This website would like to use cookies to store information on your computer to enable this website to function correctly. One of the cookies we use is vital to the operation of the site and this is already in use. You may delete and block all cookies from this site but if you do so then parts of the site may not work for you. To find out more about the cookies on this site please see our cookie policy.




JSNA Chapter : Coronary Heart Disease (CHD)

Section: Specific Condition
Next Review Date: 30/09/2014
Date Published: 22/12/2010

Return to JSNA contents


Contents

  1. Introduction
  2. Who's at risk and why?
  3. The level of need in the population
  4. Current services in relation to need.
  5. Projected service use and outcomes in 3-5 years and 5-10 years.
  6. Evidence based (what works and what does not work)
  7. Unmet needs and service gaps
  8. Equality Impact Assessment
  9. Recommendations for Commissioning
  10. Recommendations for needs assessment work
  11. Key contacts
  12. Chapter References
  13. Signed off by


Introduction

Coronary Heart Disease (CHD) is a narrowing of the blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disease. Coronary heart disease is usually caused by a condition called atherosclerosis, which occurs when fatty material and other substances form a plaque build-up on the walls of the arteries. This causes them to narrow. As the coronary arteries narrow, blood flow to the heart can slow down or stop. This can cause chest pain (stable angina), shortness of breath, heart attack, and other symptoms, usually when a person is active (1).

Coronary heart disease is among the biggest killers in this country. 1 in 5 men and 1 in 7 women die from CHD (2). Death rates from CHD have fallen by 45% for people aged under 65 years in the last 10 years . This fall is fastest in those aged 55 years and over. It is largely due to a reduction in the levels of the major risk factors (mostly smoking) and improvement in treatment amd secondary prevention. Althought the death rate from CHD has been falling in the UK at one of the fastest rates, in Europe, it is still relatively high compared with other western european countries.Only Ireland and Germany had higher rates. Also the fall in CHD mortality is not as high as that in some other countries such as Australia (48%) and Norway (54%) (2).

In Surrey there are 33,039 people on the GP Coronary Heart Disease registers(albeit models estimate that there should be 37,000)(19) and there were 1,008 premature deaths (deaths under 75 years) from CHD during 2006-08.

Lifestyle factors such as smoking, unhealthy diet and lack of physical activity and their consequences such as obesity, high cholesterol, high blood pressure and diabetes, are major risk factors for CHD.


Key issues and gaps

Full Implementation of recent NICE guidance on management recent onset chest pain

Full implementation of the NICE Quality Standards for Heart Failure (June 2011) is required. Surrey does not achieve the NICE benchmark for the numbers of people benefitting from rehabilitation following cardiac interventions. Currently cardiac rehabilitation is only accessible for 30% of people who would benefit from the service causing inequalities in health (22).


Access to cardiac rehabilitation programmes with a range of choices to improve this access
Better Robust community cardiac services are needed so patients can be managed in the community close to home rather than referrals into secondary care. For example, patients can be diagnosed and managed in Primary Care rather than needing secondary care referrals.

Repatriation of Surrey patients to be treated locally as much as possible rather than being referred for treatment to specialist centres in London, where it is clinically safe to do so. Lack clear referral care pathways within and outside Surrey to ensure access high quality and cost effective care.

Recommendations for Commissioning

All providers (acute, community and primary care) required to meet the NICE Quality Standards for Heart Failure.

Acute providers to implement the network advice on NICE guidance Recent onset chest pain

Implementation of clear referral care pathways within and outside Surrey to secure high quality and cost effective care for patients

NHS Health Checks should be implemented. This will help to reduce incidence of heart disease and improve earlier diagnosis.

Access to comprehensive cardiac rehabilitation services which are community based. 


Return to chapter contents

Who's at risk and why?

Coronary heart disease (CHD) manifests itself in two main forms; angina and heart attack, and is the major cause of death in most developed countries. Its development is influenced by a number of risk factors.

Modifiable risk factors

The modifiable risk factors of coronary heart disease include:

  • High blood pressure (hypertension)
  • Raised cholesterol
  • Irregular heart rhythm (atrial fibrillation)
  • Heart failure
  • Diabetes
  • Smoking
  • Alcohol
  • Obesity
  • Diet

Hypertension, cholesterol, atrial fibrillation and heart failure are discussed below. Diabetes, smoking, diet, alcohol and obesity are dealt with in their own JSNA chapters. The risk of coronary heart disease can be reduced with lifestyle changes and medication where indicated.

Hypertension

Hypertension means high blood pressure. It is a very common condition. High blood pressure puts a strain on the blood vessels in the body meaning the heart has to work harder to keep the circulation going. This strain can clog or weaken the blood vessels which in turn can narrow the blood vessels further (3,4). Risk factors for hypertension include increasing age, family history, race, tobacco use, excessive alcohol consumption, physical inactivity, high salt intake, low birthweight, obesity and increased levels of stress (5, 6). Untreated hypertension contributes to a higher risk of CHD and damage to the kidneys and retinae (5). Treatment of high blood pressure therefore not only reduces the chances of CHD but also stroke, other circulatory diseases, kidney damage and the need for specialised treatment in older people.

Hypertension is estimated to cause a loss in healthy life years by 1% due to the burden of this condition. It is the second most important preventable cause of premature death in economically developed countries. NICE has estimated that 40% of adults in England and Wales have hypertension, using the threshold of 140/90 mmHg, and this proportion increases with age. Hypertension is linked to about 50% of ischaemic strokes and also increases the risk of strokes due to bleeding in the brain (3). It has been estimated that a slight reduction in adults’ systolic blood pressure (SBP) of 2 mmHg, would save more than 14,000 UK lives per year (6). Stopping smoking, following a healthy diet, regular exercise and not exceeding recommended alcohol intake can all reduce hypertension.

The QOF data for 2009-2010 indicates that whilst Surrey has a lower prevalence of hypertension than England, there are areas with higher rates. Mole Valley and Spelthorne have the highest reported crude prevalence of hypertension in Surrey, above the national rate. The lowest crude prevalence of hypertension is in Guildford (See figure 1, See JSNA data/cardiovascular disease basket).

Figure 1
Crude QOF prevalence of hypertension 2009-2010

Dataset: QOF data, Source: Quality Management and Analysis System (QMAS)

 

Cholesterol

Cholesterol is a fatty substance found in the blood. Although some comes from dietary sources most of it is made by the body. It is an essential component of cell membranes and therefore essential for normal cell function. Too much cholesterol in the blood, however, increases the risk of cardiovascular disease including CHD.

Proteins carry cholesterol in the blood. The combinations of cholesterol and proteins are called lipoproteins. The two main types of lipoproteins are:

  • LDL (low-density lipoprotein), the harmful type of cholesterol  
  • HDL (high-density lipoprotein), a protective type of cholesterol (8)

High circulating LDL leads to build-up of fatty deposits in the arteries. This narrowing of the arteries (atherosclerosis) causes high blood pressure, which is linked to heart attack and stroke. Atherosclerosis increases the chance of blood clots developing in damaged artery linings, breaking away and blocking vital blood vessels in the brain and heart, causing strokes and heart attacks.

The recommended cholesterol level is less than 5mmol/L. In the UK, two out of three adults have a total cholesterol level of 5mmol/L or above. On average, men in England have a cholesterol level of 5.5mmol/L and women have a level of 5.6mmol/L. The UK population has one of the highest average cholesterol concentrations in the world. (9)

A number of trials have demonstrated that lowering cholesterol reduces the relative risk of adverse cardiac events and mortality in CHD patients. Similarly, there is evidence of benefit in reducing cholesterol levels in patients with ischaemic stroke and TIA. The issue around potential harm in haemorrhagic stroke is more controversial as some studies have found that low levels of cholesterol is associated with this condition (10). Detailed information on the cholesterol levels of the general population in Surrey is not available (11). However, the percentage of patients on the stroke register with a cholesterol value of 5mmol/L or less in Surrey PCT is 73.9%, statistically significantly lower than England (77%) and the South East Coast SHA (76.6%) - (See figure 2, See JSNA data/cardiovascular disease basket). The percentage of patients on the CHD register with cholesterol values of 5mmol/L or less reveals a similar picture: Surrey 79.8%; England 82.1% and the South East Coast SHA 81.9% (See figure 3, See JSNA data/cardiovascular disease basket). This might suggest that the proportion of those on the stroke and CHD registers with a cholesterol levels of more than 5mml/L are higher in Surrey for some reason, indicating further investigation although it should be noted the data are not adjusted for age, sex or case mix.

Figure 2
Proportion of patients with a history of stroke or TIA whose last measured total cholesterol level (measured in the previous 15 months) was five mmol/l or less (2008/09)

Dataset: Cholesterol, Source: NCHOD 

Figure 3
Proportion of patients on the CHD register whose last measured total cholesterol level (measured in last 15 months) is five mmol/l or less.

Dataset: Cholesterol, Source: NCHOD

Cholesterol can be lowered by making appropriate lifestyle changes including eating a healthy diet and doing regular exercise (9). Cholesterol-lowering medicines such as statins are prescribed for people who are at greatest overall risk of suffering from cardiovascular disease. The need to take cholesterol-lowering drugs or not depends not just on total cholesterol, HDL and LDL levels, but also on the overall risk of cardiovascular disease (8). The Department of Health estimates that more than 75,000 people in Surrey are eligible for statin treatment. If 50% of them were treated, 101 strokes could be prevented each year and the number of heart attacks would also fall (7). See JSNA resource/stroke basket

Atrial Fibrillation (AF)

AF occurs when the atria (two chambers of the heart) are not beating in a co-ordinated way, that is, they are fibrillating. Stroke is a frequent consequence of AF because the weak contractions allow the blood in the atria to become stagnant and form clots. These clots can break off and travel anywhere in the body. When they block blood vessels in the brain they cause strokes. AF can also cause heart failure, when the heart becomes weak because of the rapid rhythm (12). Treatment of AF aims either to reduce the risk of blood clots with anticoagulant drugs or to improve the heart rhythm by, for example, defibrillation, drugs or implanting a pacemaker (13).

About 5 in every 100 people over 65 have AF (13). Surrey has a crude prevalence of AF above the national rate. Mole Valley has the highest crude prevalence followed closely by Tandridge and Waverley. This could be due to these local authorities having a higher proportion of those aged 65 years and over within the Surrey population (See figure 4, See JSNA data/cardiovascular disease basket).

Figure 4
Crude QOF prevalence of atrial fibrillation 2009-2010

Dataset: QOF data, Source: Quality Management and Analysis System (QMAS)

The Department of Health estimates there are about 17,000 people in Surrey PCT with AF. In addition, 5370 people are estimated to need anticoagulants. If Surrey PCT met fully the NICE guidelines for AF, 210 strokes could be avoided every year. Surrey Heart and Stroke Network have a programme of work which focuses on implementing the NICE guidance across Surrey. They are working closely with the newly emerging Clinical Commissioning Groups (CCGs) to encourage opportunistic pulse screening and facilitate education session for GPs to highlight the utilisation of Warfarin for AF patients . This will be ongoing work through 2011/12 and into 2012/13.The network are linked into the national AF programme within NHS Improvement and are developing AF champions amongst GPs in primary care (7). See JSNA resource/stroke basket.

Heart Failure

Heart failure is the result of ineffective pumping by the heart. The most common cause of heart failure is a heart attack (myocardial infraction) with resultant damaged heart muscle. It can also result from conditions which put an extra workload on the heart, including high blood pressure, valvular heart disease and cardiomyopathies. Excessive alcohol intake or viral infections may also lead to heart failure (14). Like CHD, heart failure is more prevalent in lower socio-economic groups and in certain ethnic minorities (15). The risk of heart failure increases with age. As survival from heart attack improves and the population ages, more people are now living with heart failure.

The crude prevalence of heart failure in Surrey is lower than the national rate. Once again Mole Valley has the highest rate among local authorities due to a higher population aged 65 and over (See figure 5). The populations of Surrey Heath and Elmbridge have the lowest prevalences. (See JSNA data/cardiovascular disease basket)

Figure 5
Crude QOF prevalence of heart failure 2009-2010

Dataset: QOF data, Source: Quality Management and Analysis System (QMAS)


Smoking

Reducing smoking is important to reduce the incidence of cardiovascular disease.Mortality from CHD is 60% higher in smokers (16) and regular exposure to passive smoke increases CHD risk by 25% (17,18). Smoking is dealt with in a separate JSNA chapter but the Department of Health estimates that if people who have already had a stroke or TIA in Surrey were to give up, 44 strokes per year would be avoided (7). See JSNA resource/stroke basket

Fixed risk factors

Risk factors for cardiovascular disease that cannot be altered are age, gender, ethnicity and family history.

Age

The risk of cardiovascular disease increases with age (1). Mole Valley has the highest proportion of older people compared to the other local authorities in Surrey. (Figure 6, See JSNA data/cardiovascular disease basket)

Figure 6
Mid 2009 population by age group

Dataset: Latest population by selected ages (LSOA up), Source: Office for National Statistics (ONS)

Gender

More men than women experience cardiovascular disease (6). Just over half the Surrey population is female (See figure 7, See JSNA data/cardiovascular disease basket) the proportion of females increases with age (Figure 8, See JSNA data/cardiovascular disease basket).

Figure 7
Mid 2009 population by gender - all ages

Dataset: Mid Year Population Estimates by broad age, Source: Office for National Statistics (ONS)

Figure 8
Mid 2009 population by gender - 65+

Dataset: Mid Year Population Estimates by broad age, Source: Office for National Statistics (ONS)


Ethnicity

People of South Asian descent are at increased risk of death from CHD. They are 50% more likley to die prematurely from this condition (21). Figure 9 shows the percentages of the broad minority ethnic groups within Surrey and the local authorities. Epsom and Ewell and Woking in particular have a higher percentage of Asian or Asian British residents.

Figure 9
Population by broad ethnicity (2007)

Dataset: Population by Ethnic Group, Source: Office for National Statistics (ONS)

The South Asian countries include India, Pakistan and Bangladesh. Woking has a large Pakistani community while Epsom and Ewell has a large Indian community compared to the rest of Surrey (See figure 10).

Figure 10
Proportion of population of South Asian ethnicity

Dataset: Population by Ethnic Group, Source: Office for National Statistics (ONS)

Data on two GP Practices in Surrey shows the number people with South Asian background on the CHD register. The Practice Plc (College Road Clinic), had 64 people on their CHD register in 2010/11. Out of this number, 62 (97%) people were of south Asian background. The Sheerwater Health Centre also had 77 people on their CHD register with just about 13% (7 people) being of South Asian background. According to the Practice information, majority of these people were diagnosed before the age of 65 years.

A full breakdown of Surrey's population by ethnicity can be found by following the link to the dataset Population by Ethnic Group in the data browser.

Psychological well being

Work stress, lack of social support, depression and anxiety can all increase CHD risk (19).

Deprivation

Lower socioeconomic status is associated with higher rates of cardiovascular disease and CHD mortality rates(15). This may be due to this population being more likely to face major risk factors such as smoking and poor diet (20). In Surrey, the 5 priority places (i.e. disadvantaged areas where collaborative working among partners and additional resources could bring maximum benefits) that experience higher inequalities are Stanwell in Spelthorne, Maybury and Sheerwater in Woking, Westborough in Guildford, Merstham in Reigate and Banstead and Old Dean in Surrey Heath (Link to priortiy places chapter). 


Return to chapter contents

The level of need in the population

Coronary Heart Disease QOF Prevalence

There are 33,039 people on the GP practice register for CHD in Surrey. Crude prevalence is lower in Surrey than in England, at 27.6 versus 34.4 per 1,000 GP registered population.

Figure11 : Crude prevalence of CHD per 1000 GP registered population
Crude Prevalence per 1,000 GP registered population  - Coronary Heart Disease (CHD)

Dataset: QOF data, Source: Quality Management and Analysis System (QMAS)

Mole valley is the borough with the highest prevalence of CHD in Surrey in 2009/10, followed by Tandridge, Waverly and Epsom and Ewell.

Mortality from CHD for less than 75 years

There were 1,008 premature deaths (i.e deaths under 75 years) from CHD in Surrey during 2006-2008. Among the 1008 deaths, 766 (76%) were male.

The Standardised Mortality Ratio (SMR) for Surrey was 66.95, which is significantly lower than England and the South East. Runnymede and Spelthorne had the highest SMR from CHD for the population under 75 years (2006-2008) but this is not statistically different from the rest of Surrey except Waverley.

An SMR is essentially a comparison of the number of the observed deaths in a population with the number of expected deaths if the age-specific death rates were the same as a standard population. It is expressed as a ratio of observed to expected deaths, multiplied by 100. SMRs equal to 100 imply that the mortality rate is the same as the standard mortality rate. A number higher than 100 implies an excess mortality rate whereas a number below 100 implies below average mortality (23).

Figure 12 : Mortality from CHD for less than 75 years - SMR (2006-2008)
Mortality from CHD less than 75 years - SMR

Dataset: Mortality from Coronary Heart Disease SMRs U75, Source: NHS Information Centre

CHD and Emergency Admission Rate

In 2009/10 the emergency admission rate for CHD , in Surrey was 162.9 per 100,000 (2617 admissions) . This is significantly lower than England (205.3 per 100,000) and lower than the South East Coast (172.8 per 100,000). Male CHD emergency admission rates are significantly higher than female CHD emergency admission rates .

The emergency admission rate for CHD in Surrey has decreased by 7.3% between 2003/04 and 2009/10. In England it has decreased by 24.2% and in South East Coast it has decreased by 20.0% .

The absolute gap in CHD emergency admission rates between the most and least deprived areas in Surrey was 87.9 per 100,000 in 2009/10. This has decreased from 105.6 per 100,000 since 2003/04 which is a 17% reduction. In England the gap in the emergency admission rate has decreased by 22.2% and in South East Coast it has decreased by 28.4% .

Please see CVD Profile for more details.

Return to chapter contents


 

Current services in relation to need.

Services

Each District General Hospital (DGH) in Surrey provides a general cardiology service led by consultant cardiologist with access to diagnostic investigations and supported by team of cardiology specialist nurses.
Epsom DGH and RSCH have a more limited cardiology service but link very closely with other providers to provide equitable patient access.

Cardiology services within Surrey include access to treatment for cardiac arrhythmias including atrial fibrillation . Treatments available include pacing and intra cardiac device insertion (ICD). Each DGH has a team of cardio electro physiologists. who are key to the care and ongoing support of this cohort of patients . Specific complex treatments are usually provided at specialist cardiac centres in London .

The diagnosis and treatment of heart failure is available in both primary and secondary care . The community heart failure nursing service provides patients with ongoing support at home to achieve optimal management and the best quality of life. . They also provide links with palliative care teams as appropriate.

Recent onset Chest pain management of cardiac origin is assessed by GP referral into rapid access chest pain clinics which are provided in each DGH.

This provides access to diagnostic investigations and treatment. ASPH, FPH. SASH provide access to angioplasty . If more specialised cardiac surgery is required patients are referred to specialist cardiac centres.
The care pathway for access to emergency treatment of Acute MI, specifically STEMI has recently been redesigned to ensure 24/7 access in line with national guidance .

  • 24/7 Primary Percutaneous Coronary Intervention (PPCI) service across Surrey is available from either FPH. BSUH or SGH

Cardiac Rehabilitation is provided by our acute trusts but uptake remains low.

There are tertiary care pathways into specialist cardiology centres if patients require access to specialist cardiac treatments including cardiac surgery .

For patients with Inherited cardiac conditions they are able to access specialist services access t services at tertiary centres who provide this highly specialist expert service . There is some level of local support within Surrey if clinically appropriate and this are pathway is currently being refined .

Patients who have Adult congenital heart disease are usually support via a shared care arrangement with specialist tertiary centres.

Preventive Services

Lipid Guidance: NHS Surrey in conjunction with the Surrey Heart and Stroke Network have developed guidance for use by clinicians in primary and secondary care to support reducing lipid levels which are risk factor for CVD (see Addendum to the NHS Surrey Lipid Modification Guidance and Addendum to the NHS SurreyLipid Modification Jan09 ACS)

Management of Hypertension: NHS Surrey in conjunction with Surrey Heart and Stroke Network have developed guidance for primary care to support clinical effective management of patients with hypertension

Physical Activity - (see JSNA Chapter: Physical Activity)

Diet - (see JSNA Chapter - Diet and Lifestyle)

Smoking Cessation - (see JSNA Chapter - Smoking)


Return to chapter contents

Projected service use and outcomes in 3-5 years and 5-10 years.

The prevalence of CHD in Surrey is projected to rise from 4.2% in 2009 to 4.6% by 2020.

Figure 13 shows the projected prevalence rate of CHD for Surrey PCT and England for 2006-2010, 2015 and 2020. The overall projected prevalence of CHD for Surrey is lower than that for England.

Figure 13 : Estimated modelled prevalence for CHD (2006-2020)
Estimated modelled prevalence for CHD

Dataset: MODELLED CHD ESTIMATES and PROJECTIONS 2005-2020, Source: NHS Eastern Region Public Health Observatory (ERPHO)

 

It is projected that by 2020 there will be 26,582 male and 17,441 female with CHD in Surrey which is 5.8% and 3.5% of the adult population respectively. Mole valley will have 6.9 %, Waverly and Spelthorne will have 6.8% of their adult population with CHD by 2020.

Figure 14 : Estimated modelled prevalence for CHD by sex (2006-2020)
Projection of CHD prevalence

Dataset: MODELLED CHD ESTIMATES and PROJECTIONS 2005-2020, Source: NHS Eastern Region Public Health Observatory (ERPHO)

The chart below (Figure 15) shows the ethnic breakdown of the projected prevalence for CHD in Surrey over the period 2006-2020. Across all ethnic groups, except ‘Other’ ethnic group, the prevalence for CHD is estimated to increase up to between 10% - 12% in 2030 from 2006.

Figure 15: Estimated modelled prevalence for CHD by ethnicity (2006-2020)
Estimated modelled prevalence for CHD by ethnicity

Dataset: MODELLED CHD ESTIMATES and PROJECTIONS 2005-2020, Source: NHS Eastern Region Public Health Observatory (ERPHO)


Return to chapter contents


 

Evidence based (what works and what does not work)

National guidance 

Department of Health (2000) National Service Framework for Coronary Heart Disease
  

Coronary heart disease: national service framework for coronary heart disease - modern standards and service models

Heart disease and South Asians: Delivering the National Service Framework for Coronary Heart Disease

Public Health Guidance 25 Prevention of cardiovascular disease at population level 

Healthy Lives, Healthy People:A Tobacco Control Plan for England

NICE Guidance (CG 67) 2008 – Lipid modification and risk assessment

Department of Health (2008) Putting prevention first- vascular checks: risk assessment and management - next steps guidance for primary care trusts:  Department of Health (2009) Best practice guidance for the assessment and management of vascular risk

UK National Screening Committee (2008) – Handbook of vascular risk assessment, risk reduction, and risk management

NICE CG34 (2006) – Management of hypertension in adults in primary care

Faculty if Public Health toolkit (2005) Easing the pressure: tackling hypertension

NICE CG36 (2006) – Management of atrial fibrillation

NICE Public Health guidance, September 2008 -Identifying and supporting people most at risk of dying prematurely - Reducing the rate of premature deaths from CVD and other smoking-related diseases: finding and supporting those most at risk and improving access to services

NICE Public Health guidance 9, February 2008 - Community engagement to improve health

NICE Public Health guidance 6, October 2007 - Behaviour change at population, community and individual levels

NICE CG48 (2007) Secondary prevention of myocardial infarction (2007)

NICE Public Health guidance 25, June 2010 -Guidance on the prevention of CVD at the population level


Return to chapter contents

Unmet needs and service gaps

There are gaps in current service provision across all providers, in particular community based rehabilitation programmes in Surrey. Surrey does not achieve the NICE benchmark for the numbers of people benefitting from rehabilitation following cardiac interventions. Currently cardiac rehabilitation is only accessible for 30% of people who would benefit from the service causing inequalities in health (22).

There remains inequitable access to a community based heart failure nursing service across Surrey. Evidence is clear that access to community based heart failure specialist nurse services reduces the rate of hospital admissions for people with heart failure and improves quality of life.

Implementation of the NICE AF Guidance remains a top priority for Surrey Heart and Stroke Network and its stakeholders given the impact for reducing the incidence of stroke.


Return to chapter contents

Equality Impact Assessment

Need for equality impact assessment in services provided.


Return to chapter contents

Recommendations for Commissioning

All providers ( acute ,community and primary care) required to meet the NICE Quality Standards for Heart Failure

Acute providers to implement the network advice on NICE guidance Recent t onset chest pain

Implementation of clear referral care pathways within and outside Surrey to secure high quality and cost effective care for patients

NHS Health Checks should be implemented. It will help to reduce incidence of heart disease and improve earlier diagnosis.

Access to comprehensive cardiac rehabilitation services which are community based.

Surrey population age factors should be considered when planning services for coronary heart disease.

Commission a proper cardiac rehabilitation choices (develop menu of choice) as national research shows that this increases the uptake and attendance of cardiac rehabilitation programme.


Return to chapter contents

Recommendations for needs assessment work

Clear tasks need to be undertaken in order to identify and improve the quality of needs analysis in future JSNAs.


Return to chapter contents

Key contacts

Surrey County Council:

Anupama Shrestha, public health analyst - anu.shrestha@surreycc.gov.uk  

Pauline Jervis - pauline.jervis@surreycc.gov.uk  


Return to chapter contents

Chapter References

  1. Medline Plus. Coronary heart disease. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/007115.htm      
  2. British Heart Foundation. Coronary heart disease statistics. Mortality. 2008 edition 
  3. The stroke association. High Blood pressure and stroke. Factsheet 6 2010. Available at: http://www.stroke.org.uk/campaigns/campaign_archive/weigh_up_your_risk_of_stroke/blood_pressure_check.html (Accessed 27/1/11)
  4. World Heart Federation. Hypertension. 2011. Available at: http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/hypertension/ (Accessed 7/4/11)
  5. John M Last, A Dictionary of Public Health, 2007
  6. The Information Centre. Cardiovascular disease and risk factors in adults. Health Survey for England 2006: 2008. Available at: http://www.ic.nhs.uk/webfiles/publications/HSE06/HSE%2006%20report%20VOL%201%20v2.pdf (Accessed 31/1/11)
  7. Department of Health. ASSET toolkit for commissioners. 2006. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_106241.xls (Accessed 27/1/11)
  8. British Heart Foundation. High Cholesterol. Available at: http://www.bhf.org.uk/heart-health/conditions/high-cholesterol.aspx (Accessed 27/1/11)
  9. NHS Choices. High Cholesterol. Available at: http://www.nhs.uk/conditions/Cholesterol/Pages/Introduction.aspx (Accessed 27/1/11)
  10. Iso H, Jacobs DR Jr, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. The New England Journal of Medicine:1989, 320(14):904-Available at: http://ukpmc.ac.uk/abstract/MED/2619783 (Accessed 04/07/11)
  11. NCHOD. Data Definitions and User Guide for Computer Files. Available at http://www.nchod.nhs.uk/NCHOD/HomeDb2R6.nsf/089de59e1cffbe8f65256cd100209bf0/bf63879867c072f480256d0100621a24/$FILE/User%20Guide%202011%20(March).pdf (Accessed 6/5/11)
  12. Atrial fibrillation association. What are the risks of atrial fibrillation? Available at: http://www.atrialfibrillation.org.uk/patient-information/risks-atrial-fibrillation.html (Accessed 27/1/11)
  13. British Heart Foundation. Atrial Fibrillation. 2009. Available at http://www.bhf.org.uk/publications/view-publication.aspx?ps=1000952 (Accessed 27/1/11)
  14. British Heart Foundation. Heart Failure. Available at: http://www.bhf.org.uk/heart-health/conditions/heart-failure.aspx (Accessed 27/1/11)
  15. Geraint Lewis, Jessica Sheringham, Kanwal Kalim, Tim Crayford, Mastering Public Health, Royal Society of Medicine Press Ltd. 2008
  16. Doll R, Peto R, Boreham J, et al; Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004 Jun 26;328(7455):1519. Epub 2004 Jun 22. [abstract]
  17. Law MR, Morris JK, Wald NJ; Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ. 1997 Oct 18;315(7114):973-80. [abstract]
  18. He J, Vupputuri S, Allen K, et al; Passive smoking and the risk of coronary heart disease--a meta-analysis of epidemiologic studies. N Engl J Med. 1999 Mar 25;340(12):920-6. [abstract]
  19. Brezinka V, Kittel F; Psychosocial factors of coronary heart disease in women: a review. Soc Sci Med. 1996 May;42(10):1351-65. [abstract]
  20. ERPHO , Nov 2008
  21. Department of Health , Heart Disease and South Asians, Joint BHF&HHS Publication, London: Stationery Office; 2004
  22. NHS Surrey Strategic Commissioning plan: 2008 – 2013; NHS Surrey April 2009 - http://www.surreyhealth.nhs.uk/AboutUs/Whatwedo/Commissioning%20Intentions%20Document%20Library/SCP%20Word%20Version%201%202%201.pdf (Accessed July 2011)
  23. The Standardised Mortality Ratio (SMR). Available at: http://www.lho.org.uk/LHO_Topics/Data/Methodology_and_Sources/AgeStandardisedRates.aspx (Accessed 12/07/2011) .

 

Return to chapter contents

Signed off by

Surrey Heart and Stroke Network.

If you have any comments/feedback please send it to jsnafeedback@surreycc.gov.uk


Return to chapter contents


Updated: 25 March 2014 | Owner: Anupama Shaikh
Comments ()   (Log-in to post a comment)