Data and Intelligence
CVD and the burden it has on individuals, communities, health and social care services are highly preventable through changes to individual behaviour, population measures such as tobacco control and salt and sugar reduction, and individual level interventions such as clinical management of high risk conditions such as high blood pressure, atrial fibrillation (AF) and high cholesterol.
Behavioural risk factors such as smoking, physical inactivity and poor diet resulting in overweight and obesity are common. 15% of the population over 18 are smokers, 62.5% are physically inactive and 65.9% are overweight or obese. Smoking rates have declined significantly over the past decades and the Stockton rate is similar to the national average. 36.7% of the population drinks more than the recommended level compared to 25.7% in England. There are higher rates of physical inactivity and overweight and obesity compared to the national average.
Diagnostic and treatment gap
CVD prevention is being limited by the diagnosis and treatment gap for conditions such as high blood pressure, diabetes and atrial fibrillation, which cause lead to heart attacks and strokes. Not all patients with these conditions are diagnosed and of those who are diagnosed not all receive the best treatment.
Uncontrolled hypertension can lead to chronic kidney disease and cognitive decline and cause heart attacks and strokes. The proportion of people with hypertension is increasing year on year in England and in Stockton. In 2016/17, 15.4% of all patients in primary care in Stockton-on-Tees had a diagnosis of high blood pressure, compared to a national average of 13.8%.
Public Health England estimates that only 61% of all people with hypertension in Stockton and Hartlepool have been diagnosed. This leaves 14,000 people with hypertension in Stockton and Hartlepool who are not aware of their condition and do not receive treatment. There is significant variation with regards to undiagnosed hypertension and recommended treatment across GP practices.
Atrial fibrillation is an abnormal heart rhythm and can lead to the formation of blood clots in the heart. People with atrial fibrillation are at increased risk of having a stroke. The prevalence of atrial fibrillation is increasing year on year in England and in Stockton. 2% of all patients in primary care in Stockton-on-Tees had a diagnosis of atrial fibrillation in 2016/17 compared to a national average of 1.9%.
Public Health England estimates that 2.5% of population are suffering from atrial fibrillation in Stockton and Hartlepool, which means that there are 1,258 people with undiagnosed and untreated atrial fibrillation across the CCG. There is significant variation with regards to undiagnosed atrial fibrillation and recommended treatment across GP practices.
Hypercholesterolaemia (High blood fats)
Six out of ten adults in England have high cholesterol, with many completely unaware of it. High cholesterol itself does not usually cause any symptoms, but increases the risk of developing arteriosclerosis and cardiovascular events.
Diabetes is a major cause of premature death and greatly increases the risk of developing heart disease, kidney disease and stroke. The prevalence of diagnosed diabetes is increasing each year in England and in Stockton. 6.4 % of all patients in primary care in Stockton-on-Tees had a diagnosis of diabetes in 2016/17 compared to a national average of 6.5%. Public Health England estimates that there are a further 1.8% (2850 people) of the population with undiagnosed diabetes. In total there are about 13,000 people with diabetes living in Stockton. There is significant variation with regards to undiagnosed diabetes across GP practices.
In addition to this another 10.9% of the population (n=17,000 people) have a higher than normal blood sugar and are at risk of developing diabetes.
There is significant variation in the provision of the recommended standard of care across GP practices.
People with diabetes have a significantly higher risk of developing renal failure leading to dialysis, angina, heart failure, heart attack and stroke compared to people without diabetes.
Chronic kidney disease (CKD)
Chronic Kidney Disease is common and can progress to kidney failure and it substantially increases the risk of heart attack and stroke. 9160 people across Stockton and Hartlepool (CCG) have been diagnosed with CKD. Public Health England estimates that only 64% of CVD has been diagnosed which means that a further 5050 people with CKD remain undiagnosed. There is significant variation with regards to undiagnosed CKD and recommended treatment across GP practices.
The mortality rate from CKD in Stockton is significantly above the England average.
Coronary Heart Disease (CHD)
4% (n= 11,816) of the population of Stockton-on-Tees had a diagnosis of CHD recorded on GP systems compared to 3.2% in England. CHD has been decreasing slowly at local and national level
In 2016/17 there were 1632 hospital admissions for CHD for Hartlepool and Stockton CCG. Hospital admissions for coronary heart disease have also declined but have been significantly higher in Stockton for most years since 2002/3.
Early mortality from coronary heart disease across Stockton and Hartlepool (CCG) has decreased over the last decades and moved closer to the England average remains significantly higher than the national average.
In 2016/17 a history of stroke or transient ischemic attack was recorded for 2.1% (n= 6,089) of the population of Stockton-on-Tees compared to 1.8 % in England.
Hospital admissions for coronary heart disease have been significantly higher in Stockton compared to England. In 2016/17 there were 1632 hospital admissions for stroke for Hartlepool and Stockton CCG.
Early mortality from stroke across Stockton and Hartlepool (HAST CCG) has decreased over the last decade and moved closer to the England average.
Cardiovascular disease (CVD)
Early mortality (<75) from CVD in Stockton has reduced significantly over the last decades at local and national level, although the decrease has slowed down since 2008. The early mortality rate for Stockton is not significantly higher than the England average.
Public Health England states that premature death rates from cardiovascular disease in the most deprived 10% of the population were almost twice as high as the least deprived 10% of the population in 2013-15 in England.
NHS Health Check
The NHS Health Check is a systematic method to identify patients who are unaware their high risk of developing cardiovascular disease. In 2017/18 over 5300 people in Stockton received an NHS Health Check. 20% of patients had an increased or higher risk score of developing CVD.
6.7% of those who had an NHS health check in 2016/17 had an increased blood pressure reading, 3% had higher than normal blood fats (cholesterol ratio), 3.8% had a higher than normal blood sugar and 0.7% an irregular (arrhythmic) pulse which is indicative of atrial fibrillation.