Background & Policy
Heart Disease & Stroke
Coronary heart disease (CHD) is a disease of the heart and coronary arteries caused by the build up of fatty materials in the blood vessels that supply the heart with oxygen. This can cause a heart attack, chest pain or angina. Cerebrovascular Disease, which includes cerebrovascular accident/stroke and transient ischaemic attack (TIA), is responsible for the deaths of more than 5,000 people in Scotland every year. A stroke or TIA happens when the blood supply to part of the brain is interrupted and the brain cells are starved of oxygen. This usually occurs because a blood vessel becomes blocked. Stroke is more common in people over the age of 65.
Risk factors associated with CHD & stroke
The main preventable risk factors for coronary heart disease and stroke are smoking, lack of exercise and a poor diet. Research also indicates a strong relationship between social deprivation and these risk factors.
Detailed information on the prevalence of these risk factors is available from the Scottish Health Survey, the latest available survey being 2010. The 2003 survey included a specific report on Cardiovascular Diseases. You may also wish to refer to previous Scottish Health Survey reports from 1995 and 1998. Currently the Scottish Health Survey is running continuously from 2008-2011.
- Scottish Health Survey 2010
- Scottish Health Survey 2009
- Scottish Health Survey 2008
- Scottish Health Survey 2003
- Scottish Health Survey 2003 Cardiovascular Disease Report
- Scottish Health Survey 1998
- Scottish Health Survey 1995
Policy Context
NHSScotland service provision for patients with coronary heart disease and stroke operates within the framework of policy devised by the Scottish Government. A chronology of policy documents that steer service provision for CHD & stroke patients is outlined below.
- Coronary Heart Disease & Stroke Task Force (2001)
- Coronary Heart Disease & Stroke Strategy for Scotland (2002)
- Coronary Heart Disease & Stroke in Scotland: Strategy Update (2004)
- Delivering for Health (2005) (Scottish Government response to the "Kerr" report "Building a health service fit for the future")
- Better health, better care - action plan. (2007)
- Better coronary heart disease & stroke care: a consultation document (2008)
- Better heart disease & stroke care action plan (2009)
The Scottish Government, in their 2009 action plan, reiterated their target of reducing premature mortality from coronary heart disease by 60% between 1995 and 2010. Our latest published information on the trend in CHD mortality among under 75s (Table MC2
[150kb]) indicates the mortality rate fell from 124.6 per 100,000 in 1995 to 49.0 per 100,000 in 2010, a reduction of 60.7%. The target has therefore been achieved.
Data Quality
ISD's Data Quality Assurance was established in 1990. The team is experienced in clinical coding and in other aspects of medical records and information work. Its main remit is the routine assessment of the quality of data held on the national SMR database.
Emerging findings from the latest assessment of SMR01 data quality are available here.
The previous report Towards Better Data from Scottish Hospitals: An Assessment of SMR01 and Associated Data 2004 - 2006 [1.8Mb] was published in September 2007 and may be viewed or downloaded.
The report contains sub-sections on specific conditions and interventions, including some related to coronary heart disease.
In hospital discharge data, clinical information for diagnoses and operations/interventions is currently recorded using, respectively, ICD10 (the International Classification of Diseases 10th Revision maintained by the World Health Organization (WHO)) and OPCS4 (the Office of Population Censuses & Surveys 4th Revision Classification of Surgical Operations and Procedures maintained by the Department of Health's directorate NHS Connecting for Health (CfH)).
For ICD10 codes see the WHO website and for OPCS4 codes see the NHS Connecting for Health website. For an extract of OPCS4 codes related to the heart see the file below.
See the Extract from OPCS4 Classification of Surgical Operations and Procedures (Heart) [91kb] for details of the heart operations and procedures in its Chapter K. This document should be read in conjunction with the NHS Connecting for Health document Summary of Changes from OPCS-4.4 to OPCS-4.5 [118kb] for detalils of the latest updates to the coding classification.
Independent & voluntary sector
Although there are a number of independent & voluntary sector organisations involved in the provision of information and services to CHD & stroke patients, two of the main ones, with links to NHSScotland, are the British Heart Foundation (BHF) and Chest, Heart & Stroke Scotland (CHSS). Both organisations are involved in the funding of research and provide extensive information for patients and carers on their respective web sites at www.bhf.org.uk and www.chss.org.uk
Further Information
Our Links to other sources section offers a few examples of other information sources.
