300

400

500

600

Males Females Persons

DSR

pe

r 1

00

,00

0

Source: Hospital Episode Statistics (HES), The NHS Information Centre for health and social care, ONS

Leastdeprived

Mostdeprived

Cluster

Leastdeprived

Mostdeprived

England

Page 6 of 18

Heart failure emergency admission rates (DSRs), for all ages, 2010/11

Heart failure emergency admission rates (DSRs) for all ages, by quintile of relative deprivation, 2010/11

In England it has decreased by 22% and in Prospering Smaller

Towns it has decreased by 23.6% .


Male heart failure emergency admission rates

are significantly higher than female heart

failure emergency admission rates.

In 2010/11 the emergency admission rate for

heart failure, all persons, in Bath & North East

Somerset was 55.5 per 100,000 (190

admissions). This is lower than England (59.8

per 100,000) and higher than Prospering

Smaller Towns (50.7 per 100,000).


rate for heart failure in

2010/11 for persons who live

in the most deprived areas of


was 76.2. This was 1.5 times

greater than the emergency

admission rates for persons

who live in the least deprived

areas of Bath & North East

Somerset (50.9).

In England, the emergency admission rates for persons who live in the most deprived areas are 2.4 times greater respectively compared

to persons who live in the least deprived areas and 1.8 greater in Prospering Smaller Towns.

Proportion of deaths from heart failure that occur at

home or usual place or residence, 2006-2010

The emergency admission rate for heart failure in Bath & North

East Somerset has decreased by 19.1% between 2003/04 and

2010/11.

Trend in heart failure rates (DSRs), 2003/04 to 2010/11

47.8% of deaths from heart failure occurred in the usual place

of residence in Bath & North East Somerset which is a lower

proportion than Prospering Smaller Towns (60.1%) and

England (59.2%)

Heart failure emergency admission rates

77

.1

36

.7 55

.5

65

.1

39

.2

50

.774

.8

47

.5 59

.8

0

20

40

60

80

100

120

140

160

180

200

Male Female Persons

DSR

pe

r 1

00

,00

0

Bath & North East Somerset Prospering Smaller Towns

England

0

20

40

60

80

100

120

140

160

180

200

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

DSR

pe

r 1

00

,00

0

Source: HES, The NHS Information Centre for health and social care, ONS, DCLG




England

0

50

100

150

200

250

300

Leastdeprived

Mostdeprived

DSR

pe

r 1

00

,00

0

PCT

Leastdeprived

Mostdeprived

Cluster

Leastdeprived

Mostdeprived

England

47

.8%

60

.1%

59

.2%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


ProsperingSmaller Towns

England

Source: PHO annual deaths extract, ONS

Page 7 of 18

* STEMIs are ST elevated myocardial infarctions (as seen in an ECG) and best treated by thrombolysis or primary angioplasty

Proportion of non-STEMIs seen by member of cardiology team, 2010

30 day mortality rate for STEMI cases, 2010

The 30 day mortality rate for STEMIs was

recorded as 6% in Bath & North East

Somerset during 2008-2010, this is lower

than Prospering Smaller Towns and England

(10.2% and 9.3% respectively).

The median time to primary angioplasty treatment from a

call for help was 126 minutes in Bath & North East

Somerset, this is higher than in Prospering Smaller Towns

and England (115 and 113 respectively).

Primary Angioplasty median time to treatment from

calling for help, 2010

Percentage Primary Angioplasty used in reperfusion treatment,

2010


Primary angioplasty in Bath & North East Somerset was 98.1% of all

reperfusion for STEMI, compared to 78.7% in England.

Non-STEMIs can be treated less invasively,

but still need specialist management. The

proportion of nSTEMIs seen by a member of

the cardiology team in Bath & North East

Somerset is 81.8%, this is lower than

Prospering Smaller Towns and England

(89.9% and 92.2% respectively).

Myocardial Infarction management

98

%

75

%

79

%

0%

20%

40%

60%

80%

100%



England

12

6

11

5

11

3

0

50

100

150

200

250



England

Min

ute

s

6.0

% 10

.2%

9.3

%

0%

5%

10%

15%

20%



England

81

.8%

89

.9%

92

.2%

0%

20%

40%

60%

80%

100%



England

Source: MINAP

Source: MINAP

Source: Myocardial Ischaemia National Audit Project (MINAP)

Page 8 of 18

Angiography procedure rates (DSRs) for all ages, 2010/11

Trend in angiography rates (DSRs), 2003/04 to 2010/11

Angiography rates for persons who live in the most deprived areas of Bath & North East Somerset are 1.5 times greater

than those who live in the least deprived areas. In England and Prospering Smaller Towns they are 1.5 and 1.4 times

greater respectively.


In 2010/11 the angiography rate in Bath

& North East Somerset was 202.4 per

100,000 (465 procedures). This is

significantly lower than England (272

per 100,000) and significantly lower

than Prospering Smaller Towns (246.5

per 100,000).

Male angiography rates are 1.9 times

greater than female angiography rates

in Bath & North East Somerset.

Angiography procedure rates (DSRs) for all ages, by quintile of relative deprivation, 2010/11

Angiography rates in Bath & North East

Somerset have increased by 8%

between 2003/04 and 2010/11. In

England and Prospering Smaller Towns

they have increased by 7.5% and 15.2%

respectively.

Angiography procedures

0

100

200

300

400

500

600

700

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

DSR

pe

r 1

00

,00

0

Bath & North East Somerset Prospering Smaller Towns England

15

5.7

20

5.9

17

9.8

24

2.7

23

5.1

0

100

200

300

400

500

600

700

800

Leastdeprived

Mostdeprived

DSR

pe

r 1

00

,00

0

PCT

27

1.1

14

1.1

20

2.433

9.8

16

0.2

24

6.536

8.5

18

3.3

27

2.0

0

100

200

300

400

500

600

700

800

Male Female Persons

DSR

pe

r 1

00

,00

0





21

9.5

22

4.6

23

7.4

25

6.3

30

5.5

Leastdeprived

Mostdeprived

Cluster

22

5.7

24

2.6

26

5.8

30

0.7

34

8.1

Leastdeprived

Mostdeprived

England

Page 9 of 18

Non-elective angioplasty rates in Bath & North East Somerset have increased by 143.3% between 2003/04 and 2010/11.

Elective procedure rates have increased by 81.1%. In England and Prospering Smaller Towns non-elective procedure rates

have increased by 92.8% and 136.8% respectively. Elective procedure rates have increased by 1.9% and 8.1% respectively.

CABG procedure rates in Bath & North East Somerset have decreased by 18% between 2003/04 and 2010/11. In England

and Prospering Smaller Towns CABG procedure rates have decreased by 26.2% and 26.2% respectively.

Male angioplasty rates are 3.8 times greater than female angioplasty rates in Bath & North East Somerset.

In 2010/11 the CABG rate, all persons, in Bath & North East Somerset was 30 per 100,000 (72 procedures). This is higher

than England (29.6 per 100,000) and higher than Prospering Smaller Towns (26.7 per 100,000).


CABG procedure rates (DSRs), for all ages,

2010/11

In 2010/11 the all persons angioplasty rate in Bath & North East Somerset was 79.2 per 100,000 (179 procedures), 26.6

elective and 52.6 non-elective. This is significantly lower than England (106.9 per 100,000) and significantly lower than

Prospering Smaller Towns (97.3 per 100,000).

Elective & non-elective angioplasty procedure rates

(DSRs) for all ages, 2010/11Bath & North East

Somerset

Prospering Smaller

TownsEngland

Trend in Angioplasty rates (DSRs), 2003/04 to

2010/11

Trend in CABG rates (DSRs), 2003/04 to 2010/11

51

.1

10

.7

30

.045

.9

9.1 26

.749

.9

11

.1

29

.6

0

20

40

60

80

100

120

140


DSR

pe

r 1

00

,00

0


England

Revascularisation

Source: ONS 2006-based subnational population projections by sex and quinary

4262 64

12 15 18 27 37 40

87

96 105

21 26 3153

60 67

0

50

100

150

200

250

DSR

pe

r 1

00

,00

0


0

20

40

60

80

100

120

140

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

DSR

pe

r 1

00

,00

0

Bath & North East Somerset non-elective

Bath & North East Somerset elective

Prospering Smaller Towns non-elective

Prospering Smaller Towns elective

England non-elective

England elective

Source: HES, The NHS Information Centre for health and social care, ONS Source: HES, The NHS Information Centre for health and social care, ONS


0

10

20

30

40

50

60

70

80

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

DSR

pe

r 1

00

,00

0



England

Non-elective

Elective

Non-elective

Elective

Non-elective

Elective

Page 10 of 18

Valve procedure rates (DSRs), 2009/10-2010/11

Valve procedure rates in Bath & North East Somerset were 11.8 per 100,000 people in 2009/10-2010/11, lower than

the cluster average (14.4) and lower than England (14.6).


Revascularisation rates (DSRs) for all ages, by quintile of relative deprivation, 2010/11

Revascularisation rates for persons who live in the most deprived areas of Bath & North East Somerset are 1.2 times

greater than those who live in the least deprived areas. In England and Prospering Smaller Towns they are 1.6 and 1.4

times greater respectively.

Revascularisation - deprivation1

09

.6

89

.7

11

0.1

10

8.0

13

0.9

0

50

100

150

200

250

300

350

400

Leastdeprived

Mostdeprived

DSR

pe

r 1

00

,00

0

PCT



11

1.5

11

4.2

11

9.2

12

7.2

15

3.3

Leastdeprived

Mostdeprived

Cluster

11

3.8

11

9.5

13

2.5

15

0.9

17

8.8

Leastdeprived

Mostdeprived

England1

4.9

8.8 1

1.8

17

.7

11

.4 14

.417

.8

11

.6 14

.6

0

5

10

15

20

25

30

35

40


DSR

pe

r 1

00

,00

0

Valve surgery


Page 11 of 18

Heart Transplants by SHA, 2010/11

Strategic Health Authority

West Midlands

East Of England

North West

South East Coast

South Central

Yorkshire & The Humber

North East

South West

East Midlands

London

New pacemaker implant procedure rates (ISRs) for all ages, 2010

New implantable cardioverter-defibrillator procedure rates (ISRs) for all ages, 2010

Total cardiac resynchronisation therapy device procedure rates (ISRs) for all ages, 2010


The rate of heart transplantation

varies from 1.0 per million in

London to 3.5 per million in the

West Midlands. This data is not

available at a geography lower than

strategic health authority.

Rate per million population

3.5

2.6

2.5

2.3

2.0

1.9

1.5

1.1

1.1

1.0

The procedure rate for pacemaker

implants in Bath & North East

Somerset was 505.7. This is lower

than England (528.0).

The procedure rates for Cardiac

resynchronisation therapy devices in

Bath & North East Somerset were

27.7. This is lower than England

(114.0).

The procedure rates for Implantable

cardioverter-defibrillators in Bath &

North East Somerset were 50.9. This

is lower than England (72.0).

505.7 528.0

0

100

200

300

400

500

600

Bath & North East Somerset England

ISR

per

10

0,0

00

50.9

72.0

0

10

20

30

40

50

60

70

80


ISR

per

10

0,0

00

27.7

114.0

0

20

40

60

80

100

120


ISR

per

10

0,0

00

Cardiac procedures

Source: Cardiac Rhythm Audit, 2010

Source: UK Blood & Transplant

Page 12 of 18

Stroke emergency admission rates (DSRs) for all ages, 2010/11

Stroke emergency admission rates (DSRs), by quintile of relative deprivation, 2010/11

The rate of re-admissions within 30 days for Bath & North East Somerset is 2.0%, this is lower than England and Prospering Smaller

Towns (2.3% and 3.0% respectively).


Male stroke emergency admission rates are higher

than female stroke emergency admission rates.

In 2010/11 the emergency admission rate for stroke

in Bath & North East Somerset was 82.6 per 100,000

(268 admissions). This is lower than England (85.7

per 100,000) and higher than Prospering Smaller

Towns (78.9 per 100,000).

In England, the emergency adnission rates for persons who live in the most deprived areas are 1.7 times greater respectively compared to

persons who live in the least deprived areas and 1.5 greater in Prospering Smaller Towns.


rate for stroke in 2010/11

for persons who live in the

most deprived areas of

Bath & North East

Somerset was 98.2. This is

1.2 times greater than the

emergency admission rates

for persons who live in the

least deprived areas of

Bath & North East

Somerset (79.9).

Trend in stroke rates (DSRs), 2003/04 to 2010/11 Emergency readmission rates for patients with stroke,

2010/11

The emergency admission rate for stroke in Bath & North East Somerset has decreased by 17.2% between 2003/04 and 2010/11. In

England it has decreased by 4.7% and in Prospering Smaller Towns it has decreased by 3.1% .

Source: Quality and Outcomes Framework, 2007/08

Source: ONS 2006-based subnational population projections by sex and Source: Quality and Outcomes Framework, 2007/08

Stroke emergency admission rates

Source: ONS 2006-based subnational population projections by sex and 9

1.3

74

.5

82

.6

91

.4

66

.9

78

.910

0.1

71

.9

85

.7

0

50

100

150

200

Male Female Persons

DSR

pe

r 1

00

,00

0


England

0

50

100

150

200

250

300

Leastdeprived

Mostdeprived

DSR

pe

r 1

00

,00

0

PCT

020406080

100120140160180200

2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

DSR

pe

r 1

00

,00

0





Leastdeprived

Mostdeprived

Cluster

Leastdeprived

Mostdeprived

England


2.0

%

2.3

%

3.0

%

0%

1%

2%

3%

4%

5%

6%

7%



England

Perc

en

t

Page 13 of 18

Stroke Care

The rate TIA cases with high risk of stroke treated within 24 hrs for Bath & North East Somerset is 75.0%, this is

higher than England and Prospering Smaller Towns (70.6% and 64.0% respectively). The rate patients spending

90% of their time on a stroke unit following stroke for Bath & North East Somerset is 77.3%, this is lower than

England and Prospering Smaller Towns (81.8% and 79.0% respectively).


Percentage spending 90% of their time on a stroke unit

following stroke, July to September 2011

Percentage of hospital stroke patients discharged to

home or usual place of residence, 2010/11

Rate of carotid endarterectomy procedures DSR per

100,000, 2010/11

TIA cases with high risk of stroke treated within 24

hours, July to September 2011

The proportion of patients under the age of 75 discharged to home or usual place of residence in Bath & North

East Somerset is 70.3%, which is lower than Prospering Smaller Towns (78.2%) and England (77.3%). 52.4% of

patients aged 75 or over are discharged to home, which is significantly lower than Prospering Smaller Towns

(72.1%) and England (70.2%).

The level of carotid endarterectomies performed per 100,000 for Bath & North East Somerset is 8.1, which is

lower than England (8.8). Prospering Smaller Towns is significantly lower than England.

70

.3%

78

.2%

77

.3%

52.4

% 72.1

%

70.2

%

0%

20%

40%

60%

80%

100%



England

No border = under 75 Dotted border = 75 and over

Stroke & TIA management

77

.3%

79

.0%

81

.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



England

Source: The NHS Information Centre for health and social careSource: HES, The NHS Information Centre for health and social care

Source: HES, The NHS Information Centre for health and social care,

8.1 8.2 8.8

0

2

4

6

8

10

12



EnglandD

SR p

er 1

00

,00

0

75

.0%

64

.0%

70

.6%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%



England

Page 14 of 18

All CVD mortality rates (DSRs) in persons under 75 yrs: 1995 to 2012

% Decrease 1995 to

2010

<75

CVD deaths as a proportion of all deaths under, <75 and 75+, 2008-10

75+

CHD makes up the biggest proportion of total deaths (within CVD) for both males and females, 16.6% (5.7% AMI and 10.9% non

AMI) and 10.8% (3.4% AMI and 7.4 % non AMI ) respectively in Bath & North East Somerset. For males, 7.9% of deaths are due to

stroke and 1% are due to heart failure. For females, 12.1% of deaths are due to stroke and 2% are due to heart failure.


In 2010 the all CVD mortality rate in Bath & North East Somerset for persons under 75 yrs was 52.3, a decrease of 55.9% from 1995.

The former CVD target was set to reduce mortality rates from all CVD by 2009-11 by at least 40% in people under 75 years from a

1995/97 baseline. This target has already been met in England and in the Prospering Smaller Towns region and has been met in Bath

& North East Somerset. The target ended in June 2010.

The forecast decrease in the mortality rate (dotted line) for CVD in Bath & North East Somerset by 2012 is 66.3%. For England, the

forecast decrease is 61.6% and for Prospering Smaller Towns it is 63.9%.

Bath & North East

Somerset:

55.9%

Prospering Smaller

Towns:

57.6%

England:

56.1%

In Bath & North East Somerset the percentage of cardiovascular deaths as a proportion of all deaths was 21.4% for people aged

under 75 years and 36.1% for people aged 75 and above. This is lower than England for under 75s (24.6%) and higher than

England for those aged 75 and over (36.4%).

0

20

40

60

80

100

120

140

160

180

200

220

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12

DSR

pe

r 1

00

,00

0


Cardio vascular disease Health ProfileHull PCT

Mortality rates trend

CVD early mortality trend

Contribution of CVD deaths to overall mortality

Source: The NHS Information Centre for Health and Social Care, PHO annual deaths extract, ONS

81

73

54<570

362

146

443

72

272

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0%

5%

10%

15%

20%

25%

30%



England Bath &North EastSomerset


England

Pro

po

rtio

n o

f d

eat

hs

75

+

Pro

po

rtio

n o

f d

eat

hs

<75

CHD: non AMI CHD: AMI Stroke Heart failure Other


Page 15 of 18

CVD mortality rate (DSR) by gender for all ages, 2008-10

All CVD mortality rates (DSRs) for all persons, by quintile of relative deprivation, 2008-10


Male CVD mortality rates in Bath &

North East Somerset are significantly

higher than female CVD mortality rates

(169.6 and 117.5 respectively).

The 2008-10 CVD mortality rate in Bath

& North East Somerset for all persons

was 141.9 per 100,000. This is

significantly lower than England (167)

and significantly lower than Prospering

Smaller Towns (156.9).

In England the mortality rate for persons who live in the most deprived areas was 229.6, 1.4 times greater than the

overall rate and 1.8 times greater than in the least deprived areas. In Prospering Smaller Towns the mortality rate

for persons who live in the most deprived areas was 200.6, 1.3 times greater than the overall rate and 1.6 times

greater than in the least deprived areas.

The mortality rate in 2008-10 for persons who live in the most deprived areas of Bath & North East Somerset was

152.8 per 100,000. This is 1.1 times greater than the overall mortality rate for Bath & North East Somerset and 1.3

times greater than the mortality rate for persons who live in the least deprived areas of Bath & North East

Somerset.


Primary cause of death within CVDSource: ONS 2006-based subnational population projections by sex and quinary age

CVD mortality rates Source: NCHOD (Compendium of Health)

CVD by deprivation

16

9.6

11

7.5

14

1.919

3.7

12

5.3

15

6.920

8.1

13

1.9

16

7.0

0

50

100

150

200

250

300

350


DSR

per

10

0,0

00



12

7.4

14

1.6

15

0.9

16

2.9

20

0.6

Leastdeprived

Mostdeprived

Cluster

12

1.8

13

8.6

15

2.2

14

8.6

15

2.8

0

50

100

150

200

250

300

350

Leastdeprived

Mostdeprived

DSR

pe

r 1

00

,00

0

PCT

12

9.2

14

6.8

16

1.8

18

9.2

22

9.6

Leastdeprived

Mostdeprived

England


Page 16 of 18

The forecast decrease in the mortality rate for stroke between 1996 and 2012 for Bath & North East Somerset is 52.2% for males and

43.1% for females. For England, the forecast decrease is 55.3% and 50.2% for males and females and for Prospering Smaller Towns it is

57.3% and 49.8% respectively.


The forecast decrease in the mortality rate for CHD between 1996 and 2012 for Bath & North East Somerset is 60.6% for males and

62.1% for females. For England, the forecast decrease is 60.8% and 62.6% for males and females and for Prospering Smaller Towns it is

62.6% and 64.5% respectively.

Trend in stroke mortality rates, all ages, 1996-2012

Trend in CHD mortality rates, all ages, 1996-2012


Trends in mortality ratesSource: ONS 2006-based subnational population projections by sex and quinary age

Contribution of CVD deaths to overall mortality

0

50

100

150

200

250

300

350

96 98 00 02 04 06 08 10 12

DSR

pe

r 1

00

,00

0

0.010.020.030.040.050.060.070.080.090.0

1

Males Bath & North East Somerset Males Prospering Smaller Towns Males England

Females Bath & North East Somerset Females Prospering Smaller Towns Females England

0

20

40

60

80

100

120

140

96 98 00 02 04 06 08 10 12

DSR

pe

r 1

00

,00

0

0

20

40

60

80

100

120

140

160

180

200

96 98 00 02 04 06 08 10 12

DSR

pe

r 1

00

,00

0

0

20

40

60

80

100

96 98 00 02 04 06 08 10 12

DSR

pe

r 1

00

,00

0



Page 17 of 18

Expenditure per head of weighted* population, 2010/11

* Weighted population is the Department of Health unified weighted population for PCTs

Expenditure per head* vs outcomes, 2010/11


The expenditure per head for all circulatory diseases in Bath & North East Somerset was £130.91 in 2010/11, £1.17 lower than

England and £13.05 lower than the Prospering Smaller Towns comparator area.

Please note that assignment to a quadrant (e.g., lower spend, worse outcome) is made on the basis of a single outcome

indicator and choosing a different outcome (e.g., a quality of care measure rather than a mortality measure) could potentially

shift the outcome quadrant.

The outcomes used in the Spend and outcomes graph above are mortality for all ages from this profile. For cardiovascular

disease in Bath & North East Somerset the graph shows similar mortality outcomes and similar weighted spend compared to the

England average.


Programme budgeting expenditureSource: ONS 2006-based subnational population projections by sex and quinary age

Contribution of CVD deaths to overall mortalitySource: NCHOD (Compendium of Health)Source: NCHOD (Compendium of Health)

Source: Department of Health, 2010/11 programme budgeting benchmarking tool

He

alth

Ou

tco

me

(z-

sco

re)

Spend per head (z-score)

CVD Cluster CVD Bath and North East Somerset PCT

CHD Cluster CHD Bath and North East Somerset PCT

Cerebrovascular Cluster Cerebrovascular Bath and North East Somerset PCT

Lower Spend, Better Outcome

Higher Spend, Better Outcome

Lower Spend, Worse Outcome

Higher Spend, Worse Outcome

0

20

40

60

80

100

120

140

160

Bat

h &

No

rth

Eas

t So

me

rse

t

Pro

spe

rin

g Sm

alle

r To

wn

s Engl

and

Bat

h &

No

rth

Eas

t So

me

rse

t

Pro

spe

rin

g Sm

alle

r To

wn

s Engl

and

Bat

h &

No

rth

Eas

t So

me

rse

t

Pro

spe

rin

g Sm

alle

r To

wn

s Engl

and

Prescribing Secondary Care Other

CVD CHD Cerebrovascular

Page 18 of 18

This report has been compiled by

• Kevin Watson

• Andrew Hughes

• Max Kammerling

With acknowledgements• Isobel Perry

• Anne Griffin

• Mike Knapton

• Jane O’Grady

• Karina Paturel

• Corrine Ralph

• Michelle Roe

• Jan Vaughan

• Linda Westlake

• Garry White

• Swetlana Wolf

• Tom Quinn

Delivered by:

Solutions for Public Health

4150 Chancellor Court

Business Park South

Oxford

OX4 2GX

With special thanks to Yorkshire and Humber Public Health Observatory

whose original work formed the basis for these reports.

Source:YHPHO

cardiovascular disease pct health profile · cardiovascular disease health profile - bath &...

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