Coronary Heart Disease
Statistical Publication Notice
24 November 2009
Coronary Heart Disease Statistics Update .
INTRODUCTION
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.
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.
KEY POINTS
Coronary Heary Disease; Ages Under 75; European Age Standardised Mortality Rates per 100,000 Population
INTERPRETATION
DETAILED FINDINGS
MORTALITY
The age-standardised mortality rate (for under 75s) for CHD continues to fall, from 124.6 per 100,000 population in 1995 to 56.0 per 100,000 population in 2008. If this trend from 1995 continues, the target to reduce the mortality rate by 60% between 1995 and 2010 looks achievable (see Table MC2 ).
CHD mortality is strongly related to age. For the year ending 31st December 2008 the age-sex standardised mortality rate for 0-44 year olds was 3.8 per 100,000 population compared to 1,437.0 per 100,000 population for people aged 75 and over (see Table MC1 ).
The mortality rate from acute myocardial infarction (AMI or heart attack) maintains its steady decline. For the year ended 31st December 2008 the overall AMI death rate was 62.9 per 100,000 population, a reduction of 8.4% from the previous year (see Table MC1 ).
DEPRIVATION
In the 15% most deprived areas in Scotland, the under 75 mortality rate from CHD (standardised by age) decreased slightly from 112.4 in 2007 to 103.5 per 100,000 in 2008. This rate has shown a general decline over from the period 2000 to 2008, although there was a minor rise between 2006 and 2007 (see Table DC3 & Table DC4 ). Further information and data are available from the Scottish Government's web site "Scotland Performs" section.
Coronary Heart Disease; Ages Under 75; 15% Most Deprived Areas in Scotland; European Age Standardised Mortality Rates per 100,000 Population
There is a strong positive relationship between deprivation and CHD mortality rates. This relationship is evident for all ages but is strongest in the 0-64 age group. The 0-64 SMR is 4.5 times higher in the most deprived tenth, compared to the least deprived (see Table DC1 ).
The relationship between operation rates and deprivation in any age/sex group does not reflect the strong relationship between CHD mortality and deprivation. Table DC2 shows the ratio between the actual number of interventions performed and the number expected. The expected number is calculated using national procedure rates, taking into account the age and sex composition of the population, and the level of disease as measured by the relative level of CHD mortality in each deprivation decile. The figures show fewer interventions performed than expected for the more deprived areas - a finding first reported in the CHD and Stroke Task Force Report . Since there is no evidence that less deprived patients are having inappropriate interventions, the findings indicate inequity of access to, uptake of, or supply of interventions to more deprived populations (see Table DC2).
INCIDENCE
In the 10-year period between 1999/00 and 2008/09, the rate per 100,000 population of incident cases of CHD (standardised by age and sex) has fallen by 27.6% (from 405.6 to 293.5 per 100,000 population) (see Table IC1 ).
Between 2007/08 and 2008/09 the incidence rate for CHD (total number of people diagnosed with CHD per 100,000 population, standardised by age and sex) decreased by 5.6%. (from 310.9 cases per 100,000 population for 2007/08 to 293.5 cases per 100,000 population in 2008/09 (see Table IC1 ).
Incidence is related to age - the rate for under 75s in 2008/09 is 218.0 per 100,000 and for over 75s for the same period 2107.2 per 100,000 (see Table IC1 ).
Coronary heart disease incidence rates are consistently higher for males than females across all age groups (see Table IC1 ).
OPERATIONS
The number of Coronary Artery Bypass Graft (CABG) operations decreased from 2,446 in 2007/08 to 2,026 in 2008/09. This follows a slight increase between the years 2006/07 and 2007/08. There's a general downward trend in the numbers of CABG operations reflecting the increased use of percutaneous coronary interventions (angioplasties) in the treatment of coronary artery disease (see Table OC1 ).
The number of coronary angioplasties cases has increased from 5,974 in 2007/08 to 6,320 in 2008/09, resuming the upward trend seen in recent years which had seen a minor decrease from 2005/06 to 2006/07 (see Table OC1 ).
The number of revascularisation procedures (Coronary Artery Bypass Grafts and Coronary Angioplasties) performed by NHSScotland decreased fractionally between 2007/08 and 2008/09 but has remained stable over the last 3 to 4 years. Reductions in coronary artery bypass operations are offset by increases in the number of coronary angioplasties being performed (see Table OC1 ).
Based on provisional 2008/09 data, the number of Coronary Angiography investigations was 16,847 in 2008/09, compared to 17,540 in 2007/08, a decrease of around 4%. Comparison with the Scottish Coronary Revascularisation Register (SCRR) suggested under-recording of angiographies on the SMR01 database in the past. Although the figures for 2007/08 were comparable between SCRR and SMR01 the decline may be due to late return of SMR01 data on angiography (see Table OC1 ).
The number of discharges involving a valve operation increased by almost 31% between 2007/08 and 2008/09, from 852 to 1,115 (see Table OC1 ). This may reflect better data capture on the SMR01 database following the establishment of the West of Scotland Heart and Lung Centre at the Golden Jubilee National Hospital. Comparison of SMR01 with the Scottish Coronary Revascularisation Register suggests this could be the case.
The mainland NHS Boards with the highest mortality adjusted operation ratios (a measure of relative level of provision) for coronary revascularisation were Borders and Grampian for men and women respectively (see Table OC2 ).
HOSPITAL ACTIVITY
The number of emergency admissions for acute myocardial infarction (AMI or heart attack) increased by 11.8% from 7,327 in 2007/08 to 8,195 in 2008/09. This is probably due to recent changes in the definition of AMI, which uses more sensitive tests (i.e. troponin). The trend in mortality from AMI, and for CHD as a whole, remains downward (see Table AC1 ).
The number of emergency admissions for angina decreased from 8,943 in 2007/08 to 7,765 in 2008/09, a fall of 13% (see Tables AC1, AC2 and AC4 ).
The number of angina admissions decreased in all ages and both sexes between 2007/08 and 2008/09, from 13,343 to 12,580, a fall of 12.3% (see Tables AC1, AC2 and AC4 ).
GP PRESCRIBING
Over the decade 1999/00 - 2008/09 the numbers of prescriptions dispensed for cardiovascular related drugs continued to rise although the overall costs fell following a peak in the middle of the decade. Costs often reduce as medicines become available in generic form once drug patents expire (see Table G1).
Cardiovascular Prescribing, years ending 31st March 2000-2009
The number of prescriptions for cardiovascular disease (both coronary heart disease and cerebrovascular disease) increased by 73% in the last decade (from 14 million in 1999/00 to 24 million in 2008/09). The associated costs over the same period rose by a third, from £140 million to £187 million, and reached a peak of £230 million in 2004/05 before reducing to £187 million in 2008/09 (see Table G1 ).
MAIN CONTACTS:
Adam Redpath
Programme Principal
CHD/Stroke Programme
0131 275 6704
adam.redpath@nhs.net
David Clark
Principal Information Analyst
0131 275 6144
dclark5@nhs.net
GLOSSARY:
CHD – coronary heart disease. A group of conditions that includes acute myocardial infarction, angina and heart failure.
IHD – ischaemic heart disease. Another name for coronary heart disease.
AMI – acute myocardial infarction, commonly known as a heart attack
CABG – coronary artery bypass graft. An operation in which a blood vessel from another part of the body is grafted between the aorta (the main artery leading from the heart) and the coronary artery, or arteries, to bypass blockages and restore blood flow to the heart muscle
Heart failure – failure of the heart as a pump, the commonest cause being coronary heart disease.
Angiography - Under the guidance of an x-ray camera, a long, thin tube is threaded into the coronary arteries via a blood vessel in the groin or arm. A dye, which can be seen on the x-ray screen, is then injected, showing the pattern of the coronary arteries, and demonstrating where the artery is narrowed
Angioplasty – an operation performed to treat coronary heart disease that involves passing a thin, hollow tube up into the coronary arteries, under x-ray guidance, from an artery in the groin or arm (under local anaesthetic.) A device on the tube is then used to unblock the artery, and stretch the artery walls so that more blood and oxygen can flow to the heart muscle
PTCA – percutaneous transluminal coronary angioplasty. The full name for an angioplasty.
PCI - percutaneous coronary intervention.
Revascularisation – inclusive term referring to CABG and angioplasty procedures
Angina pectoris – recurrent chest pain as a result of coronary heart disease
ACS – acute coronary syndrome
PRE-RELEASE ACCESS:
NHS Board Chief Executives
NHS Board Communication leads
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
HISTORY OF THIS PUBLICATION:
Last Published: 25 November 2008
Next Due: 23 November 2010
Data Available Since: Most data is included within a time series for the previous decade.
Adam Redpath 
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