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Cardiovascular Disease Joint

Strategic Needs Assessment

2015

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Contents -

Section Number Section Page Number

1 Introduction 2

1.1 Population, Geography & Current CVD Prevalence

6

1.2 Predicted Future CVD Prevalence 16

2 Epidemiology 19

2.1 Mortality (including premature mortality) overview

19

2.2 LCG/Deprivation Quintile Epidemiology Overview

25

2.2.1 Coronary Heart Disease 29

2.2.2 Heart Failure 34

2.2.3 Stroke 37

2.2.4 Hypertension 42

2.2.5 Angiography 44

2.2.6 Revascularisation 46

3 Lifestyle Determinants 48

3.1 Risk Factors Associated with Cardiovascular Disease Overview

48

3.2 Ethnicity 48

3.3 Smoking 53

3.4 Physical Inactivity 59

3.5 Poor Diet 61

3.6 Obesity 64

3.7 Harmful Use of Alcohol 69

3.8 Diabetes 72

3.9 Modifiable Risk Factors – Population Level Interventions

75

4 Services for Cardiovascular Disease

78

4.1 Health Checks in Primary Care 78

4.2 Hospital Services – Quality Standards & National Audit Data

79

4.2.1 Cardiovascular Disease (MINAP) 80

4.2.2 Stroke (SSNAP) 83

4.2.3 Tackling CHD Inequalities Programme

85

5 Evidence of Effectiveness 86

5.1 Individual Level Interventions 86

5.2 Population Level Interventions 91

5.3 Clinical Guidance & Quality Standards

96

5.4 Effective CVD Prevention Programmes

101

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1. Introduction

Joint Strategic Needs Assessments (JSNAs) analyse the health needs of populations to inform and

guide commissioning of health, well-being and social care services within local authority areas. The

JSNA process helps identify current and future health and wellbeing needs, leading to agreed

commissioning priorities to improve outcomes and reduce health inequalities.

JSNA analysis includes assessment of:

Demography

Social and environmental context

Lifestyle/Risk Factors

Burden of Ill-Health

Current service provision and projected future requirements

JSNAs contribute towards the evidence base that informs the decisions taken by our Health and Wellbeing Board to improve the health and wellbeing of everyone in Peterborough. This JSNA focuses specifically on cardiovascular disease (CVD) - an umbrella term for all diseases of the heart and circulation, including coronary heart disease (CHD), stroke and peripheral arterial disease. There are eight local commissioning groups (LCGs) within the remit of Cambridgeshire & Peterborough Clinical Commissioning Group, as highlighted in the below table. This JSNA focuses primarily on the two LCGs within C&P CCG that are most closely associated with Peterborough City Council, ‘Borderline LCG’ and ‘Peterborough LCG’. Data pertaining to other LCGs will be presented in other projects by Cambridgeshire County Council’s Public Health Intelligence team.

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Figure 1 – Cambridgeshire & Peterborough CCG Local Commissioning Group Data

Local Commissioning Group Number of General Practices Registered Population at

01/01/2015

Borderline 10 109,972

CAM Health 9 88,413

CATCH 28 232,971

Hunts Care Partners 17 123,020

Hunts Health 9 69,829

Isle of Ely 10 96,168

Peterborough 20 143,613

Wisbech 4 49,476

Total 107 913,462

Source: Cambridgeshire & Peterborough Clinical Commissioning Group Cardiovascular Disease Cardiovascular disease (CVD) is generally caused by reduced blood flow to the heart, brain or body due to atheroma or thrombosis (blockages of the arteries). It is increasingly common after the age of 60 and relatively rare below the age of 30. Plaques (plates) of fatty atheroma build up in arteries during adult life; these can eventually cause narrowing of the arteries, or trigger a local thrombosis (blood clot) which completely blocks blood flow.1 CVD causes more than a quarter of all deaths in the UK, or around 160,000 deaths each year. There are an estimated 7 million people living with CVD in the UK. The total cost of premature death, lost productivity, hospital treatment and prescriptions relating to cardiovascular disease is estimated at £19 billion.2 The Global Burden of Disease Study3 has demonstrated that the UK does not perform well compared with a range of similar countries in terms of CVD related mortality and disability. Coronary Heart Disease CHD is caused by the narrowing of coronary arteries (the arteries that supply the heart muscle with oxygen-rich blood) due to gradual build-up of fatty material –atheroma-within their walls. CHD is the UK's single biggest killer; nearly one in six men and one in ten women die from coronary heart disease4. CHD is responsible for around 73,000 deaths in the UK each year, an average of 200 people each day, or one every seven minutes. Around 23,000 people under the age of 75 in the UK die from CHD each year. Approximately 2.3 million people are living with CHD in the UK - over 1.4 million

1 NICE: Prevention of cardiovascular disease: https://www.nice.org.uk/guidance/ph25 2 British Heart Foundation: https://www.bhf.org.uk/~/media/files/research/heart-statistics/cardiovascular-disease-statistics---headline-statistics.pdf 3 The LANCET: http://www.thelancet.com/global-burden-of-disease 4 NHS: http://www.nhs.uk/Conditions/Coronary-heart-disease/Pages/Introduction.aspx

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men and 850,000 women. Death rates from coronary heart disease are highest in Scotland and the north of England and lowest in the south of England.2 Stroke & Transient Ischaemic Attack (TIA) A stroke happens when the blood supply to part of the brain is cut off, causing brain cells to become

damaged or die. The two most common types of stroke are ischaemic and haemorrhagic stroke:

Ischaemic strokes happen when the artery that supplies blood to the brain is blocked, for

example by a blood clot.

Haemorrhagic strokes happen when a blood vessel bursts and bleeds into the brain,

damaging brain tissue and depriving brain cells of blood and oxygen.

Without a constant blood supply, brain cells will be damaged or die, which can affect the way the

body and mind work. Stroke causes more than 40,000 deaths in the UK each year.5 In the UK there

are 235,000 hospital episodes attributed to stroke each year. It is estimated that 1.3 million people

living in the UK have had a stroke - 650,000 men and 650,000 women. Almost half of these people

are under the age of 75.2

A transient ischaemic attack (also called a TIA or mini-stroke) happens when there is a temporary blockage in the blood supply to the brain. A TIA doesn’t cause permanent damage to the brain and the symptoms usually pass within 24 hours.2 However, a TIA needs assessment for stroke risk and referral for investigation and preventive treatment.

Aortic Disease

The aorta is the largest blood vessel in the body. The most common type of aortic disease is an aortic

aneurysm, where the wall of the aorta becomes weakened and bulges outwards. The aorta is usually

around 2cm wide but can swell to over 5.5cm; if a large aneurysm bursts, it causes internal bleeding

and can cause death.

Abdominal aortic aneurysms (AAAs) are most common in men over 65; a rupture accounts for more

than 1 in 50 of all deaths in this group and a total of 6,000 deaths in England and Wales each year.6

All men are invited for a screening test when they turn 65. If there is evidence of widening of the

aorta they are offered an elective operation or followed up with repeat tests if the aneurysm does

not meet the threshold for surgery.

Peripheral Arterial Disease

Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD) is a condition in

which a build-up of fatty deposits (called atheroma and made up of cholesterol and other waste

substances) in the arteries restricts blood supply to leg muscles. Many people within the condition

have no symptoms. However it can cause pain in the legs when walking which usually disappears

after a short rest; this is known as ‘intermittent claudication’.7

5 Jump Start: http://jumpstartonline.co.uk/blog/11/heart-stroke-and-dvt/ 6 NHS: http://www.nhs.uk/conditions/repairofabdominalaneurysm/Pages/Introduction.aspx 7 http://www.nhs.uk/conditions/peripheralarterialdisease/Pages/Introduction.aspx

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PAD/PVD is most prevalent amongst people aged over 60, with one in five affected by the condition.

Men tend to develop the condition more often than women, and smokers, those with high blood

pressure/high cholesterol and those with type 1/type 2 diabetes are also more susceptible. The five

main suggestions recommended to mediate the risk of developing PAD/PVD are:

Stop smoking

Exercise regularly

Maintain a healthy weight

Eat a healthy diet

Moderate consumption of alcohol.

Vascular Dementia

Although having similar risk factors as CVD and being caused by similar processes in the blood

vessels of the brain, vascular dementia or vascular cognitive impairment is not included in this CVD

JSNA as dementia is classified as a mental disorder. A stroke, multiple small strokes or damage to the

small blood vessels in the brain can cause dementia. The NHS Health Check programme offers

information on the signs and symptoms of dementia to people over 65 years of age and identifies

vascular risk factors for all CVD in those age 40-75 without a pre-existing condition.

1.1 Population, Geography & Current CVD Prevalence

Data from the Cambridgeshire County Council Research Group showed Peterborough to have a

population of 183,700 in 2011. This is predicted to rise by 20.1% to 220,700 by 2021 and then a

further 6.6% to 235,300 by 2031. Population growth to 2021 is expected to be particularly high for

males in the 90+, 85-89, 70-74 and 5-9 age groups, with increases of 100.0%, 50.0%, 42.9% and

40.7% respectively. Among females, the highest growth predictions are for the 90+, 5-9, 70-74 and

35-39 age groups, with predicted rises of 50.0%, 43.6%, 43.3% and 32.3% respectively.

Figure 2 – Peterborough Population Projected to 2031

Source: Cambridgeshire County Council Research Group

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Comprehensive data regarding the overall demographics of Peterborough City Council, including a

detailed exploration of various population growth estimates, is included in our JSNA core dataset,

available via the Public Health Intelligence section of the Peterborough City Council website.

This JSNA assesses the current and future health needs of the population of the Borderline and

Peterborough Local Commissioning Groups (LCGs) via a focus on the number of people registered at

each of the 30 General Practices that comprise the two LCGs - 10 within Borderline and 20 within

Peterborough.

This focus on our 'GP Registered Population' allows us to utilise routinely published data at this level

and to concentrate on residents who attend practices within the remit of this JSNA, whilst

simultaneously excluding residents who may live in Peterborough but receive healthcare advice and

treatment at providers outside of the scope of this JSNA.

‘Deprivation quintile’ refers to the registered population’s level of deprivation as calculated by the

English Indices of Deprivation 2010 which collates data on seven different dimensions of deprivation

(income, employment, health/disability, education, crime, housing/services and living environment)

to give one final ‘deprivation score’8 indicating overall levels of deprivation. A placement in a higher

deprivation quintile suggests higher levels of deprivation amongst a population, therefore quintile 1 =

least deprived and quintile 5 = most deprived.

The table below shows the composition of quintiles of deprivation within Cambridgeshire &

Peterborough CCG. Borderline & Peterborough registered populations account for 17 of 22 (77.3%)

of practices in the most deprived quintile and 24 of 43 (55.8%) of practices within the most deprived

two quintiles in the CCG. Conversely, Borderline & Peterborough registered populations comprise

only 2 of 42 (4.8%) practices in the least deprived two quintiles.

Figure 3: Cambridgeshire & Peterborough CCG Practices by Quintile of Deprivation

LCG Quintile 1 (Least Deprived) Quintile 2 Quintile 3 Quintile 4 Quintile 5 (Most Deprived) Total

BORDERLINE 0 2 2 4 2 10

CAM HEALTH 2 2 2 2 1 9

CATCH 14 5 6 3 0 28

HUNTS CARE PARTNERS 4 5 5 3 0 17

HUNTS HEALTH 0 3 4 2 0 9

ISLE OF ELY 1 4 1 4 0 10

PETERBOROUGH 0 0 2 3 15 20

WISBECH 0 0 0 0 4 4

QUINTILE TOTAL 21 21 22 21 22 107

Source: Quintiles generated based on ranks of Index of Multiple Deprivation Scores 2010

8 UK Govt: http://data.gov.uk/dataset/index-of-multiple-deprivation

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The tables and map below outline the geographical location of each of the 30 general practices within

the Borderline & Peterborough LCGs.

Figure 4: Borderline & Peterborough LCGs General Practices

# Local Commissioning Group Practice

Code Practice Name

1 Borderline D81020 NENE VALLEY MEDICAL PRACTICE

2 Borderline D81022 THORNEY

3 Borderline D81029 OLD FLETTON SURGERY

4 Borderline D81031 YAXLEY GROUP PRACTICE

5 Borderline D81039 JENNER HEALTH CENTRE

6 Borderline D81046 NEW QUEEN STREET SURGERY

7 Borderline D81053 BRETTON MEDICAL PRACTICE

8 Borderline D81630 HAMPTON HEALTH

9 Borderline K83017 WANSFORD SURGERY

10 Borderline K83023 OUNDLE

11 Peterborough D81006 NORTH STREET MED.PRACTICE

12 Peterborough D81007 PARK MEDICAL CENTRE

13 Peterborough D81019 MINSTER MEDICAL PRACTICE

14 Peterborough D81023 PASTON HEALTH CENTRE

15 Peterborough D81024 THOMAS WALKER

16 Peterborough D81026 LINCOLN ROAD SURGERY

17 Peterborough D81063 WESTGATE

18 Peterborough D81065 WELLAND MEDICAL PRACTICE

19 Peterborough D81073 WESTWOOD CLINIC

20 Peterborough D81605 HUNTLY GROVE PRACTICE

21 Peterborough D81615 THORPE ROAD SURGERY

22 Peterborough D81616 HODGSON MEDICAL CENTRE

23 Peterborough D81618 AILSWORTH MEDICAL CENTRE

24 Peterborough D81620 PARNWELL MEDICAL CENTRE

25 Peterborough D81624 DOGSTHORPE MEDICAL CENTRE

26 Peterborough D81625 THISTLEMOOR MEDICAL CENTRE

27 Peterborough D81629 BUSHFIELD

28 Peterborough D81631 MILLFIELD MEDICAL CENTRE

29 Peterborough D81645 THE GRANGE MEDICAL CENTRE

30 Peterborough Y00486 BOTOLPH BRIDGE COMMUNITY HEALTH

Source: Cambridgeshire & Peterborough Clinical Commissioning Group

Figure 5: Borderline & Peterborough LCG General Practice Map

Source: Ordnance Survey /Cambridgeshire & Peterborough CCG

The table below describes GP registered populations for the practices within the Borderline and Peterborough LCGs for 2013/14, the most recent time period for which

practice-level QOF data are available for many of the indicators used within this JSNA. Practices are ranked by total registered population. Where a practice is geographically

located within a Peterborough City Council Electoral Ward, the ward is stated in column ‘Ward – Geographically located within’. The adjacent column ‘Ward – Majority

population registered within’ shows where the majority of residents registered with the practice live.

Figure 6: Borderline LCG & Peterborough LCG General Practice Overview 2013/14

LCG Practice Name Ward - Geographically located within Ward - Majority population registered

within Deprivation

Quintile* Population

Borderline NEW QUEEN STREET SURGERY N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 2 15,993

Peterborough NORTH STREET MED.PRACTICE Central East 4 15,506

Borderline YAXLEY GROUP PRACTICE N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 1 15,295

Peterborough THISTLEMOOR MEDICAL CENTRE North North 4 14,199

Peterborough PASTON HEALTH CENTRE Paston Paston 4 13,341

Borderline NENE VALLEY MEDICAL PRACTICE Orton Longueville Orton Longueville 4 12,054

Borderline BRETTON MEDICAL PRACTICE Bretton North Bretton North 5 11,915

Peterborough MILLFIELD MEDICAL CENTRE Park Central 5 11,798

Borderline OLD FLETTON SURGERY Fletton Fletton 3 11,720

Borderline OUNDLE N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 1 10,892

Peterborough LINCOLN ROAD SURGERY Central Werrington South 3 10,736

Peterborough WESTGATE Central Central 5 9,793

Peterborough PARK MEDICAL CENTRE Park Park 4 8,884

Borderline HAMPTON HEALTH Orton & Hampton Orton & Hampton 1 8,193

Borderline JENNER HEALTH CENTRE N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 2 7,975

Borderline THORNEY Eye & Thorney Eye & Thorney 2 7,653

Peterborough THOMAS WALKER Park Park 3 6,976

Peterborough BOTOLPH BRIDGE COMMUNITY HEALTH Fletton Fletton 2 6,821

Borderline WANSFORD SURGERY N/A (Outside Peterborough UA) N/A (Outside Peterborough UA) 1 6,794

Peterborough BUSHFIELD Orton Waterville Orton Waterville 4 5,439

Peterborough WESTWOOD CLINIC Ravensthorpe Ravensthorpe 5 5,134

Peterborough THORPE ROAD SURGERY West West 2 5,076

Peterborough DOGSTHORPE MEDICAL CENTRE Welland Welland 5 4,914

Peterborough WELLAND MEDICAL PRACTICE Dogsthorpe Dogsthorpe 5 4,387

Peterborough MINSTER MEDICAL PRACTICE Park East 3 3,982

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LCG Practice Name Ward - Geographically located within Ward - Majority population registered

within Deprivation

Quintile* Population

Peterborough HODGSON MEDICAL CENTRE Werrington North Werrington North 1 3,949

Peterborough THE GRANGE MEDICAL CENTRE West West 2 2,941

Peterborough AILSWORTH MEDICAL CENTRE Glinton & Wittering Glinton & Wittering 1 2,367

Peterborough HUNTLY GROVE PRACTICE Park Park 3 2,051

Peterborough PARNWELL MEDICAL CENTRE East East 3 1,632

Source: Public Health England, National General Practice Profiles

*Quintiles in this table calculated for the 30 practices that comprise Borderline & Peterborough LCGs only.

Figure 7: Estimated General Practice Populations 65+, 2021 & 2031

The table below estimates population growth by registered practice of resident for the 65+ and 85+ age groups to illustrate possible future CVD burden, based on

Cambridgeshire Research Group estimates of 12.06% population growth between 2015-2021 and 22.5% between 2015 and 2031. April 2015 population totals are used as

the baseline, rather than the 2013/14 populations used above (which are required due to the most recent available QOF data covering the 2013/14 period). This

methodology is relatively crude due to being based on current population estimates; actual changes will vary depending on future demographic changes and planned

housing development. The number of residents aged 65+ registered with Borderline/Peterborough LCG practices in April 2015 is 35,732 for April 2015 and is estimated to

increase to 40,041 by 2021 and subsequently to 49,051 by 2031. 4,772 persons aged 85 or older were registered with a Borderline/Peterborough LCG practice in April 2015;

this is predicted to rise to 5,348 by 2021 and 6,551 by 2031.

Blue = Borderline LCG Practice

Green = Peterborough LCG Practice

GP NAME Total Population

2015 Estimated Total 2021 Estimated Total 2031 Total 65+ 2015

Total 65+ 2021

Total 65+ 2031 Total 85+ 2015 Total 85+ 2021 Total 85+ 2031

AILSWORTH MEDICAL CENTRE 2,343 2,626 2,870 405 454 556 48 54 66

BOTOLPH BRIDGE COMMUNITY HEALTH 6,823 7,646 8,358 525 588 721 56 63 77

BRETTON MEDICAL PRACTICE 11,924 13,362 14,607 1,572 1,762 2,158 146 164 200

BUSHFIELD 5,446 6,103 6,671 685 768 940 93 104 128

DOGSTHORPE MEDICAL CENTRE 4,939 5,535 6,050 314 352 431 36 40 49

HAMPTON HEALTH 8,295 9,295 10,161 413 463 567 97 109 133

HODGSON MEDICAL CENTRE 4,001 4,484 4,901 469 526 644 69 77 95

HUNTLY GROVE PRACTICE 2,052 2,299 2,514 448 502 615 57 64 78

JENNER HEALTH CENTRE 7,929 8,885 9,713 1,836 2,057 2,520 271 304 372

LINCOLN ROAD SURGERY 10,674 11,961 13,076 2,148 2,407 2,949 319 357 438

MILLFIELD MEDICAL CENTRE 12,060 13,514 14,774 568 637 780 78 87 107

MINSTER MEDICAL PRACTICE 3,998 4,480 4,898 802 899 1,101 120 134 165

NENE VALLEY MEDICAL PRACTICE 12,114 13,575 14,840 1,548 1,735 2,125 165 185 227

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GP NAME Total Population

2015 Estimated Total 2021 Estimated Total 2031 Total 65+ 2015

Total 65+ 2021

Total 65+ 2031 Total 85+ 2015 Total 85+ 2021 Total 85+ 2031

NEW QUEEN STREET SURGERY 16,126 18,071 19,754 2,942 3,297 4,039 350 392 480

NORTH STREET MED.PRACTICE 15,496 17,365 18,983 3,083 3,455 4,232 480 538 659

OLD FLETTON SURGERY 11,757 13,175 14,402 2,101 2,354 2,884 304 341 417

OUNDLE 10,792 12,094 13,220 2,324 2,604 3,190 324 363 445

PARK MEDICAL CENTRE 8,893 9,965 10,894 1,365 1,530 1,874 224 251 307

PARNWELL MEDICAL CENTRE 1,660 1,860 2,034 111 124 152 11 12 15

PASTON HEALTH CENTRE 13,449 15,071 16,475 1,558 1,746 2,139 222 249 305

THE GRANGE MEDICAL CENTRE 2,927 3,280 3,586 321 360 441 51 57 70

THISTLEMOOR MEDICAL CENTRE 14,495 16,243 17,756 836 937 1,148 72 81 99

THOMAS WALKER 6,964 7,804 8,531 1,324 1,484 1,818 215 241 295

THORNEY 7,659 8,583 9,382 1,525 1,709 2,093 191 214 262

THORPE ROAD SURGERY 5,154 5,776 6,314 660 740 906 83 93 114

WANSFORD SURGERY 6,851 7,677 8,392 1,495 1,675 2,052 219 245 301

WELLAND MEDICAL PRACTICE 4,353 4,878 5,332 313 351 430 21 24 29

WESTGATE 9,914 11,110 12,145 1,150 1,289 1,579 176 197 242

WESTWOOD CLINIC 5,121 5,739 6,273 537 602 737 42 47 58

YAXLEY GROUP PRACTICE 15,386 17,242 18,848 2,354 2,638 3,231 232 260 318

Borderline LCG Total 108,833 121,958 133,320 10,248 11,484 14,068 1,383 1,550 1,898

Peterborough LCG Total 140,762 157,738 172,433 25,484 28,557 34,983 3,389 3,798 4,652

Peterborough & Borderline LCG Total 249,595 279,696 305,754 35,732 40,041 49,051 4,772 5,348 6,551

Source: Cambridgeshire County Council Research Group

Figure 8: CVD & Associated Conditions by Practice

The table below ranks the practices within Borderline & Peterborough LCGs by estimated prevalence

of cardiovascular disease and also provides prevalence estimates for coronary heart disease,

hypertension and stroke. These data are based on the Quality Outcomes Framework (QOF). QOF

data are collected by primary care services (general practices). They represent GP diagnosed disease

and hence GP recorded levels of illness (prevalence), rather than true population prevalence which

would include undiagnosed disease. QOF data are not available by age and hence a practice, or a

geographic area, with a relatively older population would expect to have a higher level of disease

than an area with a younger population, for most cardiovascular diseases.

Comparisons of local values to local or national benchmarks are made through an assessment of

‘statistical significance’. 95% confidence intervals provide a measure of uncertainty around a

calculated value which arises due to random variation. If the confidence interval for a local value

excludes the value for the benchmark, the difference between the local value and the benchmark is

said to be ‘statistically significant’.

The percentage of the population aged over 40 (the age at which it is first possible to receive an NHS

Health Check)9; over 60 and over 80 is also included. Dark blue cells represent a percentage above

the Peterborough value whereas light blue cells represent a percentage below the Peterborough

value.

This table illustrates that a key contributing factor to the expected prevalence of CVD and associated

conditions is an older population, even if the population is relatively affluent. Need in relation to

CVD is likely to be highest in areas of relative deprivation with an older population and the below

data suggest need to be highest for populations within the electoral wards of Park, Central, East and

Fletton. Prevalence calculations are taken from Public Health England’s National GP Practice

Profiles.10

9 NHS: http://www.nhs.uk/Conditions/nhs-health-check/Pages/NHS-Health-Check.aspx 10 http://fingertips.phe.org.uk/profile/general-practice

LCG Practice Name Ward - Geographically

located within

Ward - Majority population registered

within

Deprivation Quintile*

Age 40+

Age 60+ Age 80+

Estimated prevalence of CVD (%,

all ages) 2011

Estimated prevalence of CHD (%,

all ages) 2011

Estimated prevalence of

hypertension (%, all ages) 2011

Estimated prevalence of stroke (%, 2011, all

ages)

Peterborough MINSTER MEDICAL

PRACTICE Park East 3 54.6% 26.4% 5.9% 11.5 6.2 29.5 2.7

Peterborough HUNTLY GROVE

PRACTICE Park Park 3 53.3% 26.3% 6.6% 10.9 6.2 27.8 2.5

Peterborough NORTH STREET MED.PRACTICE

Central East 2 51.2% 25.8% 6.2% 10.6 5.7 27.4 2.4

Peterborough THOMAS WALKER Park Park 3 50.6% 25.3% 6.3% 10.6 5.6 27.3 2.4

Peterborough LINCOLN ROAD

SURGERY Central Werrington South 3 51.7% 25.4% 6.3% 10.5 5.6 27.1 2.4

Borderline JENNER HEALTH CENTRE N/A (Outside Peterborough

UA) N/A (Outside

Peterborough UA) 4 58.0% 29.0% 7.0% 10.9 5.4 28.8 2.4

Borderline OLD FLETTON SURGERY Fletton Fletton 3 50.3% 23.1% 5.2% 10.1 5.3 26.3 2.2

Borderline WANSFORD SURGERY N/A (Outside Peterborough

UA) N/A (Outside

Peterborough UA) 1 60.8% 28.8% 5.4% 10.8 4.9 27.0 2.2

Peterborough PARK MEDICAL CENTRE Park Park 2 46.7% 20.1% 4.9% 9.0 4.8 24.1 2.0

Borderline THORNEY Eye & Thorney Eye & Thorney 4 54.1% 25.4% 5.1% 9.7 4.7 26.6 2.0

Borderline NEW QUEEN STREET

SURGERY N/A (Outside Peterborough

UA) N/A (Outside

Peterborough UA) 4 52.9% 24.4% 4.8% 9.7 4.7 26.5 2.0

Peterborough AILSWORTH MEDICAL

CENTRE Glinton & Wittering Glinton & Wittering 1 56.1% 23.8% 4.8% 9.2 4.1 24.2 1.9

Borderline BRETTON MEDICAL

PRACTICE Bretton North Bretton North 5 43.6% 18.5% 2.7% 8.0 4.1 22.2 1.7

Borderline NENE VALLEY MEDICAL

PRACTICE Orton Longueville Orton Longueville 2 42.8% 17.5% 2.8% 8.0 4.0 22.2 1.7

Peterborough WESTGATE Central Central 5 41.3% 16.0% 3.7% 8.2 4.0 22.0 1.7

Peterborough THE GRANGE MEDICAL

CENTRE West West 4 39.4% 16.8% 3.2% 7.4 3.9 20.9 1.5

Peterborough WELLAND MEDICAL

PRACTICE Dogsthorpe Dogsthorpe 5 32.3% 10.0% 1.4% 6.6 3.9 16.9 1.5

Borderline OUNDLE N/A (Outside Peterborough

UA) N/A (Outside

Peterborough UA) 1 56.4% 27.6% 5.5% 9.6 3.9 25.4 1.8

Peterborough PASTON HEALTH

CENTRE Paston Paston 2 42.5% 16.1% 3.3% 7.7 3.8 21.2 1.6

Peterborough DOGSTHORPE MEDICAL

CENTRE Welland Welland 5 30.2% 9.4% 1.5% 6.4 3.7 16.3 1.4

Borderline YAXLEY GROUP

PRACTICE N/A (Outside Peterborough

UA) N/A (Outside

Peterborough UA) 1 49.8% 20.8% 3.0% 8.6 3.6 21.9 1.7

Peterborough THORPE ROAD SURGERY West West 4 45.8% 17.0% 3.2% 7.9 3.6 22.4 1.6

Peterborough BUSHFIELD Orton Waterville Orton Waterville 2 43.6% 18.1% 3.5% 7.3 3.6 20.5 1.5

Peterborough WESTWOOD CLINIC Ravensthorpe Ravensthorpe 5 39.8% 14.4% 2.0% 7.1 3.5 20.0 1.4

Peterborough HODGSON MEDICAL

CENTRE Werrington North Werrington North 1 49.9% 16.5% 3.4% 7.6 3.3 22.0 1.5

Peterborough THISTLEMOOR MEDICAL

CENTRE North North 2 33.0% 9.3% 1.3% 6.0 2.7 17.0 1.1

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LCG Practice Name Ward - Geographically

located within

Ward - Majority population registered

within

Deprivation Quintile*

Age 40+

Age 60+ Age 80+

Estimated prevalence of CVD (%,

all ages) 2011

Estimated prevalence of CHD (%,

all ages) 2011

Estimated prevalence of

hypertension (%, all ages) 2011

Estimated prevalence of stroke (%, 2011, all

ages)

Peterborough MILLFIELD MEDICAL

CENTRE Park Central 5 24.8% 6.5% 1.4% 5.8 2.7 14.6 1.2

Peterborough BOTOLPH BRIDGE

COMMUNITY HEALTH Fletton Fletton 4 36.0% 10.9% 1.9% 6.0 2.4 17.0 1.1

Peterborough PARNWELL MEDICAL

CENTRE East East 3 32.2% 10.1% 1.3% 5.6 2.3 16.1 1.0

Borderline HAMPTON HEALTH Orton & Hampton Orton & Hampton 1 29.5% 6.8% 1.8% 4.7 1.4 12.0 0.8

- Cambridgeshire & Peterborough CCG

- - - 47.9% 21.2% 4.3% 8.9 4.0 23.2 1.8

- England - - - 49.3% 22.1% 4.6% 9.5 4.7 24.7 2.1


*Quintiles calculated for the 30 practices that comprise Borderline & Peterborough LCGs only.

1.2 Predicted Future CVD Prevalence

Figure 9: CVD & Associated Conditions – Predicted Future Prevalence11

The table below illustrates predicted growth rates in numbers of residents registered to GP Practices within the Borderline & Peterborough LCGs. These figures are based

on current disease prevalence estimates from Public Health England12 and the Cambridgeshire Research Group’s growth predictions to 2031, which suggest population

growth of 12.06% over the 6 years 2015-2021 and 22.5% over the 16 years 2015-2031. The estimates are resultantly susceptible to revision based on future demographic

changes, local growth/housing strategy etc. Most data within this JSNA are based on 2013/14 national GP practice profiles, to allow us to fully assess all available

information. However, the below table includes registered population data from April 2015 to allow us to more accurately project future demand; population numbers

therefore differ between this table and others within the JSNA based on published 2013/14 data.

LCG Practice

Code Practice Name

Ward - Geographically located within

Ward - Majority

population registered

within

Deprivation Quintile

Total Registered Population

Estimated persons with CVD Estimated persons with CHD Estimated persons with

hypertension Estimated persons with

stroke

2015 2021 2031 2015 2021 2031 2015 2021 2031 2015 2021 2031

Borderline D81046 NEW QUEEN

STREET SURGERY

N/A (Outside Peterborough

UA)


UA) 2 16,126 1,486 1,673 1,890 669 753 851 3,902 4,393 4,963 312 351 396

Peterborough D81006 NORTH STREET MED.PRACTICE

Central East 4 15,496 1,402 1,578 1,783 736 829 936 3,741 4,212 4,759 308 347 392

Borderline D81031 YAXLEY GROUP

PRACTICE


UA)


UA) 1 15,386 1,219 1,372 1,550 557 627 708 3,450 3,885 4,389 241 272 307

Peterborough D81625 THISTLEMOOR

MEDICAL CENTRE

North North 4 14,495 866 975 1,102 341 384 434 2,465 2,776 3,136 155 174 197

Peterborough D81023 PASTON HEALTH CENTRE

Paston Paston 4 13,449 1,421 1,600 1,808 767 864 976 3,685 4,150 4,688 323 363 410

Borderline D81020 NENE VALLEY

MEDICAL PRACTICE

Orton Longueville

Orton Longueville

4 12,114 1,325 1,492 1,686 754 849 959 3,367 3,791 4,283 307 346 391

Peterborough D81631 MILLFIELD MEDICAL CENTRE

Park Central 5 12,060 1,166 1,313 1,483 561 632 714 3,194 3,597 4,063 245 276 312

Borderline D81053 BRETTON MEDICAL PRACTICE

Bretton North Bretton North 5 11,924 1,373 1,546 1,747 744 837 946 3,520 3,963 4,477 316 356 402

11 PHE: http://fingertips.phe.org.uk/profile/general-practice 12 PHE: http://fingertips.phe.org.uk/profile/general-practice/data

17

LCG Practice

Code Practice Name


Ward - Majority


within





stroke

2015 2021 2031 2015 2021 2031 2015 2021 2031 2015 2021 2031

Borderline D81029 OLD FLETTON

SURGERY Fletton Fletton 3 11,757 1,235 1,391 1,571 663 747 843 3,183 3,584 4,049 280 316 357

Borderline K83023 OUNDLE N/A (Outside Peterborough

UA)


UA) 1 10,792 688 774 875 402 452 511 1,762 1,984 2,241 152 171 194

Peterborough D81026 LINCOLN ROAD

SURGERY Central

Werrington South

3 10,674 620 698 789 285 321 362 1,563 1,760 1,988 126 142 160

Peterborough D81063 WESTGATE Central Central 5 9,914 1,080 1,216 1,374 531 598 675 2,855 3,215 3,631 236 265 300

Peterborough D81007 PARK MEDICAL

CENTRE Park Park 4 8,893 708 797 901 361 406 459 1,974 2,222 2,510 147 166 187

Borderline D81630 HAMPTON

HEALTH Orton &

Hampton Orton &

Hampton 1 8,295 391 440 497 118 133 150 996 1,121 1,267 62 70 79

Borderline D81039 JENNER HEALTH

CENTRE


UA)


UA) 2 7,929 773 870 983 373 420 475 2,113 2,379 2,688 162 182 206

Borderline D81022 THORNEY Eye & Thorney Eye & Thorney 2 7,659 772 870 982 402 453 512 2,013 2,267 2,561 171 193 218

Peterborough D81024 THOMAS WALKER

Park Park 3 6,964 496 558 631 242 273 308 1,392 1,568 1,771 99 112 126

Borderline K83017 WANSFORD

SURGERY


UA)


UA) 1 6,851 726 817 923 387 436 492 1,869 2,105 2,378 166 186 211

Peterborough Y00486

BOTOLPH BRIDGE

COMMUNITY HEALTH

Fletton Fletton 2 6,823 407 459 518 185 208 235 1,157 1,302 1,471 76 86 97

Peterborough D81629 BUSHFIELD Orton

Waterville Orton

Waterville 4 5,446 444 500 565 218 246 278 1,197 1,348 1,522 94 106 120

Peterborough D81615 THORPE ROAD

SURGERY West West 2 5,154 444 500 565 188 212 239 1,127 1,268 1,433 86 97 110

Peterborough D81073 WESTWOOD

CLINIC Ravensthorpe Ravensthorpe 5 5,121 286 322 363 120 135 153 822 926 1,046 52 58 66

Peterborough D81624 DOGSTHORPE

MEDICAL CENTRE

Welland Welland 5 4,939 361 406 459 176 198 224 1,012 1,140 1,287 73 83 93

Peterborough D81065 WELLAND MEDICAL PRACTICE

Dogsthorpe Dogsthorpe 5 4,353 472 532 601 214 241 272 1,177 1,325 1,497 98 110 124

Peterborough D81616 HODGSON MEDICAL CENTRE

Werrington North

Werrington North

1 4,001 297 335 378 157 177 200 836 941 1,063 62 70 79

18

LCG Practice

Code Practice Name


Ward - Majority


within





stroke

2015 2021 2031 2015 2021 2031 2015 2021 2031 2015 2021 2031

Peterborough D81019 MINSTER MEDICAL PRACTICE

Park East 3 3,998 304 343 387 133 150 169 880 991 1,119 59 66 75

Peterborough D81645 THE GRANGE

MEDICAL CENTRE

West West 2 2,927 193 217 245 114 129 145 495 558 630 43 48 55

Peterborough D81618 AILSWORTH

MEDICAL CENTRE

Glinton & Wittering

Glinton & Wittering

1 2,343 188 211 239 94 106 120 519 585 661 39 44 49

Peterborough D81605 HUNTLY GROVE

PRACTICE Park Park 3 2,052 197 221 250 79 89 101 522 588 664 36 41 46

Peterborough D81620 PARNWELL MEDICAL CENTRE

East East 3 1,660 127 143 162 63 71 80 351 396 447 26 29 33

Peterborough

LCG 140,762 14,167 15,952 18,020 6,955 7,832 8,847 37,776 42,536 48,051 2,997 3,375 3,812

Borderline LCG 108,833 7,300 8,220 9,286 3,679 4,143 4,680 19,365 21,805 24,632 1,556 1,752 1,979

Peterborough & Borderline LCGs

249,595 21,467 24,171 27,306 10,635 11,975 13,527 57,141 64,340 72,683 4,553 5,127 5,791


*Quintiles calculated for the 30 practices that comprise Borderline & Peterborough LCGs only.

2. Epidemiology

2.1 Mortality (including premature mortality) overview

Figure 10: Public Health Outcomes Framework – Healthcare & Premature Mortality Overview13

Data from Public Health England show Peterborough to be a substantial negative outlier with regards mortality rates

from causes considered preventable and under 75 mortality rates from all cardiovascular diseases. Peterborough is

statistically significantly high for seven of nine related metrics, whereas the East of England region is collectively

statistically significantly low for all nine indicators.

Source: Public Health Outcomes Framework

13 PHE: http://www.phoutcomes.info/public-health-outcomes-framework#gid/1000044/pat/6/ati/102/page/0/par/E12000006/are/E06000031

20

Figure 11: Breakdown of Life Expectancy Gap between Peterborough and England by Broad Cause of Death, 2010-

201214

Source: Public Health England ‘Segmenting Life Expectancy Gaps By Cause Of Death’

The life expectancy gap at birth for Peterborough residents versus England overall is 1.3 years for males

(Peterborough = 77.9, England 79.2) and 0.5 years for females (Peterborough = 82.5, England = 83.0). The table

above illustrates Public Health England projections of the contributing causes to this life expectancy gap. Circulatory

disease is, by some margin, the largest contributing factor to the life expectancy gap for both males (accounting for

33.6% of the gap) and females (53.9% of the gap). Within this figure, ‘circulatory diseases’ include coronary heart

disease and stroke.

Figure 1215 below illustrates life expectancy years gained or lost if Peterborough had the same mortality rates as

England as a whole, by broad cause of death 2010-2012.

14 London Knowledge & Intelligence Team http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Segment/Documents/LA_E06000031.pdf 15 London Knowledge & Intelligence Team http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Segment/Documents/LA_E06000031.pdf

Figure 12: Life expectancy years gained/lost – most common conditions

Source: Public Health England ‘Segmenting Life Expectancy Gaps By Cause Of Death’

Figure 13: Mortality from all circulatory diseases (all ages), Directly Age-Standardised Rate 1995-2013

Source: Health & Social Care Information Centre

22

Peterborough’s directly age-standardised rate (DSR) for mortality from circulatory diseases is 222.9/100,000 for females (England DSR = 221.8/100,000) and 313.0/100,000

for males (England = 332.7/100,000). The Peterborough mortality rates have fallen more substantially than those for England over the last three years for which data are

available, bringing Peterborough close to the national rate for both males and females.

Figure 14: Mortality from all circulatory diseases (under 75), Directly Age- Standardised Rate 1995-2013


Peterborough’s directly age-standardised mortality rate for circulatory diseases, age under 75 is 66.4/100,000 for females and 124.25/100,000 for males. This compares

unfavourably with the England rates of 47.3/100,000 for females and 107.5/100,000 for males and illustrates that there is a disparity between the standardised rate of

mortality from circulatory diseases in Peterborough for people of all ages, which is relatively similar to the national rate, and the rate of mortality for under 75s (i.e.

premature mortality) which is above the national rate for females for every year since 2008 and males for every year since 1998. In addition, the graph suggests a widening

gap in premature CVD mortality for females in Peterborough which needs to be monitored and addressed.

23

Figure 15: Mortality from Coronary Heart Disease, Directly Age-standardised rate 1995-2013


The DSR for females in Peterborough for coronary heart disease is 94.6/100,000 in 2013; for England the DSR is 83.4. Although the Peterborough DSR for males is also

above the England rate, 176.1/100,000 vs 174.7 nationally, this difference is markedly less pronounced.

Figure 16: Mortality from Coronary Heart Disease, (under 75) Directly Age-standardised rate 1995-2013


24

The directly age standardised rate of mortality from coronary heart disease for females is 30.6/100,000 in 2013, an increase from 22.2/100,000 in 2012. Nationally, the rate

for 2013 is 17.7. For males, the directly age standardised rate has fallen for the third consecutive year, to 86.6/100,000. Nationally the age standardised rate has also fallen

in three consecutive years and is now 65.4/100,000.

Figure 17: Mortality from Stroke, Directly Age-Standardised Rate 1995-2013


Peterborough’s DSR from stroke, all ages, is marginally below the England rate for both females (57.6/100,000 vs 65.1/100,000) and males (64.1/100,000 vs 68.7/100,000).

Figure 18: Mortality from stroke (under 75), Directly Age-Standardised Rate 1995-2013


25

Peterborough’s DSR of mortality from stroke under the age of 75 years is similar to England’s for females (11.8/100,000 vs 11.6/100,000 nationally). For males,

Peterborough’s rate fell from 17.5/100,000 in 2012 to 10.9/100,000 in 2013; this latter figure is substantially better than the England rate of 16.0/100,000.

Figure 19: Mortality from Hypertensive Disease, Directly Age-Standardised Rate 1995-2013


Peterborough’s DSR for mortality from hypertensive disease for women is similar to the national rate (10.6/100,000 vs 9.0/100,000). For males, the Peterborough rate is

6.6/100,000, almost half of the national rate of 10.3/100,000 (although due to small numbers, this could be an anomaly rather than indicative of a consistent trend).

2.2 Cambridgeshire & Peterborough Clinical Commissioning Group Local Commissioning Group/Quintiles of Deprivation Epidemiology

Within the below tables, a cell shaded green illustrates the value being statistically significantly low in comparison to Cambridgeshire & Peterborough CCG, which usually

means the value for the Local Commissioning Group/quintile is ‘better’ than the CCG, i.e. a lower prevalence of stroke. Conversely, a red cell indicates the value is

statistically significantly high and therefore usually ‘worse’ than the CCG – the exception to this is indicators such as numbers of angiography/revascularisation procedures

performed, which may relate to CHD/CVD prevalence.

26

Figure 20: Epidemiology Summary (LCGs, QOF Prevalence Data 2013/14)

Data show that the Borderline LCG has a statistically significantly low prevalence of atrial fibrillation and a statistically significantly high prevalence of stroke, diabetes,

hypertension, smoking and obesity in comparison to the whole of Cambridgeshire & Peterborough Clinical Commissioning Group. Peterborough LCG has a statistically

significantly low prevalence of CHD, stroke, hypertension and atrial fibrillation and a statistically significantly high prevalence of diabetes, smoking and obesity.

Peterborough’s significantly low prevalence of conditions such as CHD and stroke may be partially explained by only 12.7% of registered population being aged 65+,

compared to 15.9% within the CCG as a whole, as CVD prevalence is higher in relatively older people.

LCG Age 65+ Age 85+ CHD Stroke Heart Failure Diabetes Hypertension Atrial Fibrillation Smoking Obesity

BORDERLINE 16.2% 2.1% 3.0% 1.6% 0.7% 6.2% 14.3% 1.3% 19.7% 9.6%

CAM HEALTH 13.9% 2.5% 2.4% 1.3% 0.6% 4.3% 10.7% 1.5% 15.8% 6.1%

CATCH 15.0% 2.1% 2.4% 1.2% 0.5% 4.0% 10.9% 1.4% 13.7% 6.1%

HUNTS CARE PARTNERS 19.2% 2.4% 3.6% 1.7% 0.7% 6.6% 15.0% 1.9% 18.2% 10.0%

HUNTS HEALTH 16.2% 1.9% 3.1% 1.5% 0.6% 5.8% 14.3% 1.7% 18.2% 9.3%

ISLE OF ELY 18.0% 2.2% 3.3% 1.5% 0.7% 6.5% 13.5% 1.7% 18.5% 9.7%

PETERBOROUGH 12.7% 1.7% 2.7% 1.3% 0.6% 6.4% 12.2% 1.0% 25.5% 10.7%

WISBECH 19.8% 2.5% 3.9% 2.0% 0.7% 7.3% 15.1% 1.8% 26.7% 12.1%

CCG 15.9% 2.1% 2.9% 1.5% 0.6% 5.6% 12.8% 1.5% 18.6% 8.7%

Source: 2013/14 Quality Outcomes Framework Data

Figure 21: Epidemiology Summary (Deprivation Quintiles within Cambridgeshire & Peterborough CCG, QOF Prevalence Data 2013/14)

Quintile Age 65+ Age 85+ CHD Stroke Heart Failure Diabetes Hypertension Atrial Fibrillation Smoking Obesity

5 - Most Deprived 14.6% 1.9% 3.1% 1.5% 0.6% 6.8% 13.0% 1.2% 26.7% 11.0%

4 16.1% 2.2% 3.2% 1.5% 0.7% 6.1% 13.5% 1.5% 21.7% 10.2%

3 14.6% 2.0% 2.7% 1.3% 0.6% 5.0% 11.9% 1.4% 16.1% 7.6%

2 16.0% 2.1% 2.6% 1.4% 0.5% 4.7% 11.8% 1.5% 13.4% 6.6%

1 - Least Deprived 19.1% 2.6% 3.1% 1.6% 0.7% 5.1% 14.0% 1.8% 13.4% 7.8%

CCG 15.9% 2.1% 2.9% 1.5% 0.6% 5.6% 12.8% 1.5% 18.6% 8.7%


Borderline & Peterborough practices comprise the majority (17/22, 77.3%) of practices in the most deprived quintile within the CCG. Within this quintile, prevalence is

significantly higher than the CCG for CHD and diabetes despite only 14.6% of population being aged 65 or older, 1.3% lower than the CCG. There are also statistically

significantly higher numbers of population that smoke and are obese in comparison to the CCG within these quintiles. Prevalence of CHD, stroke, heart failure, hypertension

and atrial fibrillation are also statistically significantly high in the least deprived quintile, although this may be in part due to having 19.1% of population aged 65 or older (vs

15.9% across the CCG).

27

Figure 22: Epidemiology Summary (LCGs, Hospital Admissions Data for Key CVD-Related Conditions (All Ages) 2014/15)

DSR per 100,000 DSR per 1,000,000

LCG Age 65+ Age 85+ CHD Heart Failure Stroke Angiography Revascularisation

BORDERLINE 16.2% 2.1% 568.2 147.3 197.0 2,544.3 1,821.0

CAM HEALTH 13.9% 2.5% 453.1 120.1 164.0 2,255.9 1,416.1

CATCH 15.0% 2.1% 419.8 124.4 159.0 2,115.8 1,309.7

HUNTS CARE PARTNERS 19.2% 2.4% 641.8 141.2 200.5 2,575.2 1,847.6

HUNTS HEALTH 16.2% 1.9% 645.1 142.8 177.8 2,280.4 2,015.9

ISLE OF ELY 18.0% 2.2% 593.7 119.8 191.7 2,616.6 1,881.6

PETERBOROUGH 12.7% 1.7% 556.4 141.0 204.5 2,452.0 1,937.6

WISBECH 19.8% 2.5% 708.9 217.3 253.4 2,031.6 1,973.0

CCG 15.9% 2.1% 551.2 138.7 187.5 2,362.8 1,714.9

Source: Cambridgeshire & Peterborough Clinical Commissioning Group SUS Dataset

Neither the Borderline nor Peterborough LCGs show any statistically significant variance with regards to admission rates for coronary heart disease, heart failure, stroke,

angiography or revascularisation. These data are directly age-standardised to account for differences in age among the population.

Figure 23: Epidemiology Summary (LCGs, Hospital Admissions Data for Key CVD-Related Conditions (U75 Only) 2014/15)

DSR per 100,000 DSR per 1,000,000

LCG Age <75 Age 75+ CHD Heart Failure Stroke Angiography Revascularisation

BORDERLINE 92.8% 7.2% 392.5 56.4 96.1 1,903.3 1,407.0

CAM HEALTH 92.9% 7.1% 327.0 48.8 101.6 1,829.4 1,134.6

CATCH 93.2% 6.8% 277.5 37.6 78.3 1,629.3 1,034.0

HUNTS CARE PARTNERS 91.7% 8.3% 436.5 56.0 85.5 1,907.1 1,435.1

HUNTS HEALTH 93.1% 6.9% 474.4 54.7 71.3 2,074.1 1,582.0

ISLE OF ELY 92.0% 8.0% 420.7 35.2 101.0 1,969.7 1,532.8

PETERBOROUGH 93.9% 6.1% 438.3 54.4 115.3 2,109.4 1,671.7

WISBECH 90.8% 9.2% 596.0 78.1 148.9 1,927.9 1,794.4

CCG 91.4% 8.6% 395.6 49.7 94.7 1,882.0 1,387.1


28

As with admissions for all ages, Borderline and Peterborough LCGs are both statistically similar to the CCG as a whole with regards to directly age-standardised admission

rates for coronary heart disease, heart failure, stroke, angiography and revascularisation.

Figure 24: Epidemiology Summary (Quintiles of Deprivation, Hospital Admissions Data for Key CVD-Related Conditions (All Ages) 2014/15)

DSR per 100,000 DSR per 1,000,000

Quintile Age 65+ Age 85+ CHD Heart Failure Stroke Angiography Revascularisation

5 - Most Deprived 14.6% 1.9% 612.9 147.5 219.2 2,309.2 1,982.3

4 16.1% 2.2% 628.6 185.7 196.4 2,667.2 1,929.6

3 14.6% 2.0% 555.2 203.1 189.0 2,282.4 1,759.6

2 16.0% 2.1% 505.8 158.7 172.5 2,366.7 1,549.6

1 - Least Deprived 19.1% 2.6% 445.3 121.2 158.0 2,193.2 1,325.7

CCG 15.9% 2.1% 527.3 147.0 187.5 2,362.8 1,714.9


Admissions are statistically significantly high with regards to CHD in the most deprived quintile and CHD and heart failure in the second most deprived quintile. In the least

deprived quintile, admissions are statistically significantly low for CHD, heart failure and revascularisation. This suggests a degree of correlation between economic

deprivation and the risk of admission for a CVD-related condition/procedure.

Figure 25: Epidemiology Summary (Quintiles of Deprivation, Hospital Admissions Data for Key CVD-Related Conditions (U75 Only) 2014/15)

DSR per 100,000 DSR per 1,000,000

Quintile Age <75 Age 75+ CHD Heart Failure Stroke Angiography Revascularisation

5 - Most Deprived 93.2% 6.8% 496.2 60.5 132.0 2,079.9 1,754.1

4 92.5% 7.5% 440.6 62.5 97.7 2,095.5 1,501.3

3 93.5% 6.5% 392.9 56.2 80.6 1,794.9 1,377.1

2 92.9% 7.1% 347.1 34.8 82.5 1,746.4 1,188.3

1 - Least Deprived 91.4% 8.6% 295.4 34.0 78.4 1,691.8 1,089.6

CCG 15.9% 2.1% 395.6 49.7 94.7 1,882.0 1,387.1


Within the most deprived quintile, under 75 hospital admissions for CHD, stroke and revascularisation are statistically significantly higher in comparison to the CCG.

2.2.1 Coronary Heart Disease

Figure 26: Coronary Heart Disease Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs

LCG Persons Prevalence Lower Interval Upper Interval Patients Aged

65+ Patients Aged

85+

CATCH 5,338 2.4% 2.3% 2.4% 15.0% 2.1%

CAM HEALTH 2,067 2.4% 2.3% 2.5% 13.9% 2.5%

PETERBOROUGH 3,809 2.7% 2.6% 2.8% 12.7% 1.7%

BORDERLINE 3,255 3.0% 2.9% 3.1% 16.2% 2.1%

HUNTS HEALTH 2,121 3.1% 3.0% 3.2% 16.2% 1.9%

ISLE OF ELY 3,153 3.3% 3.2% 3.5% 18.0% 2.2%

HUNTS CARE PARTNERS 4,371 3.6% 3.5% 3.7% 19.2% 2.4%

WISBECH 1,862 3.9% 3.8% 4.1% 19.8% 2.5%

BORDERLINE & PETERBOROUGH LCGs 7,064 2.8% 2.8% 2.9% 14.3% 1.9%

ALL OTHER LCGs 18,912 2.9% 2.9% 3.0% 16.6% 2.2%

C&P CCG 25,976 2.9% 2.9% 2.9% 15.9% 2.1%


Peterborough has a statistically significantly low prevalence of coronary heart disease in comparison to the CCG

(2.7% vs 2.9%), which may be partially as a result of having a younger population than the CCG generally; only 14.3%

of patients registered with Borderline/Peterborough practices are aged 65 or over, compared to 15.9% across the

CCG. The collective prevalence of Borderline & Peterborough LCGs is 2.8%, statistically similar to that of the CCG.

Figure 27: Coronary Heart Disease Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs


2.4% 2.4%

2.7%3.0% 3.1%

3.3%3.6%

3.9%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

CA

TCH

CA

M H

EALT

H

PET

ERB

OR

OU

GH

BO

RD

ERLI

NE

HU

NTS

HEA

LTH

ISLE

OF

ELY

HU

NTS

CA

RE

PA

RTN

ERS

WIS

BEC

H

----- = CCG Value

Green = Statistically significantly low in comparison to CCG

Blue = No statistical significance in comparison to CCG

Red = Statistically significantly high in comparison to CCG

30

Figure 28: Coronary Heart Disease Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs


Figure 29: Coronary Heart Disease Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of

Deprivation

Quintile Persons Prevalence Lower Interval Upper Interval Patients Aged

65+ Patients Aged

85+

5 – Most deprived 6,034 3.1% 3.0% 3.1% 14.6% 1.9%

4 5,764 3.2% 3.1% 3.2% 16.1% 2.2%

3 5,101 2.7% 2.6% 2.7% 14.6% 2.0%

2 4,443 2.6% 2.5% 2.7% 16.0% 2.1%

1 – Least Deprived 4,634 3.1% 3.0% 3.2% 19.1% 2.6%

C&P CCG 25,976 2.9% 2.9% 2.9% 15.9% 2.1%


As noted above, practice populations within the Borderline & Peterborough LCGs comprise the majority of the most

deprived two quintiles within the LCG, both of which have statistically significantly high CHD prevalence. The least

deprived quintile is also statistically significantly high.

2.8%

2.9%

2.6%

2.7%

2.8%

2.9%

3.0%

Borderline & Peterborough LCGs All Other LCGs

31

Figure 30: Coronary Heart Disease Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire &

Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 100,000

Area Observed

Admissions DSR Lower Interval Upper Interval

CATCH 759 419.8 390.2 451.0

CAM HEALTH 294 453.1 401.9 509.0

PETERBOROUGH 562 556.4 510.6 605.1

BORDERLINE 546 568.2 521.1 618.3

ISLE OF ELY 528 593.7 543.9 646.9

HUNTS CARE PARTNERS 772 641.8 597.2 688.9

HUNTS HEALTH 392 645.1 582.3 712.9

WISBECH 335 708.9 634.7 789.3

BORDERLINE & PETERBOROUGH LCGs 1,108 562.8 529.8 597.3

ALL OTHER LCGs 3,080 546.6 527.3 566.3

C&P CCG 4,188 551.2 534.5 568.2


The age-standardised admission rate for 2014/15 for CHD is statistically similar to the CCG for both Borderline &

Peterborough LCGs.

Figure 31: Coronary Heart Disease Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire &

Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000

Quintile Observed


5 – Most deprived 969 612.9 574.6 653.1

4 979 628.6 589.7 669.5

3 844 555.2 518.0 594.3

2 727 505.8 469.5 544.2

1 – Least Deprived 669 445.3 412.0 480.5

C&P CCG 4,188 551.2 534.5 568.2


The age-standardised admission rate for 2014/15 for CHD follows a trend of admissions reducing as economic

deprivation decreases, with statistically significantly high rates in the most deprived two quintiles and a significantly

low rate in the most affluent quintile.

Figure 32: Coronary Heart Disease Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &


Area Observed


CATCH 470 277.5 252.8 304.0

CAM HEALTH 189 327.0 281.3 378.1

BORDERLINE 360 392.5 352.8 435.6

ISLE OF ELY 350 420.7 377.6 467.3


PETERBOROUGH 412 438.3 396.2 483.5

HUNTS HEALTH 279 474.4 420.0 533.9

WISBECH 255 596.0 524.8 674.0

BORDERLINE & PETERBOROUGH LCGs 772 416.6 387.4 447.4

ALL OTHER LCGs 2,036 388.1 371.3 405.4

C&P CCG 2,808 395.6 381.0 410.6


32

Amongst under 75s, as with for all ages, age-standardised CHD admission rates show Borderline & Peterborough

LCGs to be similar to the CCG rate and, as shown in figure 33 below, rates fall in correlation with reduced levels of

relative deprivation.

Figure 33: Coronary Heart Disease Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &


Quintile Observed


5 – Most deprived 727 496.2 460.5 533.9

4 628 440.6 406.7 476.6

3 573 392.9 361.1 426.7

2 468 347.1 316.2 380.2

1 – Least Deprived 412 295.4 267.4 325.6

C&P CCG 2,808 395.6 381.0 410.6


Figure 34: Coronary Heart Disease Admissions (Emergency Admissions Only, All Ages) 2014/15, Cambridgeshire &


Area Observed


CATCH 367 198.6 178.7 220.2

CAM HEALTH 152 223.5 188.6 262.8

PETERBOROUGH 269 259.8 229.2 293.3

ISLE OF ELY 247 277.6 243.9 314.7

BORDERLINE 275 289.2 255.7 325.7


HUNTS HEALTH 177 298.2 255.4 345.9

WISBECH 182 385.7 331.5 446.2


ALL OTHER LCGs 1,473 259.4 246.2 273.0

C&P CCG 2,017 263.6 252.2 275.4


The Borderline & Peterborough LCGs are both statistically similar to the CCG with regards to emergency admissions

attributable to CHD.



Quintile Observed


5 – Most deprived 498 311.1 284.2 339.9

4 480 305.7 278.8 334.4

3 399 262.8 237.4 290.1

2 330 227.5 203.5 253.6

1 – Least Deprived 310 204.9 182.6 229.1

C&P CCG 2,017 263.6 252.2 275.4


Emergency admission rates for CHD are highest in areas of economic deprivation and statistically significantly low in

the least deprived two quintiles.

33

Figure 36: Coronary Heart Disease Admissions (Emergency Admissions Only, Under 75 Only) 2014/15,

Cambridgeshire & Peterborough LCGs, Directly Age-Standardised Admission Rate per 100,000

Area Observed


CATCH 187 106.9 92.0 123.5

CAM HEALTH 82 135.7 107.3 169.2


ISLE OF ELY 147 178.4 150.6 209.8

BORDERLINE 164 179.5 152.9 209.4

HUNTS HEALTH 106 179.6 146.8 217.5

PETERBOROUGH 185 191.9 164.8 222.2

WISBECH 128 301.4 251.2 358.5


ALL OTHER LCGs 852 160.9 150.2 172.1

C&P CCG 1,201 167.5 158.1 177.3


As with admissions for all ages, both Borderline & Peterborough LCGs are statistically similar to the CCG for under

75 CHD admissions.


Peterborough CCG Quintiles, Directly Age-Standardised Admission Rate per 100,000

Quintile Observed


5 – Most deprived 344 231.4 207.4 257.5

4 268 186.7 164.9 210.5

3 248 169.9 149.2 192.6

2 191 139.7 120.5 161.1

1 – Least Deprived 150 106.9 90.4 125.6

C&P CCG 1,201 167.5 158.1 177.3


34

2.2.2 HEART FAILURE

Figure 38: Heart Failure Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs

LCG Persons Prevalence Lower Interval Upper Interval Patients Aged

65+ Patients Aged

85+

CATCH 1,181 0.5% 0.5% 0.6% 15.0% 2.1%

PETERBOROUGH 795 0.6% 0.5% 0.6% 12.7% 1.7%

CAM HEALTH 540 0.6% 0.6% 0.7% 13.9% 2.5%

HUNTS HEALTH 433 0.6% 0.6% 0.7% 16.2% 1.9%

ISLE OF ELY 616 0.7% 0.6% 0.7% 18.0% 2.2%

BORDERLINE 720 0.7% 0.6% 0.7% 16.2% 2.1%

WISBECH 854 0.7% 0.7% 0.8% 19.8% 2.5%

HUNTS CARE PARTNERS 343 0.7% 0.7% 0.8% 19.2% 2.4%


ALL OTHER LCGs 3,967 0.6% 0.6% 0.6% 16.6% 2.2%

C&P CCG 5,482 0.6% 0.6% 0.6% 15.9% 2.1%


Borderline & Peterborough LCGs have a collective heart failure prevalence of 0.6%, statistically similar to that of the

CCG.

Figure 39: Heart Failure Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs


0.5%

0.6%

0.6%0.6% 0.7% 0.7%

0.7% 0.7%

0.0%

0.1%

0.2%

0.3%

0.4%

0.5%

0.6%

0.7%

0.8%

0.9%

CA

TCH

PET

ERB

OR

OU

GH

CA

M H

EALT

H

HU

NTS

HEA

LTH

ISLE

OF

ELY

BO

RD

ERLI

NE

WIS

BEC

H

HU

NTS

CA

RE

PA

RTN

ERS

----- = CCG Value




35

Figure 40: Heart Failure Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs


Figure 41: Heart Failure Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of Deprivation


65+ Patients Aged

85+

5 – Most deprived 1,187 0.6% 0.6% 0.6% 14.6% 1.9%

4 1,218 0.7% 0.6% 0.7% 16.1% 2.2%

3 1,099 0.6% 0.5% 0.6% 14.6% 2.0%

2 922 0.5% 0.5% 0.6% 16.0% 2.1%

1 – Least Deprived 1,056 0.7% 0.7% 0.8% 19.1% 2.6%

CCG 5,482 0.6% 0.6% 0.6% 15.9% 2.1%


Heart failure prevalence is statistically significantly high in the least socio-economically deprived quintile, however

this may as a result of 19.1% of the population within the quintile being aged 65 or older, compared to 15.9% across

the CCG as a whole.

0.6%

0.6%

0.5%

0.6%

0.7%


----- = CCG Value




36

Figure 42: Heart Failure Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough CCG

LCGs, Directly Age-Standardised Admission Rate per 100,000

Area Observed


ISLE OF ELY 102 119.8 97.6 145.6

CAM HEALTH 83 120.1 95.1 149.5

CATCH 220 124.4 108.4 142.1

PETERBOROUGH 132 141.0 117.7 167.4


HUNTS HEALTH 82 142.8 113.4 177.6

BORDERLINE 134 147.3 123.3 174.6

WISBECH 104 217.3 177.4 263.6


ALL OTHER LCGs 758 136.8 127.2 147.0

C&P CCG 1,024 138.7 130.3 147.5


The directly age-standardised admission rate as a result of heart failure is statistically significantly high in only one

LCG, Wisbech. As noted in figure 46 below, it is significantly high in the second most-deprived quintile but

significantly low in the least deprived quintiles.

Figure 43: Heart Failure Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough

Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000

Quintile Observed


5 – Most deprived 245 163.7 143.7 185.7

4 280 180.6 159.9 203.1

3 202 138.3 119.8 158.9

2 138 99.5 83.5 117.6

1 – Least Deprived 159 106.0 90.1 123.9

C&P CCG 1,024 138.7 130.3 147.5


All LCGs and quintiles of deprivation are statistically similar to the CCG overall with regards to under 75 admissions

for heart failure.

37

Figure 44: Heart Failure Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &


Area Observed


ISLE OF ELY 29 35.2 23.5 50.7

CATCH 59 37.6 28.5 48.6

CAM HEALTH 26 48.8 31.7 71.8

PETERBOROUGH 47 54.4 39.7 72.7

HUNTS HEALTH 32 54.7 37.2 77.4


BORDERLINE 48 56.4 41.5 75.0

WISBECH 33 78.1 53.6 109.7


ALL OTHER LCGs 242 47.7 41.8 54.1

C&P CCG 337 49.7 44.5 55.3


Figure 45: Heart Failure Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &


Quintile Observed


5 – Most deprived 83 60.5 48.1 75.2

4 86 62.5 49.9 77.3

3 76 54.7 43.0 68.7

2 45 35.0 25.4 46.9

1 – Least Deprived 47 34.8 25.5 46.3

C&P CCG 337 49.7 44.5 55.3


2.2.3 STROKE

With an overall prevalence of 1.3%, Peterborough LCG is one of three LCGs to be statistically significantly better

than the CCG prevalence of 1.5% for Stroke. The Borderline LCG prevalence is 1.6%, statistically significantly high;

collectively the two LCGs have a prevalence of 1.4%. Data show evidence of correlation between stroke prevalence

and age, with the LGCs with statistically significantly higher prevalence of stroke also having a higher percentage of

registered residents aged 65+. Peterborough LCG has a prevalence 0.2% lower than the CCG but also 3.2% fewer

registered persons over 65 and 0.4% fewer persons over 85.

38

Figure 46: Stroke Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs

LCG Number Prevalence LI UI 65+ % 85+

CATCH 2,813 1.2% 1.2% 1.3% 15.0% 2.1%

CAM HEALTH 1,122 1.3% 1.2% 1.4% 13.9% 2.5%

PETERBOROUGH 1,842 1.3% 1.3% 1.4% 12.7% 1.7%

ISLE OF ELY 1,415 1.5% 1.4% 1.6% 18.0% 2.2%

HUNTS HEALTH 1,039 1.5% 1.4% 1.6% 16.2% 1.9%

BORDERLINE 1,706 1.6% 1.5% 1.6% 16.2% 2.1%


WISBECH 968 2.0% 1.9% 2.2% 19.8% 2.5%


ALL OTHER LCGs 9,393 1.5% 1.4% 1.5% 16.6% 2.2%

CCG 12,941 1.5% 1.4% 1.5% 15.9% 2.1%


Figure 47: Stroke Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs


1.2% 1.3% 1.3% 1.5% 1.5% 1.6%1.7%

2.0%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

CA

TCH

CA

M H

EALT

H

PET

ERB

OR

OU

GH

ISLE

OF

ELY

HU

NTS

HEA

LTH

BO

RD

ERLI

NE

HU

NTS

CA

RE

PA

RTN

ERS

WIS

BEC

H

----- = CCG Value




39

Figure 48: Stroke Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs


Figure 49: Stroke Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of Deprivation


65+ Patients Aged

85+

5 – Most deprived 3,019 1.5% 1.5% 1.6% 14.6% 1.9%

4 2,720 1.5% 1.4% 1.5% 16.1% 2.2%

3 2,529 1.3% 1.3% 1.4% 14.6% 2.0%

2 2,329 1.4% 1.3% 1.4% 16.0% 2.1%

1 – Least Deprived 2,344 1.6% 1.5% 1.6% 19.1% 2.6%

CCG 12,941 1.5% 1.4% 1.5% 15.9% 2.1%


Stroke prevalence is statistically significantly high in the least economically deprived quintile, potentially as a result

of a high proportion of older persons.

1.4%

1.5%

1.3%

1.4%

1.5%


----- = CCG Value




40

Figure 50: Stroke Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough CCG LCGs,

Directly Age-Standardised Admission Rate per 100,000

Area Observed


CATCH 286 159.0 140.9 178.6

CAM HEALTH 113 164.0 134.6 197.8

HUNTS HEALTH 103 177.8 144.9 215.9

ISLE OF ELY 168 191.7 163.7 223.1

BORDERLINE 186 197.0 169.5 227.7


PETERBOROUGH 206 204.5 177.1 234.9

WISBECH 120 253.4 209.9 303.3

Peterborough & Borderline LCGs 392 200.7 181.1 221.8

All Other LCGs 1,028 182.6 171.6 194.2

C&P CCG 1,420 187.5 177.8 197.6


The collective directly age-standardised admission rate for Stroke for Borderline & Peterborough LCGs stands at

200.7/100,000 which is statistically similar to the CCG rate of 187.5/100,000.

Figure 51: Stroke Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough Quintiles of

Deprivation, Directly Age-Standardised Admission Rate per 100,000

Quintile Observed


5 – Most deprived 344 219.2 196.5 243.9

4 309 196.4 175.0 219.7

3 282 189.0 167.4 212.6

2 250 172.5 151.7 195.4

1 – Least Deprived 235 158.0 138.3 179.6

C&P CCG 1,420 187.5 177.8 197.6


Although the DSR as a result of Stroke falls as economic affluence increases, no quintile is statistically significantly

different to the CCG admission rate of 187.5/100,000.

41

Figure 52: Stroke admissions 2014/15 by discharge destination

Discharge Destination # % Of Total

Usual place of residence unless listed below, for example, a private dwelling whether owner occupied or owned by Local Authority, housing association or other landlord. This includes

wardened accommodation but not residential accommodation. 872 57.1%

Not applicable 189 12.4%

Patient died or still birth 179 11.7%

NHS other hospital provider - ward for general Patients or the younger physically disabled 135 8.8%

NHS run Care Home 41 2.7%

Non-NHS (other than Local Authority) run Care Home 35 2.3%

Temporary place of residence when usually resident elsewhere (includes hotel, residential educational establishment)

23 1.5%

Non-NHS run hospital 21 1.4%

NHS other hospital provider - high security psychiatric accommodation 19 1.2%

NHS other hospital provider - ward for Patients who are mentally ill or have learning disabilities

7 0.5%

Other (Categories with 5 or fewer admissions) 7 0.5%

Total (includes admitted patients who are registered with General Practices outside C&P CCG 1528 100.0%


The patient was discharged to their normal place of residence in 57.1% (872/1528) of cases. Data from Peterborough

City Council Adult Social Care shows 22.1% (151/681) of assigned social care packages were necessitated by a

Stroke/Cerebral Vascular Accident (CVA) condition, with the overall annual cost amounting to £4.02 million.

Figure 53: Stroke Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire & Peterborough CCG

LCGs, Directly Age-Standardised Admission Rate per 100,000

Area Observed


HUNTS HEALTH 42 71.3 51.2 96.6

CATCH 132 78.3 65.4 93.0


BORDERLINE 87 96.1 76.8 118.7

ISLE OF ELY 83 101.0 80.3 125.2

CAM HEALTH 59 101.6 76.9 131.5

PETERBOROUGH 111 115.3 94.4 139.4

WISBECH 62 148.9 114.1 191.1

42

Area Observed


Borderline & Peterborough LCGs 198 106.0 91.5 122.0

All Other LCGs 474 90.5 82.5 99.1

C&P CCG 672 94.7 87.6 102.2


With regards to stroke admissions for patients aged under 75 years, both Peterborough & Borderline LCGs are

statistically similar to the CCG average.

Figure 54: Stroke Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire & Peterborough

Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 100,000

Quintile Observed


5 194 132.0 113.9 152.2

4 138 97.7 82.0 115.6

3 118 80.6 66.5 96.7

2 114 82.5 67.9 99.2

1 108 78.4 64.3 94.8

C&P CCG 672 94.7 87.6 102.2


Admissions are statistically significantly high in the most deprived quintile, at 132.0/100,000 versus a CCG rate of

94.7/100,000.

2.2.4 Hypertension

Figure 55: Hypertension Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs

LCG Number Prevalence Lower Interval Upper Interval Patients Aged

65+ Patients Aged

85+

CAM HEALTH 9,236 10.7% 10.5% 10.9% 13.9% 2.5%

CATCH 24,505 10.9% 10.7% 11.0% 15.0% 2.1%

PETERBOROUGH 17,060 12.2% 12.0% 12.4% 12.7% 1.7%

ISLE OF ELY 12,735 13.5% 13.3% 13.7% 18.0% 2.2%

HUNTS HEALTH 9,754 14.3% 14.0% 14.6% 16.2% 1.9%

BORDERLINE 15,549 14.3% 14.1% 14.6% 16.2% 2.1%


WISBECH 7,160 15.1% 14.8% 15.5% 19.8% 2.5%


ALL OTHER LCGs 81,605 12.7% 12.6% 12.8% 16.6% 2.2%

CCG 114,214 12.8% 12.7% 12.9% 15.9% 2.1%


Peterborough LCG has a statistically significantly low prevalence of hypertension; however Borderline LCG’s

prevalence of 14.3% contributes towards a collective prevalence for the two LCGs of 13.1%, significantly higher than

the CCG prevalence of 12.8%.

43

Figure 56: Hypertension Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs


Figure 57: Hypertension Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs


10.7% 10.9%12.2%

13.5%14.3% 14.3%

15.0% 15.1%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

CA

M H

EALT

H

CA

TCH

PET

ERB

OR

OU

GH

ISLE

OF

ELY

HU

NTS

HEA

LTH

BO

RD

ERLI

NE

HU

NTS

CA

RE

PA

RTN

ERS

WIS

BEC

H13.1%

12.7%

12.2%

12.4%

12.6%

12.8%

13.0%

13.2%

13.4%


----- = CCG Value




44

Figure 58: Hypertension Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of Deprivation


65+ Patients Aged

85+

5 – Most deprived 25,673 13.0% 12.9% 13.2% 14.6% 1.9%

4 24,636 13.5% 13.3% 13.6% 16.1% 2.2%

3 22,813 11.9% 11.8% 12.0% 14.6% 2.0%

2 20,203 11.8% 11.7% 12.0% 16.0% 2.1%

1 – Least Deprived 20,889 14.0% 13.8% 14.2% 19.1% 2.6%

CCG 114,214 12.8% 12.7% 12.9% 15.9% 2.1%


Hypertension prevalence is significantly high in the least deprived quintile and the fourth quintile, both of which

have a higher percentage of patients aged 65+ and 85+ than the CCG collectively.

2.2.5 Angiography

Figure 59: Angiography Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough CCG

LCGs, Directly Age-Standardised Admission Rate per 1,000,000

Area Observed

Events DSR Lower Interval Upper Interval

WISBECH 95 2,031.6 1,642.4 2,485.0

CATCH 381 2,115.8 1,906.8 2,341.3

CAM HEALTH 143 2,255.9 1,895.6 2,663.8

HUNTS HEALTH 145 2,280.4 1,921.6 2,686.4

PETERBOROUGH 247 2,452.0 2,151.0 2,782.8

BORDERLINE 247 2,544.3 2,234.4 2,884.8

HUNTS CARE PARTNERS 312 2,575.2 2,296.4 2,878.5

ISLE OF ELY 233 2,616.6 2,289.6 2,977.1

Peterborough & Borderline LCGs 494 2,486.1 2,269.3 2,717.8

All Other LCGs 1,309 2,317.4 2,192.9 2,447.2

C&P CCG 1,803 2,362.8 2,254.2 2,475.2


The DSR for angiography admissions 2014/15 is calculated as rate per 1,000,000 rather than rate per 100,000 due to

relatively low numbers of operations. All LCGs are statistically similar to the CCG rate of 2,362.8.

----- = CCG Value




45

Figure 60: Angiography Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough

Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 1,000,000

Quintile Observed


5 – Most deprived 366 2,309.2 2,076.8 2,560.4

4 416 2,667.2 2,415.8 2,937.5

3 353 2,282.4 2,048.2 2,535.8

2 340 2,366.7 2,120.1 2,633.9

1 – Least Deprived 328 2,193.2 1,960.8 2,445.4

CCG 1,803 2,362.8 2,254.2 2,475.2


There is no statistical significance to note between rates of admission across the quintiles of deprivation in the CCG

compared to the collective CCG rate.

Figure 61: Angiography Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &

Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 1,000,000

Area Observed


CATCH 275 1,629.3 1,440.7 1,835.6

CAM HEALTH 106 1,829.4 1,491.6 2,219.6

BORDERLINE 176 1,903.3 1,630.8 2,208.0


WISBECH 82 1,927.9 1,531.9 2,394.6

ISLE OF ELY 165 1,969.7 1,679.3 2,295.7

HUNTS HEALTH 124 2,074.1 1,723.0 2,475.3

PETERBOROUGH 199 2,109.4 1,821.8 2,429.0


All Other LCGs 968 1,838.3 1,723.7 1,958.5

C&P CCG 1,343 1,882.0 1,782.1 1,986.1


As with the directly age-standardised rates for all ages, data for under 75 only angiography admissions shows no

statistical outliers among C&P CCGs in comparison to the CCG rate of 1,882.0/1,000,000.

Figure 62: Angiography Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &

Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 1,000,000

Quintile Observed


5 – Most deprived 306 2,079.9 1,851.6 2,328.4

4 300 2,095.5 1,863.9 2,347.8

3 265 1,794.9 1,583.6 2,026.5

2 237 1,746.4 1,529.8 1,984.9

1 – Least Deprived 235 1,691.8 1,481.1 1,924.0

CCG 1,343 1,882.0 1,782.1 1,986.1


46

Although observed admissions fall in line with economic deprivation declining, no quintiles of deprivation have

statistically significant DSRs in comparison to the CCG value.

2.2.6 Revascularisation

Figure 63: Revascularisation Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough

CCG LCGs, Directly Age-Standardised Admission Rate per 1,000,000

Area Observed


CATCH 237 1,309.7 1,147.0 1,488.8

CAM HEALTH 89 1,416.1 1,133.4 1,747.2

BORDERLINE 177 1,821.0 1,560.7 2,112.1


ISLE OF ELY 168 1,881.6 1,606.4 2,190.3

PETERBOROUGH 196 1,937.6 1,671.0 2,234.1

WISBECH 94 1,973.0 1,593.5 2,415.6

HUNTS HEALTH 124 2,015.9 1,673.9 2,406.8


All Other LCGs 935 1,655.8 1,550.8 1,766.0

C&P CCG 1,308 1,714.9 1,622.7 1,811.1


Admissions for revascularisation are statistically significantly low in the ‘CATCH’ LCG and similar to that of the CCG

for all other LCGs, however it should be noted that revascularisation rates will pertain to observed CVD/CHD

prevalence and therefore, although statistically significantly different, the DSR of the CATCH LCG should not be

interpreted as necessarily ‘better’ than the CCG DSR.

Figure 64: Revascularisation Admissions (All Admission Types, All Ages) 2014/15, Cambridgeshire & Peterborough

Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 1,000,000

Quintile Observed


5 – Most deprived 315 1,982.3 1,767.7 2,215.7

4 301 1,929.6 1,716.8 2,161.4

3 269 1,759.6 1,553.6 1,985.1

2 224 1,549.6 1,352.1 1,767.6

1 – Least Deprived 199 1,325.7 1,146.8 1,524.5

CCG 1,308 1,714.9 1,622.7 1,811.1


Revascularisation admissions fall in line with declining economic deprivation, with the rate of 1,325.7/1,000,000

standing as statistically significantly low in comparison to the CCG rate of 1,714.9/1,000,000.

47

Figure 65: Revascularisation Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &

Peterborough CCG LCGs, Directly Age-Standardised Admission Rate per 1,000,000

Area Observed


CATCH 174 1,034.0 884.9 1,200.8

CAM HEALTH 65 1,134.6 871.9 1,450.7

BORDERLINE 129 1,407.0 1,173.2 1,673.5


ISLE OF ELY 128 1,532.8 1,277.7 1,823.7

HUNTS HEALTH 93 1,582.0 1,274.8 1,940.5

PETERBOROUGH 157 1,671.7 1,415.3 1,960.4

WISBECH 78 1,794.4 1,417.4 2,240.5


All Other LCGs 700 1,331.7 1,234.4 1,434.6

C&P CCG 986 1,387.1 1,301.4 1,477.0


As with admissions of all ages, the ‘CATCH’ LCG is statistically significantly low in comparison to the CCG for

revascularisation admissions in the under 75 only age range.

Figure 66: Revascularisation Admissions (All Admission Types, Under 75 Only) 2014/15, Cambridgeshire &

Peterborough Quintiles of Deprivation, Directly Age-Standardised Admission Rate per 1,000,000

Quintile Observed


5 – Most deprived 258 1,754.1 1,544.9 1,983.6

4 215 1,501.3 1,306.4 1,716.9

3 201 1,377.1 1,191.7 1,582.9

2 160 1,188.3 1,010.3 1,388.6

1 – Least Deprived 152 1,089.6 922.3 1,278.3

CCG 986 1,387.1 1,301.4 1,477.0


Amongst under 75s, admissions are statistically significantly high in comparison to the CCG in the most deprived

quintile and significantly low in the least deprived quintile.

48

3 Lifestyle Determinants

3.1 Risk Factors Associated with Cardiovascular Disease

A number of common risk factors are recognised as increasing the likelihood of individuals developing

atherosclerosis and consequently CVD. There are three broad groups.16 Fixed risk factors are by definition

unmodifiable, but are taken into account in calculating and advising people about their overall risk:

age;

gender

family history/genetic factors

ethnicity

Lifestyle/behavioural risk factors reflect an individual’s circumstances and choices, and can be changed for the better to reduce personal risk:

smoking

physical inactivity;

poor diet

obesity; and

harmful use of alcohol

‘Bodily’ or physiological risk factors reflect changes to body systems that are preventable or reversible in their early stages, but may require medical treatment to manage the risk:

hypertension/raised blood pressure;

raised cholesterol/disordered lipids;

impaired glucose tolerance/diabetes; and

chronic kidney disease (CKD).

Individuals will often have a number of these risk factors, and may also have more than one clinical manifestation

of CVD. For instance people with diabetes or CKD or who are smokers or suffer from hypertension are more likely

to have strokes, heart attacks, or develop heart failure. It is estimated that each additional risk factor present

doubles the previous overall risk for that individual.17 This multiplicative association of risk factors underpins the

need for an integrated approach to reducing risk both at population and individual level. It is also estimated that in

over 90% of cases, the risk of a first heart attack is related to one or more of nine potentially modifiable risk

factors18 - smoking, poor diet, insufficient physical activity, high blood pressure, obesity, diabetes, psychosocial

stress, alcohol consumption and high blood cholesterol.

3.2 Ethnicity as a risk factor contributing to CVD

British Heart Foundation statistics show that there is a disparity between ethnicities with regards to the prevalence

of cardiovascular disease and associated risk factors– for example, Black Caribbean, Indian, Pakistani and

Bangladeshi men have a considerably higher prevalence of diabetes than the general population and stroke

16 Department of Health: https://www.gov.uk/government/publications/cardiovascular-disease-outcomes-strategy-improving-outcomes-for-people-with-or-at-risk-of-cardiovascular-disease 17 Yusuf S et al; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937-952 18 http://www.nice.org.uk/guidance/ph25/documents/prevention-of-cardiovascular-disease-draft-guidance2 p.5

http://www.nice.org.uk/guidance/ph25/documents/prevention-of-cardiovascular-disease-draft-guidance2

49

incidence rates in the black ethnic group are higher than in the white ethnic group for both sexes.19 Although

identifying particular ethnic factors that influence cardiovascular disease is complicated (with a requirement to

factor in genetic makeup, cultural and social practices and risk factors such as obesity and diabetes), there is

evidence of inequalities between ethnicities with regards to access to treatment20 as well as behavioural factors

such as smoking, alcohol consumption, diet and physical activity.

Peterborough has a relatively high proportion of black & ethnic minority (BME) residents – in the 2011 national

census, 17.5% of residents identified as BME compared to 14.6% of respondents nationally.

Figure 70 ranks Peterborough’s 24 electoral wards by percentage of BME residents and includes statistics related

to cardiovascular disease for each ward. Data show that there is clear correlation between hospital admissions

from, and deaths as a result of, circulatory diseases and high percentages of BME ethnicities as a percentage of

overall population. However, there is also strong correlation between levels of income deprivation and the hospital

admission and mortality rates. Deprivation is associated with the wider determinants of cardiovascular disease-

higher levels of smoking and obesity, a less healthy diet, lower levels of physical activity, more stress and less

control in employment.

19 http://www.esrc.ac.uk/news-and-events/features-casestudies/features/14709/the-ethnicity-of-heart-disease.aspx 20 http://www.parliament.uk/documents/post/postpn276.pdf

50

Figure 67: Peterborough ward ethnicity & CVD-related metrics

Area Name

% Black & Minority Ethnic

Population (2011)

% living in income

deprived households

(2010)

Standardised Mortality

Ratio: Deaths from circulatory

diseases, all ages (2008-

2012)


Ratio: Deaths from circulatory diseases, under 75

years (2008-2012)


Ratio: Deaths from

coronary heart

disease, all ages (2008-

2012)


Ratio: Deaths from

coronary heart

disease, under 75

years (2008-2012)


Ratio: Deaths from

stroke, all ages (2008-

2012)

Standardised Admission

Ratio: Emergency

hospital admissions for coronary

heart disease

(2008/09-2012/13)


Ratio: Elective hospital

admissions for coronary

heart disease

(2008/09-2012/13)


Ratio: Emergency

hospital admissions for stroke (2008/09-2012/13)


Ratio: Emergency

hospital admissions

for myocardial infarction (2008/09-2012/13)

Central 58.2 25.5 116.2 172.1 152.2 229.9 86.1 160.9 166.0 145.2 115.4

Park 35.8 21.7 154.5 200.8 149.5 212.6 209.4 150.4 162.4 122.4 113.0

Ravensthorpe 30.8 25.4 138.7 224.5 185.9 262.0 68.7 146.9 149.7 116.8 115.5

West 29.5 10.5 130.6 86.5 121.3 62.3 164.9 92.6 112.1 107.4 71.3

East 26.8 25.3 123.8 181.2 132.8 188.9 79.2 139.0 149.3 113.0 105.0

North 23.0 26.5 95.8 137.4 127.8 161.5 76.1 135.8 152.2 107.3 63.4

Dogsthorpe 18.4 28.0 123.8 161.0 142.9 197.1 102.7 126.6 139.1 98.3 75.9

Bretton South 14.8 14.3 90.5 101.4 120.7 164.1 77.6 90.2 114.0 98.6 70.9

Orton with Hampton

14.0 10.3 88.2 68.2 87.1 51.0 66.7 96.6 159.1 102.1 81.2

Bretton North 12.4 23.3 106.1 123.9 108.7 114.5 98.1 115.5 134.2 88.3 99.2

Fletton and Woodston

11.5 17.3 121.9 149.6 140.9 167.2 81.7 117.3 148.4 119.8 93.3

Orton Longueville

10.1 24.0 145.0 166.6 141.1 178.6 150.3 137.7 164.0 98.3 92.9

Paston 9.6 25.7 93.5 134.0 91.9 134.4 80.9 111.1 121.6 84.1 101.3

Stanground East

8.3 13.1 71.4 79.3 67.1 53.6 70.3 105.7 152.7 105.0 92.2

Walton 8.2 15.6 93.7 108.3 111.3 123.5 76.9 104.3 125.0 95.1 81.4

Werrington North

7.4 11.2 78.5 84.3 85.9 85.5 77.5 109.0 137.9 79.2 94.4

Orton Waterville

7.2 10.3 76.8 96.0 72.9 63.5 64.5 91.9 122.7 84.6 78.5

Stanground Central

6.9 14.6 103.2 100.5 112.7 119.7 88.6 104.9 152.1 114.1 86.5

Eye and Thorney

5.0 11.7 118.1 100.5 142.6 85.8 104.4 91.5 138.3 99.9 73.3

Werrington South

4.9 10.1 104.2 93.4 90.0 89.7 115.0 92.9 125.6 71.8 83.4

Newborough 4.7 6.7 55.6 54.4 52.6 48.7 61.8 87.0 131.5 47.6 87.9

51

Area Name

% Black & Minority Ethnic

Population (2011)

% living in income

deprived households

(2010)


Ratio: Deaths from circulatory

diseases, all ages (2008-

2012)


Ratio: Deaths from circulatory diseases, under 75

years (2008-2012)


Ratio: Deaths from

coronary heart

disease, all ages (2008-

2012)


Ratio: Deaths from

coronary heart

disease, under 75

years (2008-2012)


Ratio: Deaths from

stroke, all ages (2008-

2012)


Ratio: Emergency

hospital admissions for coronary

heart disease

(2008/09-2012/13)


Ratio: Elective hospital

admissions for coronary

heart disease

(2008/09-2012/13)


Ratio: Emergency

hospital admissions for stroke (2008/09-2012/13)


Ratio: Emergency

hospital admissions

for myocardial infarction (2008/09-2012/13)

Glinton and Wittering

2.8 5.3 83.8 69.6 77.4 34.0 48.1 95.1 135.8 89.4 88.5

Barnack 2.7 4.7 111.6 100.2 104.2 78.3 72.6 87.8 126.5 89.9 78.9

Northborough 2.3 5.7 100.1 60.5 123.1 81.2 62.7 116.9 167.6 95.0 115.1

Peterborough Unitary

Authority 17.5 17.8 110.5 122.3 117.6 125.8 101.1 114.3 140.8 101.4 89.9

Source: Local Health Profiles

Figure 68: Peterborough Hospitals Admissions 2014/15 – Ethnic Breakdown

Ethnicity Category All Admissions All CHD All Heart Failure All Stroke All Angiography All Revascularisation

British 72.2% 78.0% 76.7% 70.7% 81.5% 77.4%

Not Known 9.4% 11.6% 11.2% 9.7% 5.8% 15.8%

Not Stated 7.3% 3.5% 4.2% 10.9% 4.8% 1.5%

Any Other White Background 4.7% 1.8% 3.7% 3.8% 2.2% 0.4%

Pakistani 1.5% 1.4% 1.2% 1.4% 1.3% 1.1%

Indian 0.9% 1.0% 0.4% 0.6% 1.4% 1.2%

Any Other Ethnic Group 0.7% 0.6% 0.5% 0.4% 0.7% 0.6%

Any Other Asian Background 0.6% 0.4% 0.3% 0.5% 0.6% 0.3%

Irish 0.6% 0.6% 0.4% 0.7% 0.6% 0.6%

African 0.4% 0.0% 0.0% 0.1% 0.1% 0.0%

Any Other Mixed Background 0.3% 0.1% 0.2% 0.1% 0.1% 0.1%

Chinese 0.3% 0.2% 0.1% 0.1% 0.1% 0.2%

52

Ethnicity Category All Admissions All CHD All Heart Failure All Stroke All Angiography All Revascularisation

Any Other Black Background 0.2% 0.1% 0.1% 0.4% 0.2% 0.1%

Caribbean 0.2% 0.1% 0.3% 0.4% 0.1% 0.0%

Bangladeshi 0.2% 0.3% 0.9% 0.2% 0.5% 0.3%

White and Asian 0.2% 0.1% 0.0% 0.0% 0.2% 0.1%

White and Black Caribbean 0.2% 0.0% 0.1% 0.1% 0.1% 0.0%

White and Black African 0.1% 0.1% 0.0% 0.0% 0.0% 0.3%

Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%


Data show that 72.2% of patients admitted to Peterborough City Hospital in 2014/15 self-identified as British; this ethnic group accounted for

a 78.0% of admissions as a result of CHD, 76.7% of heart failure admissions, 81.5% of angiography procedures and 77.4% of revascularisation

procedures. 9.4% of all admissions had a ‘Not Known’ ethnicity status – this also applies to 11.6% of CHD admissions, 11.2% of heart failure

admissions, 9.7% of stroke admissions and 15.8% of revascularisation procedures. Caution should therefore be exercised in use of these data

as it is difficult to draw conclusions with regards to proportion of admissions attributable to ethnic groups when, incorporating ‘Not Known’

and ‘Not Stated’ status in ethnicity field, 16.7% of admissions do not provide the data required for analysis by ethnicity of admitted patient.

53

3.3 Smoking as a CVD risk factor

Reducing tobacco use is one of the most important actions that can be taken to improve health. Tobacco is addictive and harms the people that use it, those around them and communities. Smoking remains the leading cause of preventable death and disease in England, accounting for more preventable deaths than the following five preventable causes, combined. Over 81,400 deaths in England each year in those aged 35 years and over are caused by smoking. That equates to 18% of deaths in this age group. Smoking is also one of the most significant factors that has an impact on health inequalities and ill health, with an estimated 461,000 hospital admissions for people aged 35 years and older estimated to be attributable to smoking.21

The table below shows that tobacco smoking is the primary leading risk factor contributing to ‘Years of Life Lost’ in the United Kingdom. Figure 69: Leading Risk Factors, % of total Years of Life Lost, 2010 (United Kingdom)

Source: Yorkshire & Humber Public Health Observatory

21 BMA: http://bma.org.uk/working-for-change/improving-and-protecting-health/tobacco/smoking-statistics

54

However, by successfully stopping smoking, people can avoid smoking-related diseases and live longer, whatever their age22. The table below demonstrates the benefits in terms of life expectancy and associated overall health associated with stopping smoking:

Age at which stopped smoking Years of life gained

30 10

40 9

50 6

60 3

Source: HM Government ‘Healthy Lives, Healthy People: A Tobacco Control Plan for England’

The Government strategy, Healthy Lives, healthy people: A Tobacco Control Plan for England23 set out an assessment of what could be delivered through national action, supported and associated with locally driven comprehensive tobacco control practice. The plan’s ambition of reducing smoking prevalence among adults in England to 18.5% or less by the end of 2015 appears achievable with 2013 data showing national prevalence of 18.4%. Although the 2015 ASH report Smoking Still Kills advocates an ambition to reduce smoking in the adult population to 13% by 2020 and 9% by 2025.24

Smoking rates in Peterborough have been declining over recent years. In 2010 one in four (25.2%) adults in Peterborough smoked, while in 2013 this rate had declined to one in five (20.8%) adults smoking, a reduction of 4.4 percentage points. In comparison the England average rate has reduced 2.4 percentage points to 18.4% and the East of England average rate has reduced 2.1 percentage points to 17.5% over the same period.

Figure 70: Smoking prevalence among persons aged 18 years and over Trend 2010-2013 (%)

Source: Public Health Outcomes Framework Indicator 2.14

Smoking rates in Peterborough do however remain worse that the England and the East of England average rates as shown in figure 74.

22 UK Govt: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213757/dh_124960.pdf 23 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213757/dh_124960.pdf 24 http://www.ash.org.uk/files/documents/ASH_962.pdf

55

Figure 71: Smoking prevalence among persons aged 18 years and over 2013 – East of England (%)


There is a strong relationship between smoking and people suffering from mental health problems. People with longstanding anxiety, depression or another mental health condition are twice as likely to be smokers as those who do not have any mental health problems. Depression is two to three times more common in a range of cardiovascular diseases including cardiac disease, coronary artery disease, stroke, angina, congestive heart failure, or following a heart attack25. Rates of smoking increase with the severity of the mental health disorder, ranging from 25 per cent among people with eating disorders to 56 per cent among those with probable psychosis. Over the last 20 years, smoking prevalence has changed little in those with severe illness26. It has been estimated that 42% of overall tobacco consumption in England is by this group27.

There is also a strong relationship between smoking and occupation. Smoking prevalence is twice as high among people in routine and manual occupations compared to those in managerial and professional occupations. In Peterborough smoking prevalence among people in routine and manual occupations is 34%, the highest in the East of England. Prevalence has been consistently falling nationally over the period 2011-2013 but rose in Peterborough from 34.3% to 34.7% between 2012 and 2013.

Figure 72: Smoking prevalence among persons working in ‘routine and manual’ occupations 2013 (%)


25 http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/long-term-conditions-mental-health-cost-comorbidities-naylor-feb12.pdf 26 http://www.ash.org.uk/files/documents/ASH_962.pdf 27 http://www.natcen.ac.uk/media/21994/smoking-mental-health.pdf

56

Figure 73: Smoking prevalence among persons working in ‘routine and manual’ occupations Trend

2011-2013 (%)


Smoking status of residents registered with GP practices in 2013/14 demonstrates an association between high levels of deprivation and high rates of smoking. Of the eight registered GP practice populations with highest smoking rates in Peterborough and Borderline, six are in the most deprived 30% of the England population as defined by the 2010 Index of Multiple Deprivation.

Figure 74: Smoking Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs


Data show both the Borderline and Peterborough LCGs to have a statistically significantly high level

of smoking prevalence, with a collective prevalence of 22.9% vs 18.6% across the CCG collectively.

These data are not age-standardised so prevalence may be affected by the relatively young

population of Peterborough, due to smoking prevalence generally declining with age.

LCG Number Prevalence Lower Interval Upper Interval Patients Aged 65+

Patients Aged 85+

CATCH 26,247 13.7% 13.5% 13.9% 15.0% 2.1%

CAM HEALTH 11,677 15.8% 15.5% 16.1% 13.9% 2.5%


HUNTS HEALTH 10,255 18.2% 17.9% 18.6% 16.2% 1.9%

ISLE OF ELY 14,157 18.5% 18.2% 18.8% 18.0% 2.2%

BORDERLINE 17,395 19.7% 19.4% 20.0% 16.2% 2.1%

PETERBOROUGH 28,455 25.5% 25.2% 25.7% 12.7% 1.7%

WISBECH 10,586 26.7% 26.2% 27.2% 19.8% 2.5%


ALL OTHER LCGs 91,400 17.0% 16.8% 17.1% 16.6% 2.2%

CCG 137,250 18.6% 18.5% 18.7% 15.9% 2.1%

57

Figure 75: Smoking Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs


Figure 76: Smoking Prevalence 2013/14, 16+, Cambridgeshire & Peterborough CCG LCGs


13.7%15.8%

18.2% 18.2% 18.5%19.7%

25.5%26.7%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

CA

TCH

CA

M H

EALT

H

HU

NTS

CA

RE

PA

RTN

ERS

HU

NTS

HEA

LTH

ISLE

OF

ELY

BO

RD

ERLI

NE

PET

ERB

OR

OU

GH

WIS

BEC

H

22.9%

17.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%


----- = CCG Value




58

Figure 77: Smoking Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles of

Deprivation

Quintile Persons Prevalence LI UI 65+ % 85+

5 – Most deprived 42,577 26.7% 26.5% 27.0% 14.5% 1.9%

4 33,178 21.7% 21.4% 21.9% 16.2% 2.3%

3 26,243 16.1% 15.9% 16.3% 14.8% 2.0%

2 18,631 13.4% 13.2% 13.6% 16.2% 2.1%

1 – Least Deprived 16,621 13.4% 13.2% 13.6% 19.5% 2.6%

CCG 137,250 18.6% 18.5% 18.7% 14.5% 1.9%


Smoking prevalence is significantly higher amongst the more deprived elements of the CCG

population, falling as deprivation decreases to a low of 13.4% in the two least deprived quintiles.

Addressing current levels of smoking prevalence in Peterborough will have a direct impact on the prevalence of cardiovascular disease. The further development of comprehensive tobacco control locally, including targeted action to reduce smoking prevalence among specific groups, should be considered.

Figure 78: NICE smoking and tobacco guidance

PH1 – Brief interventions and referral for smoking cessation

PH5 – Workplace interventions to promote smoking cessation

PH10 – Smoking cessation services

PH14 – Preventing the uptake of smoking by children and young people

PH15 - Identifying and supporting people most at risk of dying prematurely

PH23 – School based interventions to prevent smoking

PH39 – Smokeless tobacco cessation: South Asian communities

PH45 – Tobacco Harm reduction

PH48 – Smoking cessation in secondary care and tobacco guidance

Source: http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/smoking-and-tobacco

----- = CCG Value




http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/smoking-and-tobacco

59

3.4 Physical inactivity as a CVD Risk Factor

There is growing evidence that sedentary behaviours (e.g. sitting for long periods at work, for

travel, study and ‘screen time’) is independently and adversely linked to all-cause mortality,

cardiovascular deaths, type 2 diabetes, some cancers and depression.28 An increase in sedentary

behaviour can be associated with social, economic and cultural trends that have removed physical

activity from daily life, evidenced by a reduction in manual jobs and the continual use of technology

for work and leisure that requires people to sit for long periods.

Studies show that doing more than 150 minutes of moderate physical activity or 75 minutes of

vigorous physical activity reduces the risk of coronary heart disease by approximately 30%.29

Physical activity promotes cardiovascular health through regulating weight and the body’s use of

insulin, as well as providing health benefits relating to blood pressure, blood lipid levels, blood

glucose levels, blood clotting factors and the health of blood vessels.

Figure 79: The percentage of adults who are physically active in Peterborough (54.6%) is lower

than the East of England average (57.8%) and the England average (56.0%).

Area Physically active

% Physically inactive

%

Peterborough 54.6% 31.2%

East of England 57.8% 26.9%

England 56.0% 28.9%

Source: Sport England Local Sport Profiles 2014

Approximately eight deaths could be prevented annually if 25% more persons aged 40-79 in

Peterborough engaged in physical activity. The reduction in deaths could rise to 117 if 100% more

were involved.

Figure 80: Number of deaths that could be prevented by increasing levels of physical activity

among 40-79 year olds

Percentage more active Peterborough East of England England

25% 8 163 1,749

50% 45 1,394 13,438

75% 81 2,625 25,127

100% 117 3,856 36,815


28 ’Start active, stay active’- a report on physical activity and health from the four home countries’ Chief Medical Officers, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf 29 ’Start active, stay active’- a report on physical activity and health from the four home countries’ Chief Medical Officers, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216370/dh_128210.pdf

60

The cost of physical inactivity in terms of expenditure on related ailments in Peterborough in

2009/10 financial year was estimated to be over £2.7 million. More than half of the estimated

expenditure (£1.4 million) was on coronary heart disease.

Figure 81: Health costs of physical inactivity, split by disease type, 2009/10

Disease category Peterborough East of England England

Coronary heart disease £1,463,791 £60,186,615 £491,095,943

Diabetes £787,339 £19,484,702 £190,660,420

Cerebrovascular disease e.g. stroke £267,574 £11,718,678 £134,359,285

Cancer lower GI e.g. bowel cancer £133,227 £5,853,928 £67,816,189

Breast Cancer £94,798 £5,755,887 £60,357,887

Total Cost £2,746,729 £102,999,810 £944,289,723


There is a clear correlation between health and where we live. A number of published studies have

provided evidence that our local environments can have a positive effect on individual health and

wellbeing. However, many aspects of cities and towns deter people from being physically active.

Lack of access to open and green spaces can be detrimental to people’s physical and mental health.

This is particularly evident within areas of deprivation that have access to green space. Within such

areas all-cause mortality rates of residents have been found to be significantly lower compared to

those of other residents in deprived areas with less access to green space.

Barriers to walking or cycling as part of everyday life also restrict and discourage people to from

becoming more physically active. The Campaign for Better Transport’s 2014 Car Dependency

Scorecard30 rated Peterborough as ‘the most car-dependent’ of 29 assessed cities.

Figure 82: Campaign for Better Transport 2014 Car Dependency Scorecard

Source: Campaign for Better Transport

30 http://www.bettertransport.org.uk/sites/default/files/pdfs/Car_Dep_Scorecard_2014_LOW_RES.pdf

61

Figure 83: NICE physical activity guidance

PH2 – Four commonly used methods to increase physical activity

PH8 – Physical activity and the environment

PH41 – Walking and cycling: local measures to promote walking and cycling as forms of travel and recreation

PH44 – Brief advice for adults in primary care

PH54 – Exercise referral schemes to promote physical activity

Source: http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/physical-activity

3.5 Poor Diet as a CVD Risk Factor

Evidence shows that the risk of a new major cardiac event can be reduced up to 73% by consuming

a diet low in saturated fats and including substantial amounts of fresh fruit and vegetables31. Foods

that can contribute towards cardiovascular health include:

• Fresh fruits and vegetables – low intake of fresh fruit and vegetables accounts for about 20% of

cardiovascular disease worldwide, as they contain components that protect against heart disease

and stroke.

• Fish – in countries where fish consumption is high there is a reduced risk of death from all causes,

including cardiovascular mortality

• Nuts – eating nuts regularly is associated with decreased risk of coronary heart disease

• Wholegrain cereals – Unrefined whole grains contain folic acid, B vitamins and fibre, all of which

protect against heart disease.

• Soy – Evidence shows that soy has a beneficial effect on blood lipid levels and reduces cholesterol

levels.

Dietary factors that are known to damage cardiovascular health include:

• A diet high in trans fats (e.g. fast food, cakes) and saturated fats (e.g. cheese, butter) increases

levels of cholesterol and can contribute towards abnormal blood lipid levels, which have a strong

31 http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diet/

http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/physical-activity

62

correlation with the risk of coronary artery disease.32 It is recommended that the average man

should eat no more than 30g of saturated fat per day and the average woman no more than 20g.

• Salt/Sodium – high consumption of sodium is linked to high blood pressure, a major risk factor for

cardiovascular disease. It has been estimated that a universal reduction in dietary intake of sodium

by approximately 1g of sodium per day (about 3g of salt) would lead to a 50% reduction in the

number of people needing treatment for hypertension, a 22% drop in the number of deaths from

strokes and a 16% fall in deaths from coronary heart disease.33

In 2013, the UK government introduced front-of-pack nutrition labelling to help consumers easily

assess the content of their food. Red colour coding means the food or drink is high in this nutrient

and should be consumed in moderation or avoided. Amber colour coding means the food or drink

has a relatively average amount of the nutrient and can be safely consumed on a regular basis.

Green colour coding means the food or drink is low in this nutrient and is therefore likely to

represent ‘the healthier choice’ within a diet.

Figure 84: UK front-of-pack nutrition labelling example

Government guidance suggests that people should consume at least 5 portions of fruit and

vegetables per day to maintain their health. The below table shows the percentage of residents

within each of Peterborough’s wards that self-reported as consuming at least 5 portions of fruit and

vegetables per day, as well as data pertaining to the number of emergency hospital admissions and

deaths within wards.

Data show a clear correlation between low levels of economic deprivation, high levels of healthy

eating and relatively low levels of emergency hospital admissions and deaths. Conversely, where

deprivation is relatively high, levels of healthy eating tend to be relatively low and hospital

admission rates are high.

32 http://www.nhs.uk/livewell/goodfood/pages/eat-less-saturated-fat.aspx 33 http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diet/

63

Figure 85: % of Healthy eating adults and associated emergency hospital admission/mortality

metrics

Within the table below, indirectly age-standardised rates are presented from emergency hospital

admissions for all causes and deaths from all causes. Indirect age-standardisation provides a

method through which the rate of observed events can be compared between two or more areas

(e.g. Peterborough City Council electoral wards compared to England) in the absence of age-specific

data that would be required for direct age standardisation. The rate for England is set at 100.0; a

local rate below 100.0 illustrates fewer observed events than would be expected based on values

for England, whereas conversely a rate above 100.0 shows a greater number of observed events

than would be expected in comparison to the rate for England.

Area % living in income

deprived households (2010)

% health eating adults (2006-2008)

Standardised Admission Ratio: Emergency hospital admissions for all causes

(2008/09-2012/13)

Standardised Mortality Ratio: Deaths from all

causes, all ages (2008-2012)

Barnack 4.7 37.2 88.8 80.0

Glinton and Wittering

5.3 36.1 85.8 81.1

Northborough 5.7 35.2 86.8 95.7

Newborough 6.7 29.6 76.7 75.1

Werrington South

10.1 28.9 85.7 104.7

Orton Waterville

10.3 32.7 86.2 73.5

Orton with Hampton

10.3 28.9 96.8 90.2

West 10.5 35.3 92.8 136.0

Werrington North

11.2 28.3 85.4 76.9

Eye and Thorney

11.7 28.4 94.3 125.5

Stanground East

13.1 26.4 93.9 80.5

Bretton South 14.3 32.0 95.0 83.0

Stanground Central

14.6 26.2 99.6 102.2

Walton 15.6 27.7 99.1 102.9

Fletton and Woodston

17.3 27.3 109.8 103.4

Park 21.7 30.0 119.3 150.9

Bretton North 23.3 23.6 111.9 96.3

Orton Longueville

24.0 24.8 118.3 131.2

East 25.3 26.6 114.4 108.1

Ravensthorpe 25.4 23.3 123.1 117.5

Central 25.5 28.2 127.5 105.9

Paston 25.7 23.9 107.2 95.2

North 26.5 23.4 117.4 95.1

Dogsthorpe 28.0 23.0 113.0 109.7

Peterborough Unitary

Authority 17.8 28.0 104.2 105.6

64

Area % living in income

deprived households (2010)

% health eating adults (2006-2008)

Standardised Admission Ratio: Emergency hospital admissions for all causes

(2008/09-2012/13)

Standardised Mortality Ratio: Deaths from all

causes, all ages (2008-2012)

Cambridgeshire &

Peterborough Clinical

Commissioning Group

10.6 31.6 86.8 91.9

England 14.7 28.7 100.0 100.0

Source: Local Health Profiles

Figure 86: NICE diet guidance

PH47 – Managing overweight and obesity in children and young people

PH53 - Managing overweight and obesity in adults – lifestyle weight management services

Source: http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/diet--nutrition-and-obesity

3.6 Obesity as a CVD Risk Factor

Obesity is a term used to describe somebody who is very overweight, with a lot of body fat34. Being

obese can dramatically increase the risk of developing a range of serious diseases. Additionally,

moderate obesity (a BMI of 30-35) was found to reduce life expectancy by an average of three years,

while morbid obesity (a BMI of 40-50) reduces life expectancy by 8-10 years – a similar reduction in

life expectancy to that caused by a lifetime of smoking tobacco.35 NICE guidance recommends lower

thresholds of obesity for intervening to prevent ill health among adults from black, Asian and other

ethnic groups (with an increased risk of chronic conditions BMI≥ 23 kg/m² and a high risk of chronic

conditions BMI ≥27.5kg/m²).36

Obesity can lead to physical problems including type 2 diabetes, cardiovascular disease and

obstructive sleep apnoea as well as psychosocial risks such as low self-esteem and impaired quality

of life for both children and adults.37

34 http://www.nhs.uk/Conditions/Obesity/Pages/Introduction.aspx 35 http://www.noo.org.uk/NOO_about_obesity/obesity_and_health 36 http://publications.nice.or.uk/gb13 37 http://www.noo.org.uk/NOO_about_obesity/obesity_and_health/health_risk_child

http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/diet--nutrition-and-obesity

65

Source: https://www.noo.org.uk/slide_sets

The most widely used method for classifying a person’s general health in relation to their weight is

body mass index (BMI). For adults, BMI is calculated as:

Weight in kilograms/height in metres/height in metres

For example, an adult weighing 70kg and 1.75 tall would calculate their BMI as:

70 / 1.75 / 1.75 = 22.9.

BMI is calculated differently for adults and children. For adults:

A BMI under 18.5 is considered underweight;

A BMI of 18.5 to 24.9 is considered a healthy weight;

A BMI of 25 to 29.9 is considered overweight;

A BMI of 30 to 39.9 is considered obese;

A BMI of 40 or above is considered morbidly obese.

The below chart provides a broad indication of healthy weight for height ranges for adults.

66

Figure 87: Healthy Weight/BMI Chart

Source: Diabetes UK

For children, BMI is interpreted by reference to a child’s BMI centile – how they compare in

relation to other children of the same age, height and sex.38

Public Health England predict that 70% of adults will be overweight or obese by the year 2034 39

- this would amount to approximately 170,000 people within Peterborough if Cambridgeshire

research group population growth projections prove accurate.

The most recent estimates released by Public Health England (based on the 2012 Active People

Survey) suggest the actual percentage of adults classified as obese in Peterborough to be 24.1%,

2.5% higher than the estimate for Cambridgeshire (21.6%). The Public Health Outcomes Framework

also includes an estimated percentage of adults classified as either overweight or obese; in

Peterborough, this figure is 65.5% whereas in Cambridgeshire it is 65.0%.

38 http://www.nhs.uk/Livewell/loseweight/Pages/BodyMassIndex.aspx#women 39 https://www.noo.org.uk/slide_sets

67

Area % of adults classified as obese

(Active People Survey, 2012)

% of adults with excess

weight (PHOF indicator 2.12),

2012

Peterborough 24.1% 65.5%

Cambridgeshire 21.6% 65.0%

Source: Active People Survey, Public Health England

Figure 88: Recorded Obesity Prevalence 2013/14, 16+, Cambridgeshire & Peterborough CCG LCGs

LCG Number Prevalence LI UI 65+ 85+

CATCH 11,443 6.1% 6.0% 6.2% 15.0% 2.1%

CAM HEALTH 4,457 6.1% 5.9% 6.3% 13.9% 2.5%

HUNTS HEALTH 5,150 9.3% 9.1% 9.6% 16.2% 1.9%

BORDERLINE 8,305 9.6% 9.4% 9.8% 16.2% 2.1%

ISLE OF ELY 7,469 9.7% 9.5% 9.9% 18.0% 2.2%


PETERBOROUGH 11,659 10.7% 10.5% 10.8% 12.7% 1.7%

WISBECH 4,720 12.1% 11.8% 12.4% 19.8% 2.5%


ALL OTHER LCGs 43,220 8.1% 8.1% 8.2% 16.6% 2.2%

CCG 63,184 8.7% 8.6% 8.8% 15.9% 2.1%


The prevalence of recorded obesity across the CCG is 8.7%. Both Borderline & Peterborough LCGs

have prevalence statistically significantly higher than the CCG, with the combined prevalence of the

two LCGs standing at 10.2% (19,964 people).



6.1% 6.1%

9.3% 9.6% 9.7% 10.0% 10.7%12.1%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

CA

TCH

CA

M H

EALT

H

HU

NTS

HEA

LTH

BO

RD

ERLI

NE

ISLE

OF

ELY

HU

NTS

CA

RE

PA

RTN

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PET

ERB

OR

OU

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BEC

H

68


The combined prevalence of obesity amongst all LCGs other than Borderline & Peterborough is

statistically significantly below that of the CCG (8.1% vs 8.7%). Prevalence in Borderline &

Peterborough LCGs is statistically significantly higher at 10.2%.


Figure 91: Recorded Obesity Prevalence 2013/14, Cambridgeshire & Peterborough CCG Quintiles

of Deprivation

Quintile Persons Prevalence LI UI 65+ % 85+

5 – Most deprived 17,189 11.0% 10.8% 11.2% 14.6% 1.9%

4 15,328 10.2% 10.0% 10.3% 16.1% 2.2%

3 12,144 7.6% 7.4% 7.7% 14.6% 2.0%

2 9,076 6.6% 6.4% 6.7% 16.0% 2.1%

1 – Least Deprived 9,447 7.8% 7.6% 7.9% 19.1% 2.6%

CCG 63,184 8.7% 8.6% 8.8% 15.9% 2.1%


10.2%

8.1%

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%


----- = CCG Value




----- = CCG Value




69

3.7 Harmful use of alcohol as a CVD Risk Factor

People who consume alcohol in excessive amounts place themselves at a substantial risk of

damaging their health, which in turn places a higher financial burden on the local

healthcare economy. The NHS recommends that men should not exceed 3-4 units of

alcohol a day and women not more than 2-3units a day.40 There are approximately 2 units

of alcohol in a regular strength (ABV 3.6%) beer, 3 units in a large glass of wine (ABV 12%)

and 1 unit in a standard 25ml shot of spirits (ABV 40%).

Figure 95 below shows that Peterborough City Council’s directly age standardised rate of

hospital admissions for alcohol-related cardiovascular disease (all persons) has been

statistically significantly higher than the England rate for the six consecutive years spanning

2008/09 – 2013/14. The Unitary Authority rate has, however, remained relatively

consistent over the past there years, during which time the England rate has increased.

Figure 92: Alcohol Related Cardiovascular Disease Hospital Admissions, All Persons

2008/09 – 2013/14 (Directly Age-Standardised Rate per 100,000)41

Source: Local Alcohol Profiles for England

40 http://www.nhs.uk/Livewell/alcohol/Pages/alcohol-units.aspx 41 http://www.lape.org.uk/

0

200

400

600

800

1,000

1,200

1,400

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Peterborough UA Cambridgeshire & Peterborough CCG England

70

Admissions

Period Peterborough UA Cambridgeshire & Peterborough CCG

England

2008/09 1,026 928 759

2009/10 1,172 1,021 855

2010/11 1,249 1,089 958

2011/12 1,168 1,047 988

2012/13 1,172 1,049 997

2013/14 1,168 1,085 1,049


Figure 93 shows that Peterborough’s admissions rate for all persons and for males is

statistically significantly high for each year between 2008/09 and 2013/14. For both all

persons and for males only, the Peterborough rate has remained relatively similar for each

of the past three years, during which time the rate for England has risen.

Figure 93: Alcohol Related Cardiovascular Disease Hospital Admissions, Males, 2008/09 –

2013/14 (Directly Age-Standardised Rate per 100,000)


0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14


71

Admissions


England

2008/09 1,548 1,382 1,114

2009/10 1,721 1,503 1,252

2010/11 1,864 1,623 1,399

2011/12 1,724 1,547 1,444

2012/13 1,715 1,553 1,457

2013/14 1,703 1,616 1,524


The rate for females is statistically significantly high in Peterborough for each year between

2008/09 and 2013/14. Within the CCG overall, the rate was statistically significantly high

for the three years 2008/09 – 2010/11 but has been similar to that of England for the most

recent three years for which data are available. The admission rate is, however, much

lower for females than for males.

Figure 94: Alcohol Related Cardiovascular Disease Hospital Admissions, Females, 2008/09

– 2013/14 (Directly Age-Standardised Rate per 100,000)


0

100

200

300

400

500

600

700

800

900

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14


72

Admissions


England

2008/09 638 569 488

2009/10 747 639 549

2010/11 768 662 617

2011/12 725 643 634

2012/13 744 636 636

2013/14 734 647 673


Figure 95: NICE alcohol guidance

PH24 - Alcohol-use disorders: preventing harmful drinking

Source: http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/alcohol

3.8 Diabetes as a CVD risk factor

Diabetes occurs when the body doesn’t produce, or respond to, the hormone insulin which maintains blood glucose. There are 3.2 million people diagnosed with diabetes in the UK and an estimated 630,000 people who have the condition, but don’t know it.42

There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes. In Type 1 diabetes, the cells that produce insulin are damaged by the body’s immune system. This usually develop before the age of 40, requires insulin injections and accounts for about 10% of diabetes. Type 2 diabetes accounts for about 90% of cases and is caused when the body doesn’t produce enough insulin or the insulin produced doesn’t work effectively. It is treated with diet and exercise and often progresses to need drugs or insulin. It is more common with increasing age and in people who are overweight or obese-including a rising number of young people.

Ethnicity is a factor in the development of diabetes with South Asians having a 50% higher lifetime risk of Type 2 diabetes than white Europeans and in often develops at a younger age and at a lower level of obesity.

Deprived people are 2.5 times more likely to have diabetes on average, at any given age, mostly as deprivation is associated with higher levels of obesity and physical inactivity. The risk in people with a mental illness is also 2-3 times higher than in those without; this is thought to be due to differences in diet and physical activity and also a side effects of drugs which can promote weight gain and affect glucose metabolism.

http://www.nice.org.uk/guidance/lifestyle-and-wellbeing/alcohol

73

There is a strong correlation between cardiovascular disease (CVD) and diabetes. Heart diseases and stroke are the number one causes of death and disability among people with type 2 diabetes. At least 65 percent of people with diabetes die from some form of heart disease or stroke. Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes. The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.

People with diabetes, particularly type 2 diabetes, often have the following conditions that contribute to their risk for developing cardiovascular disease.

High blood pressure (hypertension);

Abnormal cholesterol and high triglycerides;

Obesity;

Lack of physical activity/ sedentary lifestyles;

Poorly controlled blood sugars (too high) or out of normal range which damages small blood vessels;

Smoking; Insulin Resistance.

Figure 96: Public Health Outcomes Framework – East of England Diabetes Profile

Source: Public Health England, East of England Diabetes Profile

74

Figure 97: Diabetes Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs

LCG Number Prevalence LI UI 65+ % 85+

CATCH 7,366 4.0% 3.9% 4.1% 15.0% 2.1%

CAM HEALTH 3,060 4.3% 4.1% 4.4% 13.9% 2.5%

HUNTS HEALTH 3,142 5.8% 5.6% 6.0% 16.2% 1.9%

BORDERLINE 5,313 6.2% 6.1% 6.4% 16.2% 2.1%

PETERBOROUGH 6,931 6.4% 6.3% 6.6% 12.7% 1.7%

ISLE OF ELY 4,937 6.5% 6.3% 6.7% 18.0% 2.2%


WISBECH 2,813 7.3% 7.0% 7.6% 19.8% 2.5%


ALL OTHER LCGs 27,758 5.3% 5.2% 5.4% 16.6% 2.2%

CCG 40,002 5.6% 5.5% 5.6% 15.9% 2.1%


Both Borderline & Peterborough LCGs have statistically significantly high prevalence of diabetes;

collectively the prevalence for the two LCGs is 6.3% vs 5.6% across the LCG as a whole.

Figure 98: Diabetes Prevalence 2013/14, Cambridgeshire & Peterborough CCG LCGs


4.0% 4.3%

5.8%6.2% 6.4% 6.5% 6.6%

7.3%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

CA

TCH

CA

M H

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H

HU

NTS

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LTH

BO

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ERLI

NE

PET

ERB

OR

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ISLE

OF

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CA

RE

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ERS

WIS

BEC

H

----- = CCG Value




75

Figure 99: Diabetes Prevalence 2013/14, Borderline & Peterborough vs All Other LCGs


3.9 Modifiable Risk Factors - Population Level Interventions

These are interventions also focusing on modifiable risk factors but at population-level

which could lead to further substantial reduction in cardiovascular disorders. These can be

achieved in a number of ways but must be supported by national and/or local policies and

legislation. The table below summarises NICE guidance Prevention of Cardiovascular Disease

(PH25) https://www.nice.org.uk/guidance/ph25 recommendations for policy.

Figure 100: NICE guidance Prevention of Cardiovascular Disease (PH25)

Issue Summary of rationale Policy Goal

Salt High levels of salt in the diet are

linked with high blood pressure

which, in turn, can lead to stroke

and coronary heart disease. High

levels of salt in processed food have

a major impact on the total amount

consumed by the population.

To reduce population-level consumption of salt.

Saturated Fats Reducing general consumption of

saturated fat is crucial to preventing

CVD.

To reduce population-level consumption of saturated fats including the continued promotion of semi-skimmed milk for children aged over 2 years.

6.3%

5.3%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

Borderline & Peterboruogh LCGs All Other LCGs

----- = CCG Value




https://www.nice.org.uk/guidance/ph25

76

Trans fats Industrially-produced trans fatty

acids (IPTFAs) constitute a significant

health hazard.

Ensure all groups in the population

are protected from the harmful

effects of IPTFAs. This includes

establishing guidelines for local

authorities to monitor

independently IPTFA levels in the

restaurant, fast-food and home food

trades using existing statutory

powers (in relation to trading

standards or environmental health).

Marketing and

promotions aimed

at children and

young people

Eating and drinking patterns get

established at an early age so

measures to protect children from

the dangers of a poor diet should be

given serious consideration.

Ensure children and young people

under 16 are protected from all

forms of marketing, advertising and

promotions (including product

placements) which encourage an

unhealthy diet.

Commercial

Interests

If deaths and illnesses associated

with CVD are to be reduced, it is

important that food and drink

manufacturers, retailers, caterers,

producers and growers, along with

associated organisations, deliver

goods that underpin this goal.

Ensure dealings between government, government agencies and the commercial sector are conducted in a transparent manner that supports public health objectives.

Product labelling Clear labelling which describes the

content of food and drink products

is important because it helps

consumers to make informed

choices. It may also be an important

means of encouraging

manufacturers and retailers to

reformulate processed foods high in

saturated fats, salt and added

sugars.

Evidence shows that simple traffic

light labelling consistently works

better than more complex schemes

and should be encouraged.

Health impact

assessment

Policies in a wide variety of areas

can have a positive or negative

impact on CVD risk factors and

frequently the consequences are

unintended. The Cabinet Office has

indicated that, where relevant,

government departments should

assess the impact of policies on the

health of the population.

Use a variety of methods to assess

the potential impact (positive and

negative) that all local policies and

plans may have on rates of CVD and

related chronic diseases.

Take account of any potential impact

on health inequalities.

Physically active

travel

Travel offers an important

opportunity to help people become

more physically active. However,

Ensure guidance for local transport plans supports physically active travel. This can be achieved by

77

inactive modes of transport have

increasingly dominated in recent

years.

allocating a percentage of the integrated block allocation fund to schemes which support walking and cycling as modes of transport. Create an environment and incentives which promote physical activity, including physically active travel to and at work.

Consider and address factors which

discourage physical activity,

including physically active travel to

and at work. An example of the

latter is subsidised parking.

Public sector

catering guidelines

Public sector organisations are

important providers of food and

drink to large sections of the

population. It is estimated that they

provide around one in three meals

eaten outside the home. Hence, an

effective way to reduce the risk of

CVD would be to improve the

nutritional quality of the food and

drink they provide.

Ensure publicly funded food and drink provision contributes to a healthy, balanced diet and the prevention of CVD. Ensure public sector catering practice offers a good example of what can be done to promote a healthy, balanced diet.

Take-aways and

other food outlets

Food from take-aways and other

outlets (the 'informal eating out

sector') comprises a significant part

of many people's diet. Local

planning authorities have powers to

control fast food outlets.

Encourage local planning authorities to restrict planning permission for take-aways and other food retail outlets in specific areas (for example,within walking distance of schools). Help them implement existing planning policy guidance in line with public health objectives.

Monitoring CVD is responsible for around 33%

of the observed gap in life

expectancy among people living in

areas with the worst health and

deprivation indicators compared

with those living elsewhere in

England.

Independent monitoring, using a full

range of available data, is vital when

assessing the need for additional

measures to address such health

inequalities, including those related

to CVD.

Use available data to assess the need

for additional measures to address

health inequalities related to CVD.

78

4 Services for Cardiovascular Disease

4.1 Health Checks in Primary Care

Everyone aged 40-74 who is does not have a pre-existing condition is eligible for an NHS Health

Check every five years to identify those with risk factors for cardiovascular and kidney disease and

diabetes. Older people, aged over 65 years, are provided with information on the signs and

symptoms of dementia and on local services.

Figure 101: Observed Number of People Invited for an NHS Health Check Q1 2013/14 – Q3

2014/1543

Source: Public Health Outcomes Framework Indicator 2.22iii

22,462 people have now been invited for an NHS Health Check in Peterborough; 45.8% of the

eligible population. This figure is statistically significantly better than the percentage observed in

England overall which stands at 33.1%.

However, the proportion taking up the tests remains disappointing. Only 10,769 eligible people in

Peterborough took up an NHS Health Check in 2014/5, 47.9% of the total of invites (22,462). This

number is statistically similar to England; in the previous six periods of measurement, Peterborough

has been statistically significantly worse than England with regards to converting invitations in to

Health Checks.

Figure 102: Outcome of NHS Heath Checks, 2013-1444

43 http://fingertips.phe.org.uk/profile/nhs-health-check-detailed

44 Tackling Inequalities in Coronary Heart Disease programme update 3, May 2014

79

4.2 Hospital Services – Quality Standards & National Audit Data

The majority of Peterborough residents with cardiovascular conditions are admitted to

Peterborough and Stamford Hospitals NHS Foundation Trust. The hospital participates in the

national audits of treatments for heart disease and stroke.

However, patients with acute chest pain are taken to Papworth Hospital, the specialist cardiac

hospital. Peterborough doesn’t offer emergency treatment to restore the blood flow in the coronary

arteries and there is some evidence that specialist centres, with high numbers of cases, achieve

better outcomes for patients.

4.2.1 Coronary heart disease (MINAP)

MINAP, the Myocardial Ischaemia National Audit Project, analyses data from ambulance and

hospital services on the process and outcomes of care to inform the public, clinicians and

commissioners on the quality of local care by publishing an annual report.

Heart attack or myocardial infarction is part of a spectrum of conditions know as acute coronary

syndrome. The term includes both ST-elevation myocardial infarction (STEMI- named for the ECG

changes seen ) where emergency re-perfusion of the coronary arteries with primary percutaneous

In 2013/14, Peterborough planned to undertake health checks on 6,059

registered patients aged 40-74. All 25 GP practices participated in the

programme with individual targets supported by clinical coaching and

Public Health events across all communities.

The programme has achieved 99.7% of the target (6042 completed checks

against a target of 6059). This is 12% increase on the number of completed

health checks compared to the 2012/13 programme.

Based on national and regional statistics Peterborough city council is 22nd

out 151 LAs and second across Eastern LAs. This is an excellent effort from

all GP practices working in partnership with the local authority to reduce

the prevalence of chronic disease.

Specific outcomes for Peterborough include:

777 patients assessed with a CVD risk of more than 20% (10 year

risk of developing a chronic disease.

164 Hypertensive patients identified (high blood pressure)

54 Diabetics diagnosed

495 patients referred to weight management programmes

1840 patients received dementia awareness advice

2003 patients received Alcohol Audit C assessment

557 patient referred to physical activity programme

471 patients prescribed statins to lower cholesterol

80

intervention (PCI) or thrombolytic drugs is indicated in eligible patients; and non-ST-elevation

myocardial infarction (nSTEMI) which is more common and requires different treatment.

The vast majority of patients (99.8%) with STEMI admitted to Papworth, (not just Peterborough

residents) received primary PCI in 2013-14 (1) and 30 day mortality unadjusted rates were below the

national average (6.3% vs 7.2% in primary PCI capable centres, 2011-14). (1)

Data for non-STEMI patients is more likely to be incomplete, particularly if they are not admitted to a

cardiac ward. In Peterborough, as in England, 94% were seen by a cardiologist or a member of their

team. Of those admitted to Peterborough hospital, all who were eligible were referred for

angiography with increasing numbers receiving this during their admission.

81

Figure 103: Primary PCI in hospitals in England, Wales and Belfast (extract of local data)

Source: MINAP National Clinical Audit 2014

82

Use of secondary prevention medication after the acute admission is proven to improve outcomes for patients with either STEMI or n-STEMI by reducing

the risk of a further heart attack or complications such as heart failure. NICE Clinical Guidance 48 supports the use of combinations of drugs in all eligible

patients who have had a heart attack. The audit also collects information on the percentage of patients with an acute coronary syndrome and eligible for

each secondary prevention medication who are discharged on that treatment. (Patients are not included if they die, are transferred to another hospital, are

not eligible for a medication or decline treatment)

Figure 104: Secondary prevention medication eligibility, 2012/13 and 2013/14 (extract of local data)

Source: MINAP National Clinical Audit 2014

83

4.2.2. Stroke (SSNAP)

The Sentinel Stroke National Audit Programme (SSNAP) aims to improve the quality of stroke care by

auditing stroke services against evidence based standards, and national and local benchmarks.

There are six domains for acute stroke care, each scored into five bands. The total organisational

score is obtained by calculating the average of the 6 domain scores, which are divided into bands A-

E, with A as the highest performance band. These results reflect the stroke service audit data of July

2104.

Figure 105: The six domains of stroke services organisation, SNAPP, 2014

Source: Sentinel Stroke National Audit Programme (SNAPP), RCP, regional results, 2014

Local hospitals, including Peterborough and Stamford Hospitals NHS Foundation Trust participate in

the audit. Peterborough City Hospital provided acute stroke care, including thrombolysis available

24/7 for eligible patients, a 36 bed stroke unit with access to a range of specialist staff and prompt

access to investigate and initiate treatment in high risk transient ischaemic attacks (TIA).

84

Figure 106: Stroke national acute organisational audit, east of England, 2014

Source: Sentinel Stroke National Audit Programme (SNAPP), RCP, Regional Results 2014

85

4.2.3 Tackling Coronary Heart Disease inequalities programme Recognising the challenge in inequalities in coronary heart disease, the Peterborough and Borderline

LCGs instigated a programme of work to improve population outcomes. The programme had four

areas of activity:

Smoking cessation

Health checks

Cardiac rehabilitation

Primary care and prevention.

Physiological/metabolic risk factors are generally managed in primary care with support from hospital services and clinicians. It was not possible to include information on the management of high blood pressure, hypercholesterolaemia, atrial fibrillation etc. or these services in this JSNA although some data is included in the quality and outcomes framework.

Following Peterborough City Council prioritising cardiovascular disease, the programme is reviewing

its remit and with a view to including the detection and management of atrial fibrillation, a risk

factor for strokes and transient ischaemic attacks. Across Cambridgeshire and Peterborough CCG,

the East Midlands Strategic Clinical Network model suggests that 348 strokes and 115 deaths per

year could be prevented by optimum management of atrial fibrillation compared to the 134 strokes

and 44 deaths per year prevented by current management.

Figure 107: Tackling Health Inequalities in Coronary Heart Disease 2015/16

Source: Tackling Inequalities in Coronary Heart Disease Board, 2015

86

Service Gaps

Further work is needed to better understand the range of services for prevention, treatment,

rehabilitation and continuing support for people with CVD across sectors and to map pathways of

care against quality standards and needs.

Consideration of equity and inequalities in access and outcome should be central to this work.

The views of users –and those who don’t take up services, such as the offer of an Health Check-and an understanding of barriers to accessing services particularly for BME and deprived communities should be considered.

The process of engagement through the CVD JSNA steering group and workshops is central to developing this programme of work.

5. Evidence of Effectiveness

Available evidence on what works in CVD prevention is based on reviews carried out by the National

Institute for Health and Clinical Excellence (NICE). Findings From these reviews have been used in

developing guidance documents currently utilized in the development of intervention programmes

in the UK. Recommended interventions are either at individual or population level.

5.1 Individual Level Interventions

These are interventions focussing on modifiable (CVD) risk factors and aim at changing an

individual's behaviour. They are supported by a range of existing NICE guidance listed in figure 108.

Figure 108: NICE guidance CVD prevention individual level interventions

Risk Factor

Rationale NICE guidance

Alcohol

Excessive alcohol can cause

abnormal heart rhythms, high

blood pressure, damage to the

heart muscle and lead to a

stroke.

Alcohol-use disorders: preventing

harmful drinking. NICE public health

guidance 24 (2010).

Physical

Activity

Lack of regular exercise

increases the risk for

developing high blood

pressure, high cholesterol

Promoting physical activity for children

and young people. NICE public health

guidance 17 (2009).

https://www.bhf.org.uk/heart-health/conditions/abnormal-heart-rhythms

https://www.bhf.org.uk/heart-health/risk-factors/high-blood-pressure

https://www.bhf.org.uk/heart-health/risk-factors/high-blood-pressure

http://www.nice.org.uk/guidance/ph24




87

levels, high stress levels and

being overweight. All of which

are risk factors for CVD.

Promoting physical activity in the

workplace. NICE public health guidance

13 (2008).

Physical activity and the environment.

NICE public health guidance 8 (2008).

Four commonly used methods to

increase physical activity. NICE public

health guidance 2 (2006).

Smoking

Smoking and other tobacco use

are significant risk factors for

CVD. The toxins (poisons) in

tobacco can damage and

narrow coronary arteries,

making affected persons more

vulnerable to coronary heart

disease.

Preventing the uptake of smoking by

children and young people. NICE public


Smoking cessation services. NICE public


Workplace interventions to promote

smoking cessation. NICE public health

guidance 5 (2007).

Brief interventions and referral for

smoking cessation in primary care and

other settings. NICE public health

guidance 1 (2006).

Obesity

Being overweight or obese

increases the risk of developing

diabetes and high blood

pressure.

Maternal and child nutrition. NICE public


Obesity: the prevention, identification,

assessment and management of

overweight and obesity in adults and

children. NICE clinical guideline 43

(2006).

Obesity in

BME groups

The prevalence of conditions

such as Type 2 diabetes , CHD

and stroke is up to 6 times

higher (and they occur at a

younger age) among BME

groups.

Lifestyle interventions

targeting sedentary lifestyles

Body mass index thresholds for

intervening to prevent ill health among

black, Asian and other minority ethnic

groups 2014

http://www.publications.nice.org/lgb13















http://www.nice.org.uk/guidance/cg43




http://www.publications.nice.org/lgb13

88

and weight have reduced the

incidence of diabetes by 50% in

high risk individuals.

BMI thresholds recommended

as a trigger to intervene to

prevent ill health among adults

from black, Asian and other

ethnic groups :

Increased risk chronic

conditions BMI 23

kg/m2

High risk of chronic

conditions BMI

27.5KG/m2

Hypertension

High blood pressure

(hypertension) can damage

artery walls and increase the

risk of developing a blood clot

and eventually a stroke.

Usually a normal blood

pressure reading should be

below 130/80mmHg.

Hypertension: Clinical management of

primary hypertension in adults. NICE

clinical guideline 127 (2011).

Health

Checks

Local authorities and their

partners should encourage

people to have NHS health

checks and support them to

change their behaviour to

reduce their risk factors.

NHS health checks

should be offered to

each eligible person

aged 40-75 once every

Encouraging people to have NHS Health

Checks and supporting them to reduce

risk factors [LBG15] 2014

https://www.nice.org.uk/advice/lgb15

https://www.nice.org.uk/advice/lgb15

89

5 year, with recall every

5 year if still eligible;

People having a health

check should be told

their cardiovascular risk

score and other results;

And provided with

individually tailored

advice which will

motivate them and

support any necessary

lifestyle changes to help

them manage risk.

Identifying

and

supporting

people most

at risk of

dying

prematurely

Aims to support the

identification and provision of

services to people who are

disadvantaged and most at risk

of dying early from heart

disease. The risk of dying early

can be reduced by providing

services to help people stop

smoking and the treatment of

high cholesterol and other

conditions which increase the

risk of heart disease.

GPs and other NHS staff

and local authorities

should set up systems

to identify people who

are disadvantaged and

Identifying and supporting people most

at risk of dying prematurely [PH15] 2008



90

at high risk of heart

disease.

NHS organisations and

the local authority

should work together

to provide flexible

services to improve the

health of these people;

The NHS and local

authorities should

ensure that services

aiming to improve the

health of people who

are disadvantaged are

coordinated and that

there are enough

people trained to run

them.

91

5.2 Population Level Interventions

These are interventions also focusing on modifiable risk factors but at population-level

which could lead to further substantial reduction in cardiovascular disorders. These can be

achieved in a number of ways but must be supported by national and/or local policies and

legislation. Figure 108 summarises recommendations for local action by commissioners and

providers of public health services. They are based on extensive and consistent evidence

compiled by NICE.45

Figure 109: NICE guidance CVD prevention - population level interventions

Issue

National Strategy

Recommended Local Action for

commissioners and providers of

public health services

Salt

High levels of salt in the diet are

linked with high blood pressure

which, in turn, can lead to stroke

and coronary heart disease. High

levels of salt in processed food

have a major impact on the total

amount consumed by the

population. The government

food standards agency is working

with the food industry to reduce

salt in everyday foods.

Ensure all food procured by, and

provided for, people working in the

public sector and all food provided for

people who use public services: is low

in salt and saturated fats, is

nutritionally balanced and varied, in

line with recommendations made in

the 'eat well plate.' 46

Saturated

Fats

Reducing general consumption of

saturated fat is crucial to

preventing CVD. The government

food standards agency is working

with consumers and food

industry to reduce the

population's intake.




people who use public services: is low

in saturated fats and is nutritionally

balanced and varied, in line with

recommendations made in the 'eat

well plate.'

45 NICE: Prevention of cardiovascular disease: https://www.nice.org.uk/guidance/ph25 46 Department of Health: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/340869/2014-250_-_eatwell_plate_Final_version_2014.pdf

92

Issue

National Strategy




Trans fats

Industrially-produced trans fatty

acids (IPTFAs) constitute a

significant health hazard. The

government food standards

agency is working with

manufacturers and caterers to

ensure reduction in the amount

of IPTFAs in their products.




people who use public services does

not contain industrially produced trans

fatty acids (IPTFAs).

Marketing

and

promotions

aimed at

children and

young

people

Eating and drinking patterns get

established at an early age so

measures to protect children

from the dangers of a poor diet

should be given serious

consideration. Current

advertising restrictions have

reduced the number of

advertisements for foods high in

fat, salt or sugar during television

programmes made for children

and young people.

Encourage venues frequented by

children and young people and

supported by public money to resist

sponsorship or product placement

from companies associated with foods

high in fat, sugar or salt. (This includes

fun parks and museums).

Commercial

Interests

Dealings between government,

government agencies and the

commercial sector should be

conducted in a transparent

manner that supports public

health objectives and is in line

with best practice. (This includes

full disclosure of interests).

Encourage best practice for all

meetings, including lobbying, between

the food and drink industry and

government (and government

agencies). This includes full disclosure

of interests by all parties. It also

involves a requirement that

information provided by the food and

93

Issue

National Strategy




drink, catering and agriculture

industries is available for the general

public and is auditable.

Product

labelling

Clear labelling which describes

the content of food and drink

products is important because it

helps consumers to make

informed choices. It may also be

an important means of

encouraging manufacturers and

retailers to reformulate

processed foods high in

saturated fats, salt and added

sugars. Evidence shows that

simple traffic light labelling

consistently works better than

more complex schemes.

Encourage local food and drink

manufacturers and retailers to adopt

traffic light labelling of their products

Health

impact

assessment

Policies in a wide variety of areas

can have a positive or negative

impact on CVD risk factors and

frequently the consequences are

unintended. The Cabinet Office

has indicated that, where

relevant, government

departments should assess the

impact of policies on the health

of the population.

Use a variety of methods to assess the

potential impact (positive and

negative) that all local policies and

plans may have on rates of CVD and

related chronic diseases.

Take account of any potential impact

on health inequalities.

Physically

active travel

Travel offers an important

opportunity to help people

Ensure the physical environment

encourages people to be physically

94

Issue

National Strategy




become more physically active.

However, inactive modes of

transport have increasingly

dominated in recent years. In

some areas in England, schemes

are in place to encourage people

to opt for more physically active

forms of travel such as walking

and cycling.

active. This includes prioritising the

needs of pedestrians and cyclists over

motorists when developing or

redeveloping highways. It also includes

developing and implementing public

sector workplace travel plans that

incorporate physical activity.

Encourage and support employers in

other sectors to do the same.

Public sector

catering

guidelines

Public sector organisations are

important providers of food and

drink to large sections of the

population. It is estimated that

they provide around one in three

meals eaten outside the home.

Hence, an effective way to

reduce the risk of CVD would be

to improve the nutritional quality

of the food and drink they

provide.

When public money is used to procure

food and drink in venues outside the

direct control of the public sector,

ensure those venues provide a range

of affordable healthier options

(including from vending machines).

Ideally, the healthier options should be

cheaper than the less healthy

alternatives.

Encourage venues frequented by

children and young people and

supported by public money to resist

sponsorship or product placement

from companies associated with foods

high in fat, sugar or salt. (This includes

fun parks and museums).

Take-aways

and other

food outlets

Food from take-aways and other

outlets (the 'informal eating out

sector') comprises a significant

part of many people's diet. Local

Use bye-laws to regulate the opening

hours of take-aways and other food

outlets, particularly those near schools

that specialise in foods high in fat, salt

or sugar.

95

Issue

National Strategy




planning authorities have powers

to control fast food outlets.

Use existing powers to set limits for

the number of take-aways and other

food outlets in a given area. Directives

should specify the distance from

schools and the maximum number

that can be located in certain areas.

Help owners and managers of take-

aways and other food outlets to

improve the nutritional quality of the

food they provide.

Ensure the links between nutrition and

health are an integral part of training

for catering managers

Monitoring

CVD is responsible for around

33% of the observed gap in life

expectancy among people living

in areas with the worst health

and deprivation indicators

compared with those living

elsewhere in England.

Independent monitoring, using a

full range of available data, is

vital when assessing the need for

additional measures to address

such health inequalities,

including those related to CVD.

Use available data to assess the need

for additional measures to address

health inequalities related to CVD

96

5.3 Clinical Guidance & Quality Standards

Figure 110: NICE guidance -Clinical guidance; and quality standards

Issue Summary of rationale

and recommendations

Guidance

Atrial Fibrillation

(AF)

AF is the most common

heart irregularity and

prevalence increases

with age. It is a risk

significant risk factor for

strokes.

Personalised packages of

care should be offered to

those in AF to include

consideration of

Anticoagulants

Drugs or cardio-

version to

correct heart

rhythm

Those with a

CHA2 DS2-VASC2

score of 2 or

above should be

offered

anticoagulation

with a NOVAC,

taking risk of

bleeding into

account

Do not offer

aspirin

monotherapy

solely for stroke

prevention.

Atrial fibrillation: the management of

atrial fibrillation [CG180]


-

Acute coronary

events

Makes recommendations

on referral, assessment,

Chest pain of recent onset: assessment

and diagnosis of recent onset chest pain

97

diagnosis, investigation

and management.

and discomfort of suspected cardiac

origin [CG95] 2010

Unstable angina

and STEMI

Guidance on the

investigation,

management and

assessment of risk and

prevention of future

events in angina and

non-ST segment

elevation myocardial

infraction.

Unstable angina and STEMI [CG 94] 2010

https://www.nice.org.uk/guidance/cg95

Myocardial

infarction with ST-

segment elevation

Guidance on assessment

& investigation (coronary

angiography) for

immediate reperfusion

by percutaneous

coronary intervention

[PCI] within 120 minutes

or fibrinolysis within 12

hours of presentation.

Myocardial infarction with ST-segment

elevation: the acute management of

myocardial infarction with ST segment

elevation [CG 167] 2013


Myocardial

infarction -

secondary

prevention

Recommends cardiac

rehabilitation (with an

exercise component )

and lifestyle changes,

psychological support

and medication following

an MI.

MI-secondary prevention: secondary

prevention in primary and secondary

care for patients following a myocardial

infarction, 2013

Chronic Heart

Failure

Recommends evidence –

based management and

treatment for people

with chronic heart

failure, including offering

a group based exercise

programme as part of

the cardiac rehabilitation

programme and planning

for end of life care.

Chronic heart failure: management

chronic heart failure in adults in primary

and secondary care [CG108] 2010


NICE Clinical knowledge summaries,

Heart Failure-chronic, revised May 2015

http://cks.nice.org.uk/heart-failure-

chronic#!changes

98

Stroke and TIA –

initial

management

Stroke is preventable and

treatable. Half of the

people living with a

stroke need assistance

with activities of

everyday living.

In a TIA (transient

ischaemic attack,

symptoms resolve within

24 hours.

A screening test

such as FAST

(the Face, arm,

speech test)

should be used

outside

hospital;

People who

have had a TIA

should be

assessed for

stroke risk with

a validated

scoring system

such as ABCD2

and referred for

specialist

assessment and

prevention

People with

acute stroke

should be cared

for in specialist

acute stoke

units; receive

urgent brain

imaging and be

assessed for

thrombolysis

with alteplase

Stroke: diagnosis and acute management

of stroke and TIA [CG 68]

99

and anti-

platelet drugs.

Stroke –

rehabilitation

Makes recommendations

on organising health and

social care for people

needing rehabilitation

after a stroke

Initially in a

dedicated stroke

inpatient unit

From a specialist

stroke team in

the community

Offering early

supported

discharge

6 month and then

annual reviews

Strength, fitness,

speech and

language training;

assessment of

cognitive and

visual

impairment;

depression;

return to work

and long term

health and social

support.

Stroke rehabilitation: long term

rehabilitation after stroke [CG 162]


Stroke services-

quality standard

Services should be

commissioned from and

coordinated across

agencies.

An integrated approach

to service provision is

fundamental to high

quality care.

Stroke quality standard[QS2] 2010

https://www.nice.org.uk/guidance/qs2

100

11 quality statements

including:

1.ambulance staff to

screen those with

neurological

symptoms with a

validated tool for

stroke and TIA and

transfer to stroke unit

within 1 hour

2. acute stroke

patients to receive

brain imaging within 1

hour of arrival ;

3. admit to a

specialist stroke unit

assess for

thrombolysis

4. screen for

swallowing reflex

within 4 hours

5. assessment and

management by a

specialist stroke team

6. inpatient

rehabilitation on a

specialist stroke unit

101

5.4 Effective CVD Prevention Programmes

Figure 111: Effective CVD Prevention Programmes

NICE recommends the following six components for effective CVD prevention programmes.47

1. Good practice principles

Programmes should comprise intense and multicomponent interventions that address

identified risk factors.

They should be sustainable for a minimum of five years and should be allocated adequate

resources.

2. Preparation

Programme leads should gain a good understanding of local CVD prevalence, existing risk

factors and ongoing interventions.

3. Programme development

Programmes should adopt a population based approach underpinned by a proven

theoretical model.

Programmes should link with other existing interventions e.g. NHS Health Checks.

Programmes should take account of existing NICE guidance.

4. Resources

Ensure programmes last a minimum of 5 years and are allocated adequate financial and

human resources.

5. Leadership

Identify senior figures in the local community and request them to act as champions for

CVD prevention.

6. Evaluation

Ensure evaluation is built in and results are freely available and are shared with partner

organisations.

47 NICE: Prevention of cardiovascular disease: https://www.nice.org.uk/guidance/ph25