Annual Publication Summary

Introduction

This summary page offers an overview of the latest publication of statistical information from ISD's Coronary Heart Disease (CHD) & Stroke Programme. There are separate summaries for each of CHD and stroke. This page relates to coronary heart disease.

Background

Coronary Heart Disease, also known as Ischaemic Heart Disease, is a preventable disease which kills around 9,000 people in Scotland every year.

The disease is caused when the heart's blood vessels, the coronary arteries, become narrowed or clogged and cannot supply enough blood to the heart. This can cause a heart attack, chest pain or angina. Almost fifty thousand people suffer from angina and ten thousand people have a heart attack annually in Scotland.

CHD is a priority in Scotland where prevalence of the associated risk factors such as smoking, diet and physical inactivity is high and around 7% of men and 6% of women are living with coronary heart disease (Scottish Health Survey 2008).

The Scottish Government published their strategy document Better Heart Disease and Stroke Care Action Plan in June 2009 which confirmed that CHD would continue to be a national clinical priority for NHSScotland.

Mortality

CHD is the second most common cause of death in Scotland where death rates are amongst the highest in Western Europe. In Scotland, almost a fifth of deaths are directly related to coronary heart disease.

Trends in Scotland nevertheless offer some reassurance and mortality rates have significantly reduced over the last 10 years. The overall age sex standardised rate for CHD mortality fell from 194.4 per 100,000 population in 1999 to 113 per 100,000 in 2008, a reduction of almost 43%. Rates in premature mortality (deaths in ages under 75) reduced by 41% over the same 10 year time period (see Table MC1).

CHD is a priority area for the Scottish Government and there is a national target of a 60% reduction in premature deaths from coronary heart disease in the 15 years up to 2010. The chart below shows progress against this target, suggesting that the target looks set to be achieved (see Table MC2).

Coronary heart disease has associations with significant health inequalities. Mortality rates from CHD in the most deprived areas in Scotland are almost double those in the least deprived areas. For premature deaths, the inequality gap is even greater (see Table DC1).

In recognising this, the Scottish Government have set a target to reduce the premature mortality rate from CHD in the 15% most deprived areas. The chart below shows the trend in coronary heart disease mortality rates among under 75s in the most deprived communities in Scotland (see Table DC3 & Table DC4).

Hospital Admission

A person suffering from CHD is likely to be admitted to hospital at some point during their life. In the year ending March 2009 there were around 49,100 hospital admissions for coronary heart disease, roughly 36% of which were emergencies. There has been a general downward trend in hospital admissions for CHD over the last 10 years with the age-sex standardised rate falling from 926.8 per 100,000 population in 1999/00 to 739.6 per 100,000 population in 2008/09 (see Table AC1).

Incidence

Incidence (new cases) of CHD has also been decreasing over the past decade. The number of acute myocardial infarctions (heart attacks) has decreased from 14,003 per year in 1999/00 to 10,415 in 2007/08 but increased to 11,294 in 2008/09. The recent increase is due to the change in the clinical definition of AMI, based on more sensitive tests (i.e. troponin) (see Table IC2).

Prevention and Treatment

Key lifestyle risk factors for coronary heart disease include smoking, poor diet and lack of exercise.

About one million people in Scotland smoke. The incidence of CHD is highest amongst people who are obese. Overall, 26% of men and 28% of women in Scotland are now obese (Scottish Health Survey 2008). Regular physical activity reduces the risk of coronary heart disease mortality. Physically inactive people have about double the risk of CHD.

Those at risk of CHD should normally be prescribed statins. These are drugs that reduce the levels of cholesterol (also sometimes called lipids) in the blood. High cholesterol levels are a significant risk factor for coronary events. In the year ending March 2008 spending on statins was around £70 million (see Table G2).

Coronary heart disease can often be controlled by drugs alone, but in many cases, an operation or procedure is also required. The number of operations carried out to treat CHD has increased over the years. An angiogram (angiography) is performed to determine if the coronary arteries have narrowed. In the year ending 31st March 2009 approximately 17,000 angiographies were carried out (around 4% fewer than the previous year although there are data recording issues with regard to angiographies in comparison with the Scottish Coronary Revascularisation Register) (see Table OC1).

If the coronary arteries have narrowed, an angioplasty (percutaneous coronary intervention) may be carried to widen the artery by inflating a balloon in the narrowed coronary artery. In the year ending 31st March 2009 around 6300 angioplasties were performed, a 6% rise on the preceding year (see Table OC1).

A less common and more invasive type of surgery is a Coronary Artery Bypass Graft (CABG). In the year ending 31st March 2009, just over 2,000 CABG procedures were carried out. The number of CABGs carried out has been decreasing over the decade to 2009 while the number of angioplasties has been increasing. Angioplasty and CABG is often collectively referred to as revascularisation. The chart below illustrates the trend in rates of angioplasty.

Waiting Times

The current national waiting time standards are that no patient will wait more than 16 weeks for cardiac intervention following GP referral through rapid access chest pain clinic (RACPC) and no patient will wait more than 16 weeks for treatment after they have been seen as an outpatient by a heart specialist who has recommended treatment. Cardiac services are delivered on a regional basis and each region has set local targets for the cardiac journey component parts while ensuring that the total maximum wait meets the national target of 16 weeks.

The monitoring of waiting times, including those for interventions to treat coronary heart disease, was revised from 1st january 2008 when 'New Ways of Defining and Measuring Waiting Times' (termed "New Ways") was introduced. This was a significant change in how NHSScotland collects and defines waiting times, and also how waiting lists are clinically and administratively managed.

For further information on waiting times for cardiac interventions see the web pages of ISD's Waiting Times Programme . Figures indicating NHSScotland performance against the above cardiac waiting times targets are available from the "Patient Journey - Cardiac" of the Waiting Times Programme's web pages.

Cardiac Rehabilitation

Cardiac rehabilitation can improve prognosis and quality of life in people with CHD. Cardiac rehabilitation offers people advice and help with education, psychological support, exercise training and behavioural change. Historically, the majority of CHD patients have not received cardiac rehabilitation. This is a situation which the National Audit for Cardiac Rehabilitation and the National Campaign for Cardiac Rehabilitation are seeking to address and where progress is beginning to be made.

The 2009 annual report of the National Cardiac Rehabilitation Audit Project  omitted Scottish data because of the audit of cardiac rehabilitation services in Scotland being undertaken by NHS Quality Improvement Scotland and ISD during the autumn of 2009.

General Information

The internet offers a broad range of sources with information on on the prevention, diagnosis and treatment of coronary heart disease.

For example, the British Heart Foundation (BHF) offers patient information booklets about many of the issues discussed above and the BBC offers a Heart Disease guide in its 'Lifestyle' section. BHF also publish their own summary of heart disease statistics for the UK and this is available via their "Heartstats" web pages.

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