Cardiovascular disease profile - Cardiovascular risk factors April 2016 NHS Havering CCG Background

Key information

This chapter of the cardiovascular disease profiles focuses on risk factors for cardiovascular disease and is produced by the National Cardiovascular Intelligence Network (NCVIN). The profiles are available for each clinical commissioning group (CCG) in England. Each profile is made up of five chapters which look at risk factors, coronary heart disease (CHD), diabetes, kidney disease and stroke. This profile compares the CCG with data for England, a group of similar CCGs and the London strategic clinical network. Lifestyle and behavioural risk factors (such as smoking, physical inactivity, poor diet and obesity) reflect an individual’s circumstances and choices. There are also a number of risk factors for cardiovascular disease (CVD) which are not dependant on how people behave but on biological and social aspects of their lives, such as age, sex, ethnicity and deprivation. In addition, physical risk factors (including hypertension) reflect changes to body systems that are also reversible or preventable in their early stages but may require medical treatment. Key facts

Local

Comparator CCGs 18.5

SCN

England

Population aged 65 and over (per cent)

18.5

11.5

Estimated smoking prevalence (per cent)

16.7

16.9

17.8

18.4

Current smokers offered support and treatment (per cent)

89.0

86.4

86.5

85.8

Observed prevalence of hypertension (per cent) Expected prevalence of hypertension (per cent)

13.9

14.8

11.1

13.8

25.5

25.2

21.2

24.7

The resident population of NHS Havering CCG is 246,000 and 45,600 of these people are aged 65 and over, a higher proportion than across England as a whole. In NHS Havering CCG, 8.9% of people live in the most deprived fifth of areas in England. In 2015 it was estimated that 16.7% of adults in NHS Havering CCG smoked. Between 2012 and 2014 it was estimated that 65.5% of adults in NHS Havering CCG were classified as overweight or obese. In 2015 there were 36,000 people diagnosed with hypertension in NHS Havering CCG. This was lower than the expected number and 11.6% of adults could have hypertension that has not been diagnosed.

17.6

Produced by the National Cardiovascular Intelligence Network (NCVIN) PHE publications gateway number 2015692 © Crown copyright 2016

In 2014/15 the NHS Health Check was offered to 18.7% of the eligible population of NHS Havering CCG. 7.7% of the eligible population received a NHS Health Check.

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Risk factors for cardiovascular disease

April 2016

NHS Havering CCG Quantifying non-behavioural risk factors The prevalence of CVD increases with age, which is important in the light of an ageing population. In 2013 the proportion of people aged 65 and over in NHS Havering CCG was 18.5% which is higher than across England as a whole, where 17.6% of the population were aged 65 and over.

Age profile and population projections, 2014 (per cent)

Women England 2014

Deprivation, 2015 (per cent) Local

Men England 2036

England

30 90+ 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

25 20 15 10 5 8.9

22.2

25.6

26.4

16.8

0 8%

6%

4%

2%

0%

2%

4%

6%

Most deprived

8%

Least deprived

Source: IMD 2015

Source: 2014 Mid-year population estimates

People from a more deprived background are at greater risk of CVD than the general population. In NHS Havering CCG, 8.9% of the population are in the most deprived national quintile and 16.8% of the population in the least deprived. Minority ethnic groups, 2011 (per cent) England

Local 7.8

Asian

4.9 3.5

Black

4.8 2.3

Mixed

2.1 1.0

Other

Source: ONS 2011

0.6 0

10

20

30

40

50

60

70

Ethnic group (per cent)

England has become more ethnically diverse with rising numbers of people identifying with minority ethnic groups in the 2011 Census. The relationship between ethnic group and CVD prevalence is complex. For example, the risk of stroke is higher in south Asian, African or Caribbean populations living in England. In NHS Havering CCG an estimated 12.3% of the population are from Black, Asian, mixed or other groups, compared to 14.6% across England.

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April 2016

Risk factors for cardiovascular disease NHS Havering CCG Behavioural risk factors - prevalence

A number of common risk factors are recognised as increasing the likelihood of individuals developing CVD. These include smoking, obesity, physical inactivity, poor nutrition and drinking too much alcohol. Smoking prevalence, 2014/15 (per cent) Local Comparator CCGs SCN England

16.7 16.9 17.8 18.4

0

5

10

15

20

Source: Quality and Outcomes Framework (QOF), 2014/15

25 30 35 Smoking prevalence (per cent)

40

45

50

In 2015 it was estimated that 16.7% of adults in NHS Havering CCG smoked. Excess weight in adults, 2012 to 2014 (per cent) Local

65.5

Comparator CCGs

66.9

SCN

58.2

England

64.6 0

10

20

30

40 50 60 Excess weight prevalence (per cent)

70

80

90

100

Source: Active people survey, Sport England, 2014

Between 2012 and 2014 it was estimated that 65.5% of adults in NHS Havering CCG were classified as overweight or obese. Physical inactivity, 2014 (per cent) Local

26.8

Comparator CCGs

27.0

SCN

27.1

England

27.7 0

5

10

15

Source: Active people survey, Sport England, 2014

20

25 30 35 40 Prevalence of physical inactivity (per cent)

45

50

In 2014 it was estimated that 26.8% of adults in NHS Havering CCG were classified as ‘inactive’. Healthy eating (estimated proportion of adults who consume five or more portions of fruit or veg per day), 2014 (per cent) Local

52.9

Comparator CCGs

53.2

SCN

50.2

England

53.5

0

10

20

30

40 50 60 Prevalence of 5 a day (per cent)

70

80

90

100

Source: Active People Survey, Sport England 2014

In 2014 it was estimated that 52.9% of adults in NHS Havering CCG ate five or more portions of fruit and vegetables a day.

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Local

CCGs

umber

gland

Risk factors for cardiovascular disease

April 2016

NHS Havering CCG Admission episodes for alcohol-related cardiovascular disease conditions rate per 100,000 population, 2014 (per cent) Local

1,088

England

1,049

This chapter 0 of

200

400

600

800 1,000 1,200 1,400 1,600 Directly standardised rate per 100,000 population

1,800

2,000

Source: Public Health England 2014

In 2014 there were 1,088 episodes for alcohol-related cardiovascular disease conditions in NHS Havering CCG.

Hypertension - prevalence Blood pressure measurements indicate the pressure which the circulating blood puts on the walls of blood vessels. Blood pressure is measured in millimetres of mercury (mmHg) and is usually written as the systolic blood pressure/diastolic blood pressure. Blood pressure measurements are on a continuous scale and therefore there is no specific point at which normotension (normal blood pressure) becomes hypertension (high blood pressure). However, a blood pressure of 140/90 mmHg or greater is usually used to indicate hypertension because persistent levels of blood pressure above this start to be associated with increased risks of cardiovascular events. For the purpose of the Quality and Outcomes Framework (QOF), hypertension is defined as a blood pressure measurement of 150/90. Hypertension is important because when uncontrolled it is a major risk factor for stroke, heart attack, heart failure, aneurysms and chronic kidney disease. In 2015 there were 36,196 people on GP lists in NHS Havering CCG with diagnosed hypertension. This equated to 13.9% of the population registered with a GP, however, it was estimated the expected prevalence of hypertension in the CCG was 25.5%, meaning that 11.6% or 30,000 adults could have hypertension that has not been diagnosed. Diagnosed and estimated prevalence of hypertension, 2014/15 (per cent) Observed hypertension prevalence 13.9 25.5

8.8 Local 15.6 Comparator CCGs 12.1 21.6 14.0 25.0

14.8 25.2 11.1 21.2

SCN

13.8 24.7

England

13.7 24.6

Expected hypertension prevalence

0

5

0 Source: QOF, 52014/15

10

/13 and national general practice profiles 2011

10 15

20

15 20 Hypertension (per cent ) 25

25

30

30

Percentage %

Variation by general practice of diagnosed hypertension prevalence, 2014/15 (per cent) Diagnosed hypertension prevalence 30 Observed hypertension prevalence (per cent )

Local CCG diagnosed hypertension prevalence

20 10 0

Practices

Source: QOF 2014/15 (practices censored at 30%)

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Risk factors for cardiovascular disease NHS Havering CCG Care processes and treatment indicators

The Quality and Outcomes Framework (QOF) rewards practices for the provision of quality care and helps to standardise improvements in the delivery of clinical care. The risk of developing cardiovascular disease can be reduced in patients with hypertension by careful management of blood pressure and other cardiovascular risk factors such as physical inactivity and smoking. The graphs below show achievement against QOF hypertension and primary prevention of cardiovascular disease clinical indicators for the CCG as a whole. Hypertension Patients with hypertension in whom the last blood pressure is 150/90 or less, HYP006, 2014/15 (per cent)

Optimal treatment

Non-optimal treatment

Exceptions

1.7

Local

81.0

14.4

1.7

Comparator CCGs

80.1

15.0

1.5

0.4

April 2016

SCN

16.4

14.5

79.2

England 80.4 10 20 30 40 Source: QOF 2014/15 0

15.8

17.3

15.8

15.8 50

10

60

20

70

30

80 40

90 50

100 60

70

80

90

100

In those patients with a new diagnosis of hypertension aged 30 or over and who have not attained the age of 75, recorded between the preceding 1 April to 31 March (excluding those with pre-existing CHD, diabetes, stroke and/or TIA), who have a recorded CVD risk assessment score (using an assessment tool agreed with the NHS CB) of ≥20% in the preceding 12 months who are currently treated with statins, PP001, 2014/15 (per cent) Optimal treatment

Non-optimal treatment

Exceptions

.7

Local

58.7

14.4

.7

Comparator CCGs

67.9

15.0

.5

SCN

72.3

14.5

.4

England

67.7

10

20 30 Source: QOF 2014/15

0 40

0.7 2.1 2.0

15.8

10 50

20 60

3070

4080

2.3 5090

100 60

70

80

90

100

The percentage of patients aged 45 or over who have a record of blood pressure in the preceding 5 years, BP002 2014/15 (per cent) Optimal treatment

Non-optimal treatment

Exceptions

1.7

Local

91.8

14.4

7.7

1.7

Comparator CCGs

91.3

15.0

8.3

1.5

SCN

90.7

0.4

England 90.6 10 20 30 40 Source: QOF 2014/15 0

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14.5

8.8

15.8 50

10

60 20

70 30

80 40

9.0 90 50

100 60

70

80

90

100

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Risk factors for cardiovascular disease

April 2016

NHS Havering CCG Smoking QOF includes information on the percentage of patients with a smoking status recorded and whether those identified as smokers are offered support or treatment to stop smoking. Patients with certain conditions who have their smoking status recorded CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar disorder or other psychoses, SMOK002, 2014/15 (per cent) Optimal treatment

Non-optimal treatment

Exceptions

Local

93.5

Comparator CCGs

92.9

14.4

6.3

SCN

93.1

15.0

5.9

England

93.2

14.5

5.9

0

Source: QOF 2014/15

5.8

10

20

30

40 15.8

50

60

70

80

90

100

10Patients 20aged

40 over who 50 are recorded 60 70 80 smokers 90 who have 100 a record of an offer of support and 1530years and as current treatment within the preceding 24 months, SMOK004, 2014/15 (per cent) Optimal treatment

7

Non-optimal treatment

Local

89.0

Comparator CCGs

86.4

SCN

86.5

England

85.8

7

5

4

Source: QOF 2014/15 10

20

30

0

Exceptions

10.1 14.4

12.7

15.0

12.1

14.5

10 40

20

50

30

60

70

40

15.8

80

13.1 50

60

90

100

70

80

90

100

NHS Health Check Programme The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions, will be invited once every five years to assess their risk of developing these conditions. They are given support and advice to help them reduce or manage that risk. In NHS Havering CCG in 2014/15 an estimated 67,000 residents were eligible to be offered a Health Check. Local authorities offer the programme to all the eligible population over a five year period. During 2014/15, 18.7% of eligible residents were offered a Health Check and 7.7% of eligible residents received a Health Check. Proportion of eligible people who were offered and received a Health Check, 2014/15 (per cent) Percentage of eligible people offered check Local Comparator CCGs SCN England

Percentage of eligible people receiving a check

18.7 7.7 19.3 8.9 23.7 11.6 19.7 9.6

0 Source: NHS Health Check 2014/15

5

10

15

20

25

30

Percentage

Note: Local Authority data has been used to estimate CCG Health Check figures. Where more than one local authority is within the CCG, the proportion of local authority activity has been aggregated to create the CCG figures. A list of references for each chapter is given in the indicator guide for the profiles. © Crown copyright 2016 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v3.0. To view this licence, visit OGL or email [email protected]. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquires should be sent to [email protected]

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