Cardiovascular disease Local Authority health profile · Page 10: Myocardial Infarction management Page 11: Angiography procedures Page 12: Revascularisation procedures Page 13: Revascularisation

Contact Details: This report, interactive atlases and the accompanying glossary and technical appendix are available to download on the

SEPHO website. SEPHO will be part of Public Health England from April 2013 - http://www.sepho.nhs.uk

There is a slightly lower proportion of stroke patients under 75 years discharged back to their usual place of residence

compared to the national picture.

Derby lies within the boundaries of the East Midlands

Strategic Clinical Network (as of 1st April 2013, pictured

right).

This information is also available for each stategic clinical

network, and as an interactive atlas.

This Cardiovascular Disease (CVD) Health Profile brings

together a wide range of data on cardiovascular disease

in each upper tier local authority in England and in

associated Strategic Clinical Networks. Its aim is to

provide information to health care professionals,

commissioners and other interested parties about CVD

issues in their local community, as an aid to planning and

development.

Cardiovascular disease (CVD) is the second largest cause

of death in England causing around 130,190 deaths in

2011 (29% of all deaths). Around 46% of all deaths from

CVD are from coronary heart disease (CHD) and almost a

fifth from stroke (18%). CHD is the most common single

cause of death in England (13% of all deaths in 2011).

For people having myocardial infarction reperfusion in 2011/12, the median time to primary angioplasty treatment from

a call for help was 94 minutes in Derby, this is lower than in East Midlands and England (112 and 111 respectively).

Early mortality (under 75 years) rates from cardiovascular disease are similar to the national rate, and have decreased by

59.5% since 1995.

Emergency admission rates for both CHD and stroke are similar to the national rate.

There were less than 5 deaths recorded within 30 days of hospital admission for STEMI patients.

Derby is classified as a member of the East Midlands strategic clinical network.

The area is benchmarked against the national value and the average value of the strategic clinical network in which it is either entirely or mostly located

LA boundaries

Cardiovascular disease Local Authority health profile

Key messages

Derby

© Crown copyright and database rights 2013 Ordnance Survey 100039906

Network boundaries

Benchmarking

Version 1.1

http://www.sepho.nhs.uk/

IndicatorLocal

Value

Eng

Avg

Eng

Low

Eng

High

1 66.6 58.8 34.3 107.0

2 30.5 34.5 23.0 50.8

3 22.0 20.7 14.0 31.0

4 23.4 24.2 13.9 30.7

5 17.9 17.4 10.0 27.2

6 0.6 0.6 0.3 0.8

7 0.5 0.5 0.3 0.5

8 212.2 198.3 124.4 366.4

9 83.0 89.5 48.7 160.2

10 8.7 0.0 20.6

11 73.1 77.9 56.7 97.5

12 40.1 58.5 19.2 99.0

13 178.1 278.2 122.3 676.0

14 141.9 140.5 87.1 249.3

Page 1: Contents & summary Indicators

Page 2: Demographic profile

Page 3: Lifestyle behaviours

Page 4: Quality and Outcomes Framework - exceptions & prevalence

Page 5: Quality and Outcomes Framework - performance

Page 6: NHS Health Checks

Page 7: Coronary heart disease emergency admission rates

Page 8: Heart failure emergency admission rates

Page 9: Stroke emergency admission rates

Page 10: Myocardial Infarction management

Page 11: Angiography procedures

Page 12: Revascularisation procedures

Page 13: Revascularisation procedures by deprivation & valve surgery

Page 14: Cardiac procedures & stroke management

Page 15: CVD mortality rates and contribution of CVD deaths

Page 16: CVD mortality rates and CVD mortality rates by quintile of relative deprivation

Page 17: Trends in mortality rates

Estimated % obese (16+)

% of long term conditions who smoke

Obs/Exp CHD prevalence

Obs/Exp Hypertension prevalence

Cardiovascular disease health profile - Derby

England Range

Early cardiovascular mortality (<75 yrs)

Stroke mortality

Estimated % smokers (16+)

CHD emergency admissions

Angiography rates

Revascularisation rates

Stroke emergency admissions

30 day mortality in STEMI

% stroke discharged to usual residence

% HF who die at usual place residence

Source: ONS mid year population estimates, 2007 Source: Calculated from ONS ethnic group population estimate, 2005 Source: IMD2007 and ONS mid year population estimates, 2007

Cardio vascular disease Health Profile Hull PCT

Summary Indicators

Contents

Significantly Higher than England average Significantly Lower than England average Not significantly different from England average No significance available 25th

Highest Lowest

Network average

England average

Percentile 75th

1. Directly standardised rate per 100,000, 2011 under 75. 2. Directly standardised rate per 100,000, 2011 3. Percentage estimate of smokers , 16+, 2006-08. 4. Percentage estimate of obese adults, 16+, 2006-08. 5. Percentage of those registered with long-term conditions who smoke, 2010/11. 6. Ratio of 2011/12 CHD QOF disease registers to estimated prevalence in 2011. 7. Ratio of 2011/12 hypertension QOF disease registers to estimated prevalence in 2011. 8. Directly standardised rate per 100,000, 2011/12. 9. Directly standardised rate per 100,000, 2011/12. 10. Percentage, 2011. 11. % of all patients diagnosed with stroke under 75, 2011/12. 12. Percentage of deaths due to heart failure at their usual place of residence 2007-2011 13. Directly standardised rate per 100,000, 2011/12. 14. Directly standardised rate per 100,000, 2011/12.

Page 1 of 17

Age profile and population projections in Derby

National deprivation structure (IMD 2010)

Ethnicity recorded from the 2011 census

The proportion of the population in Derby

which is from black and minority ethnic

groups is estimated to be 19.7%. South

Asian men are more likely to develop CHD at

younger age, and have higher rates of

myocardial infarction. Black people have the

highest stroke mortality rates.

The definition of BME used here excludes 'White

Irish', 'White Gypsy or Irish traveller', ' and 'White

other' ethnic groups.

Derby has 27.9% of its population in the

most deprived national quintile and 23.9% of

the population in the least deprived quintile.

The population estimate of Derby in 2011 was 248,900 and is

projected to increase to 274,300 in 2021.


Age is a key factor in cardiovascular disease. The prevalence of

cardiovascular disease increases significantly after the age of

40 years.

The percentage of the population aged 40 or over in Derby is

expected to remain unchanged at at 21.8% for males and

decrease from 23.7% to 23.1% for females between 2011 and

2021.

The population aged 40 or over in the East Midlands Network

is expected to increase from 24.4% to 24.8% for males and

from 26.3% to 26.6% for females. In England it is expected to

increase from 23.5% to 23.9% for males and from 25.7% to

25.8% for females.

10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10%

0-4 5-9

10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84

85+

Percentage

Age

Ban

ds

F 2021 F 2011 M 2021

M 2011 ENG M 2011 ENG F 2011

Demographic profile

Source: Office for National Statistics (ONS) 2011 MYE & 2011 interim subnational population projections

0%

20%

40%

60%

80%

100%

Derby East Midlands England

Re

sid

en

ts

Most deprived Least deprived

Source: IMD 2010 Department of Communities and Local Government (DCLG)

4.8% 3.1% 4.0%

12.0%

6.0% 7.1%

2.9%

2.1% 3.5%

0%

5%

10%

15%

20%

25%


BM

E

Black Asian Other

Source: 2011 Census: Key Statistics for local authorities in England and Wales

Page 2 of 17

Lifestyle estimates for adults

Smoking

Increasing and high

risk drinking

(combined)

Obesity

22.0% 21.4% 23.4%

21.4% 22.5% 24.4%

20.7% 22.3% 24.2%

Smoking

Increasing and high risk drinking (combined)

Adult obesity

QOF data shows that the percentage

of patients with long-term conditions

who smoke in Derby was 17.9% in

2011/12. This is significantly higher

than the rate in England (17.4%) and

significantly higher than the rate in

East Midlands (17.4%).

Percentage of patients registered with a GP with any combination of registered long-term conditions who

smoke, QOF 2011/12

Using modelled estimates from the Health Survey for England, it is estimated that 23.4% of the adult population in Derby are

classifed as obese. This is lower than England (24.2%) and lower than East Midlands (24.4%).•

•

•


Using modelled estimates from the General Lifestyle Survey, it is estimated that 21.4% of the population in Derby have increasing

or high risk drinking behaviour. This is lower than England (22.3%) and lower than East Midlands (22.5%).

Using data from the Integrated Household Survey it is estimated that 22.0% of the population in Derby smoke. This is higher than

the estimated proportion in England (20.7%) and higher than East Midlands (21.4%).

Derby

East Midlands

England

Lifestyle behaviours

17.4%

17.4%

17.9%

0% 5% 10% 15% 20% 25% 30%

England

East Midlands

Derby

Sources: Smoking: Integrated Household Survey, 2010/11 High Risk drinking: Modelled estimates from the General Lifestyles Survey, 2008-09 Obesity: Modelled Estimates from Health Survey for England, 2006-08

Source: Quality and Outcomes Framework 2011/12

Page 3 of 17

Effective exception rate (EER)

Area

2011/12

EER

Derby 7.5%

East Midlands 6.1%

England 5.6%

Number and percentage of practices with high exception reporting rates

Atrial

fibrillation

Coronary

heart

disease

Heart

failure

Hyper-

tension

Stroke &

TIA

CVD

Primary

Prevention

Practices

with any

high

exception

rates

Total

number of

practices

Derby 1 3 1 2 0 2 9 29

Derby % 3.4% 10.3% 3.4% 6.9% 0.0% 6.9% 31.0% 29

East Midlands % 1.7% 9.3% 2.6% 1.5% 3.7% 3.5% 22.3% 655England % 2.1% 7.5% 3.6% 2.0% 4.1% 2.1% 21.3% 8124

Observed (GP registered) prevalence in 2011/12 versus estimated prevalence in 2011

Coronary heart disease

Stroke

Hypertension

The observed prevalence for hypertension in Derby is 46.6%

of the estimated prevalence. This compares to 46.0% for

England and 46.1% for East Midlands. The gap between

recognised and treated hypertension, and actual

hypertension levels in the community have been long

recognised.


GPs can exclude patients from the calculation of measures in the

Quality and Outcomes Framework, to allow practices to pursue the

quality improvement agenda and not be penalised, where, for

example, patients do not attend for review, or where a medication

cannot be prescribed due to a contraindication or side-effect.

However, the number of such exceptions varies substantially

between practices. In 2011/12, the exception rate in Derby was

7.5%. Within England, the exception rate varied between 3.9% to

8.6% for individual areas.

The observed prevalence for stroke in Derby is 67.8% of the

estimated prevalence. This compares to 68.4% for England

and 70.9% for East Midlands.

The observed prevalence for CHD in Derby is 57.8% of the

estimated prevalence. This compares to 58.2% for England

and 62.4% for East Midlands.

GPs record information on whether their patients have CHD

or have a stroke. This information is crude and does not

consider population structure. The estimated prevalence is

population structure adjusted, but is for the 16+ population,

so does not match the all age population of GP registers.

Quality and Outcomes Framework - exceptions

3.4

%

3.6

%

3.4

%

5.9

%

5.7

%

5.8

%

0%

2%

4%

6%

8%

10%


Pre

vale

nce

1.7

%

1.8

%

1.7

%

2.5

%

2.5

%

2.5

%

0%

1%

2%

3%

4%

5%


Pre

vale

nce

13

.9%

14

.1%

13

.6%

29.8

%

30.6

%

29.7

%

0%

10%

20%

30%

40%


Pre

vale

nce

Sources: Quality and Outcomes Framework 2011/12 and modelled estimates of prevalence, Eastern Region Public Health Observatory, December 2011

Observed Estimated

Quality and Outcomes Framework - prevalence

Page 4 of 17

2011/12

Significantly lower than England The same as England Significantly higher than England

Derby East

Midlands

England Derby East

Midlands

England

% newly diagnosed angina

patients referred for exercise

testing or assessment99.3 97.9 98.2

% stroke patients whose

blood pressure was 150/90 or

less88.9 88.9 88.6

% CHD patients in whom last

blood pressure reading was

150/90 or less91.0 90.4 90.1

% stroke patients with record

of cholesterol in last 15

months90.5 91.8 91.4

% CHD patients in whom last

cholesterol measurement was

5mmol/l or less83.7 82.0 80.4

% stroke patients whose

cholesterol was 5mmol/l or

less80.4 79.3 77.2

% CHD patients taking aspirin,

an alternative anti-platelet

therapy or an anti-coagulant in

last 15 months

92.0 93.0 93.3

% stroke patients immunised

preceding Sept-March90.1 90.0 90.0

% CHD patients currently

treated with beta blocker

75.5 75.5 74.2

% non-haemorrhagic/with

history of TIA stroke patients

taking anti-platelet agent/anti-

coagulant93.1 93.7 93.6

% patients with history of

myocardial infarction currently

treated with ACE inhibitor or

angiotensin II antagonist94.6 91.1 91.1

% new patients with a stroke

referred for further

investigation 92.3 89.2 89.6

Hypertension

Atrial fibrillation% atrial fibrillation patients

currently treated with anti-

coagulation drug therapy or an

anti-platelet therapy

94.0 94.2 93.7

% hypertension patients (with

record in last 9 months) in

whom last blood pressure

was 150/90 or less

80.4 80.2 79.7

Heart failure Primary prevention% heart failure patients

diagnosed after 1st April 2006

with diagnosis confirmed by an

echocardiogram or specialist

assessment

95.6 95.1 95.7

% hypertension patients aged

30 to 74 who have had a

cardiovascular risk

assessment at the outset of

diagnosis

83.8 79.2 80.0

% patients with a current

diagnosis of heart failure due to

LVD currently treated with an

ACE inhibitor or angiotensin

receptor blocker

89.2 89.1 89.3

% hypertension patients who

are given lifestyle advice in

the for physical activity,

smoking cessation, alcohol

consumption and diet

79.6 81.6 81.5

91.0


% CHD patients immunised

against influenza in Sept-March

0592.9 92.5 92.5 % hypertension patients with

record of blood pressure in

last 9 months91.6 91.3

Coronary heart disease Stroke

Quality and Outcomes Framework - performance

Source: Quality and Outcomes Framework 2011/12

Page 5 of 17

Percentage people offered a health check from those eligible to be invited for a health check during 2011/12

Local authorities can access a 'Ready Reckoner' that allows them to identify the potential service

implications, benefits and cost savings resulting from implementing NHS Health Checks:

http://www.healthcheck.nhs.uk/national_resources/ready_reckoner_tools

Percentage uptake of people offered a health check (within the eligible population) during 2011/12


Based on PCT performance data submitted in 2011-2012, there were 78,650 local authority

residents in Derby who were eligible to be invited for an NHS Health Check. Local authorities are

mandated to offer the programme to 100% of their eligible population over a five year period, from

April 2013. During 2011-2012, 19.1% of eligible residents were invited to attend the programme

with an uptake rate of 53.8%.

The NHS Health Check programme was formally introduced in April 2009 as a key policy to reduce

health inequalities and increase life expectancy from preventable CVD conditions.

NHS Health Check Programme

51.6

65.3

53.8

0 20 40 60 80 100

England

East Midlands

Derby

Source: Public Health Outcomes Framework and the Department of Health, 2012

13.9

10.0

19.1

0 20 40 60 80 100

England

East Midlands

Derby

Page 6 of 17

CHD emergency admission rates (DSRs), for all ages, 2011/14

CHD emergency admission rates (DSRs) for all ages, by quintile of relative deprivation, 2011/12

Trend in CHD rates (DSRs), 2004/05 to 2011/12

The emergency admission rate for CHD in

Derby has decreased by 37.3% between

2004/05 and 2011/12.

In England it has decreased by 23.1% and in

East Midlands it has decreased by 25.9%.


In 2011/12 the emergency admission rate for

CHD, all persons, in Derby was 212.2 per

100,000 (646 admissions). This is higher than

England (198.3 per 100,000) and East Midlands

(199.4 per 100,000).

Male CHD emergency admission rates are

significantly higher than female CHD emergency

admission rates.

The emergency admission rates for persons who live in the most deprived areas of England are 2.2 times greater compared to persons

who live in the least deprived areas and 2 times greater in East Midlands.

The emergency admission

rate for CHD in 2011/12 for

persons living in the most

deprived areas of Derby was

302.9. This is 1.9 times

greater than emergency

admission rates for persons

living in the least deprived

areas of Derby (157.4).

Coronary heart disease emergency admission rates

0

100

200

300

400

500

600

700

800

Least deprived

Most deprived

DSR

pe

r 1

00

,00

0

LA

0

100

200

300

400

500

600

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

DSR

pe

r 1

00

,00

0

Source: HES, Health and Social Care Information Centre, ONS, Department of Communities and Local Government (DCLG)

Derby East Midlands England 3

03

.9

12

5.4

21

2.2

27

9.1

12

5.4

19

9.4

27

9.6

12

4.6

19

8.3

0

100

200

300

400

500

600

Males Females Persons

DSR

pe

r 1

00

,00

0

Source: Hospital Episode Statistics (HES), Health and Social Care Information Centre ONS

Least deprived

Most deprived

Network

Least deprived

Most deprived

England

Source: HES, Health and Social Care Information Centre, ONS


Page 7 of 17

Heart failure emergency admission rates (DSRs), for all ages, 2011/12

Heart failure emergency admission rates (DSRs) for all ages, by quintile of relative deprivation, 2011/12

In England it has decreased by 18% and in East Midlands it has

decreased by 21.3% .


Male heart failure emergency admission rates

are significantly higher than female heart

failure emergency admission rates.


heart failure, all persons, in Derby was 75.9 per

100,000 (286 admissions). This is significantly

higher than England (60.7 per 100,000) and

East Midlands (62.1 per 100,000).


rate for heart failure in

2011/12 for persons who live

in the most deprived areas of

Derby was 107.2. This was

3.5 times greater than the

emergency admission rates

for persons who live in the

least deprived areas of Derby

(30.7).

In England, the emergency admission rates for persons who live in the most deprived areas are 2.3 times greater respectively compared

to persons who live in the least deprived areas and 2.3 times greater in East Midlands.

Proportion of deaths from heart failure that occur at

home or usual place of residence, 2007-2011

The emergency admission rate for heart failure in Derby has

decreased by 12.1% between 2004/05 and 2011/12.

Trend in heart failure rates (DSRs), 2004/05 to 2011/12

40.1% of deaths from heart failure occurred in the usual place

of residence in Derby which is a lower proportion than East

Midlands (61.3%) and England (58.5%)

0

50

100

150

200

250

300

Least deprived

Most deprived

DSR

pe

r 1

00

,00

0

LA

Heart failure emergency admission rates

91

.9

62

.8

75

.9

78

.0

49

.0

62

.1

77

.7

47

.2

60

.7

0

50

100

150

200

250

Male Female Persons

DSR

pe

r 1

00

,00

0


0

20

40

60

80

100

120

140

160

180

200

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

DSR

pe

r 1

00

,00

0


Least deprived

Most deprived

Network

Least deprived

Most deprived

England

40

.1%

61

.3%

58

.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Source: PHO annual deaths extract, ONS



Source: HES, Health and Social Care Information Centre, ONS, DCLG

Page 8 of 17

Stroke emergency admission rates (DSRs) for all ages, 2011/12

Stroke emergency admission rates (DSRs), by quintile of relative deprivation, 2011/12

The rate of emergency readmissions within 30 days for Derby is 0.8%, this is lower than England and East Midlands (2.9% and 2.8%

respectively).


Male stroke emergency admission rates are

significantly higher than female stroke emergency

admission rates.


stroke, all persons, in Derby was 83.0 per 100,000

(301 admissions). This is lower than England (89.5

per 100,000) and East Midlands (84.0 per 100,000).

In England, the emergency admission rates for persons who live in the most deprived areas are 1.8 times greater respectively compared

to persons who live in the least deprived areas and 1.6 times greater in East Midlands.


rate for stroke in 2011/12


most deprived areas of

Derby was 118.5. This is

1.6 times greater than the

emergency admission rates


least deprived areas of

Derby (75.4).

Trend in stroke rates (DSRs), 2004/05 to 2011/12 Emergency readmission rates for patients with stroke,

2011/12

The emergency admission rate for stroke in Derby has increased by 15.6% between 2004/05 and 2011/12. In England it has increased by

3% and in East Midlands it has increased by 2% .

Source: Quality and Outcomes Framework, 2007/08

Source: ONS 2006-based subnational population projections by sex and Source: Quality and Outcomes Framework, 2007/08

Stroke emergency admission rates

Source: ONS 2006-based subnational population projections by sex and 1

04

.6

62

.2

83

.0

98

.2

70

.3

84

.0

10

4.8

75

.1

89

.5

0

50

100

150

200

250

Male Female Persons

DSR

pe

r 1

00

,00

0


0

50

100

150

200

250

300

Least deprived

Most deprived

DSR

pe

r 1

00

,00

0

LA

0 20 40 60 80

100 120 140 160 180 200

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

DSR

pe

r 1

00

,00

0



Least deprived

Most deprived

Network

Least deprived

Most deprived

England


0.8

%

2.8

%

2.9

%

0%

1%

2%

3%

4%

5%

6%

7%



Page 9 of 17

* STEMIs are ST elevated myocardial infarctions (as seen in an ECG) and best treated by thrombolysis or primary angioplasty

Proportion of non-STEMIs seen by member of cardiology team, 2011/12

Mortality within 30 days of admission to hospital for STEMI patients, 2011/12


Non-STEMI patients can be treated less

invasively, but still need specialist

management. The proportion of non-STEMIs

seen by a member of the cardiology team for

Derby residents is 100%, this is higher than

East Midlands and England (94.8% and 93.7%

respectively).

Primary Angioplasty median time to treatment from

calling for help, for STEMIs, 2011/12

Percentage Primary Angioplasty used in reperfusion treatment for

patients with STEMI* diagnosis, 2011/12

Primary angioplasty for Derby residents was 100% of all reperfusion for patients diagnosed as STEMI, compared to 95% in England.

The median time to primary angioplasty treatment from a call for help was 94 minutes for Derby residents, this is lower than in

East Midlands and England (112 and 111 respectively).

There were less than 5 deaths recorded

within 30 days of hospital admission for

STEMI patients resident in Derby in 2011/12.

The 30 day mortality rate in East Midlands

and England was 9.8% and 8.7% respectively.

Myocardial Infarction management

10

0.0

%

88

.8%

95

.0%

0%

20%

40%

60%

80%

100%


94

11

2

11

1

0

50

100

150

200

250

300

350


Min

ute

s

9.8

%

8.7

%

0%

5%

10%

15%

20%

25%


10

0.0

%

94

.8%

93

.7%

0%

20%

40%

60%

80%

100%


Source: MINAP

Source: MINAP

Source: Myocardial Ischaemia National Audit Project (MINAP)

Page 10 of 17

Angiography procedure rates (DSRs) for all ages, 2011/12

Trend in angiography rates (DSRs), 2004/05 to 2011/12

Angiography procedure rates for persons who live in the most deprived areas of Derby are 1.2 times greater than those

who live in the least deprived areas. In England and East Midlands they are 1.5 and 1.4 times greater respectively.


In 2011/12 the angiography procedure

rate in Derby was 178.1 per 100,000

(490 procedures). This is significantly

lower than England (278.2 per 100,000)

and East Midlands (255.3 per 100,000).

Male angiography rates are 1.6 times

greater than female angiography rates

in Derby.

Angiography procedure rates (DSRs) for all ages, by quintile of relative deprivation, 2011/12

Angiography rates in Derby have

decreased by 27.9% between 2004/05

and 2011/12. In England and East

Midlands they have increased by 8.4%

and 25% respectively.

Angiography procedures

0

100

200

300

400

500

600

700

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

DSR

pe

r 1

00

,00

0


16

2.0

16

6.5

17

2.3

20

2.2

19

8.5

0

100

200

300

400

500

600

700

800

900

Least deprived

Most deprived

DSR

pe

r 1

00

,00

0

LA

22

0.7

13

7.4

17

8.1

34

6.0

17

0.2

25

5.3

37

7.5

18

7.2

27

8.2

0

200

400

600

800

1000

Male Female Persons

DSR

pe

r 1

00

,00

0


21

5.5

23

6.7

25

0.6

28

3.3

30

9.0

Least deprived

Most deprived

Network

23

0.3

24

6.0

27

1.6

31

2.5

35

4.6

Least deprived

Most deprived

England




Page 11 of 17

Non-elective angioplasty rates in Derby have increased by 290.2% between 2004/05 and 2011/12. Elective procedure rates

have decreased by 21.9%. In England and East Midlands non-elective procedure rates have increased by 74.8% and 151.4%

respectively. Elective procedure rates have decreased by 15.7% and decreased by 9.1% respectively.

CABG procedure rates in Derby have decreased by 21.6% between 2004/05 and 2011/12. In England and East Midlands

CABG procedure rates have decreased by 25.4% and 29.4% respectively.

Male angioplasty procedure rates are 3.9 times greater than female angioplasty rates in Derby.

In 2011/12 the CABG procedure rate, all persons, in Derby was 24.5 per 100,000 (70 procedures). This is lower than England

(29.5 per 100,000) and similar to East Midlands (24.5 per 100,000).


CABG procedure rates (DSRs), for all ages,

2011/12

In 2011/12 the all persons angioplasty procedure rate in Derby was 117.4 per 100,000 (302 procedures), 29 per 100,000

elective and 88.4 per 100,000 non-elective. This is higher than England (111 per 100,000) and lower than East Midlands

(122.1 per 100,000).

Elective & non-elective angioplasty procedure rates

(DSRs) for all ages, 2011/12


Trend in Angioplasty rates (DSRs), 2004/05 to 2011/12 Trend in CABG rates (DSRs), 2004/05 to 2011/12

33

.8

15

.7

24

.5 41

.2

9.0

24

.5

49

.9

10

.9

29

.5

0

10

20

30

40

50

60

70

80

90

100


DSR

pe

r 1

00

,00

0



Revascularisation

Source: ONS 2006-based subnational population projections by sex and quinary

47 70 62

11 20 17 29 45 39

140 121

114

37 36 34

88 78 72

0

50

100

150

200

250

300

350

400

DSR

pe

r 1

00

,00

0


0

20

40

60

80

100

120

140

160

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

DSR

pe

r 1

00

,00

0

Derby non-elective Derby elective

East Midlands non-elective East Midlands elective

England non-elective England elective

0

10

20

30

40

50

60

70

80

90

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

DSR

pe

r 1

00

,00

0




Non-elective

Elective

Non-elective

Elective

Non-elective

Elective

Page 12 of 17

Valve procedure rates (DSRs), 2010/11-2011/12


Revascularisation rates (DSRs) for all ages, by quintile of relative deprivation, 2011/12

Revascularisation rates for persons who live in the most deprived areas of Derby are 1.5 times greater than those who

live in the least deprived areas. In England and East Midlands they are 1.6 and 1.6 times greater respectively.

Valve procedure rates in Derby were 14.8 per 100,000 in 2010/11-2011/12, lower than the network average (15.9) and

similar to England (14.8).

Cardiac procedures

10

5.1

14

0.5

16

9.0

14

3.5

15

7.4

0

100

200

300

400

500

Least deprived

Most deprived

DSR

pe

r 1

00

,00

0

LA

11

7.2

13

2.4

14

3.7

16

7.2

18

7.3

Least deprived

Most deprived

Network

11

3.7

12

5.2

13

7.5

15

8.4

18

0.8

Least deprived

Most deprived

England

Revascularisation - deprivation


17

.8

12

.0

14

.8 20

.0

12

.0

15

.9

18

.1

11

.9

14

.8

0

5

10

15

20

25

30

35

40

45

50


DSR

per

10

0,0

00



Page 13 of 17

Heart Transplants by SHA, 2011/12

Strategic Health Authority

Rate per million

population

West Midlands 3.8

North East 3.4

East Midlands 2.7

North West 2.7

East Of England 2.2

South West 1.9

South Central 1.7

South East Coast 1.6

Yorkshire and The Humber 1.1

London 1.1

The rate of carotid endarterectomies performed per 100,000 for Derby is 6.3, which is significantly lower than East

Midlands (7.6) and England (8.7). East Midlands is significantly lower than England.

The rate of heart

transplantation varies from

1.1 per million in London to

3.8 per million in the West

Midlands. This data is not

available at a geography

lower than strategic health

authority.


Percentage of hospital stroke patients discharged to

home or usual place of residence, 2011/12

Rate of carotid endarterectomy procedures

(DSR's), 2010/11-2011/12

The proportion of patients under the age of 75 discharged to home or usual place of residence in Derby is 73.1%,

which is lower than East Midlands (76.8%) and England (77.9%). 90.9% of patients aged 75 or over are discharged to

home, which is higher than East Midlands (68.3%) and England (70.1%).

73

.1%

76

.8%

77

.9%

90.9

%

68.3

%

70.1

%

0%

20%

40%

60%

80%

100%


No border = aged under 75 Dotted border = aged 75 and over

6.3

0

7.6

1

8.7

2

0

5

10

15

20

25


DS

R p

er

10

0,0

00

Stroke management

Cardiac procedures

Source: UK Blood & Transplant


Page 14 of 17

All CVD mortality rates (DSRs) in persons under 75 yrs: 1995 to 2011 (predicted to 2014)

<75

CVD deaths as a proportion of all deaths under, <75 and 75+, 2009-11

75+

CHD makes up the biggest proportion of total deaths (within CVD) for both males and females, 18.2% (6.5% AMI and 11.6% non

AMI) and 14.8% (5.4% AMI and 9.4 % non AMI ) respectively in Derby. For males, 5.9% of deaths are due to stroke and 0.9% are

due to heart failure. For females, 9.7% of deaths are due to stroke and 1.6% are due to heart failure.


In Derby the percentage of cardiovascular deaths as a proportion of all deaths was 25.1% for people aged under 75 years and

36.4% for people aged 75 and above. This is higher than England for under 75s (23.8%) and higher than England for those aged 75

and over (34.7%).

The Public Health Outcomes Framework has an objective of reducing the numbers of people living with preventable ill health and

people dying prematurely, while reducing the gap between communities. One of the key indicators for this objective is early

mortality from CVD. In 2014 the early CVD mortality rate in Derby for persons under 75 yrs is predicted to be 60.9, which would be a

10 year decrease of 39.5% (from 2004). The early CVD mortality rate for England is predicted to be 50.1, a 10 year decrease of 44.2%

and the East Midlands rate is predicted to be 50.3, a 10 year decrease of 44.3%.

0

20

40

60

80

100

120

140

160

180

200

220

240

95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14

DSR

pe

r 1

00

,00

0


Cardio vascular disease Health Profile Hull PCT

Mortality rates trend

CVD early mortality trend

Contribution of CVD deaths to overall mortality

Source: The NHS Information Centre for Health and Social Care, PHO annual deaths extract, ONS

202

118

95 6

124

454

253

393

75

306

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

0%

5%

10%

15%

20%

25%

30%

Derby East Midlands England Derby East Midlands England

Pro

po

rtio

n o

f d

eat

hs

75

+

Pro

po

rtio

n o

f d

eat

hs

<75

CHD: non AMI CHD: AMI Stroke Heart failure Other

Source: Health and Social Care Information Centre, PHO annual deaths extract, ONS


Page 15 of 17

CVD mortality rates (DSR's) by gender for all ages, 2009-11

All CVD mortality rates (DSRs) for all persons, by quintile of relative deprivation, 2009-11


Male CVD mortality rates in Derby are

significantly higher than female CVD

mortality rates (196.5 and 135.1

respectively).

The 2009-11 CVD mortality rate in Derby

for all persons was 164.8 per 100,000.

This is significantly higher than England

(155.6) and higher than East Midlands

(157.7).

In England the mortality rate for persons who live in the most deprived areas was 213.1, 1.4 times greater than the

overall mortality rate for England and 1.8 times greater than the mortality rate for persons who are in the least

deprived areas. In East Midlands the mortality rate for persons who live in the most deprived areas was 211.9, 1.3

times greater than the overall mortality rate and 1.7 times greater than the mortality rate for persons who live in

the least deprived areas.

The mortality rate in 2009-11 for persons who live in the most deprived areas of Derby was 257.1 per 100,000.

This is 1.6 times greater than the overall mortality rate for Derby and 2.3 times greater than the mortality rate for

persons who live in the least deprived areas of Derby.


Primary cause of death within CVD Source: ONS 2006-based subnational population projections by sex and quinary age

CVD mortality rates Source: NCHOD (Compendium of Health)

CVD by deprivation

19

6.5

13

5.1

16

4.8

19

7.5

12

2.6

15

7.7

19

5.2

12

1.8

15

5.6

0

50

100

150

200

250

300

350


DSR

per

10

0,0

00


Source: PHO annual deaths extract, ONS

12

1.5

13

6.8

15

5.3

17

9.8

21

1.9

Least deprived

Most deprived

Network

10

9.5

14

3.8

17

1.1

17

4.8

25

7.1

0

50

100

150

200

250

300

350

Least deprived

Most deprived

DSR

pe

r 1

00

,00

0

LA

12

0.6

13

6.6

15

1.3

17

6.9

21

3.1

Least deprived

Most deprived

England

Source: PHO annual deaths extract, ONS, DCLG

Page 16 of 17

In 2014, the mortality rate for cerebrovascular disease in Derby is predicted to be 28.8 for males and 32.2 for females, this is a 10 year

decrease of 43.3% for males and 39.4% for females. In England, the mortality rate is predicted to decrease by 44.4% to 33.1 for males

over the same 10 years and by 41.7% to 31.9 for females. The rates in East Midlands are predicted to decrease by 47.7% for males to

29.1 and by 49.2% to 27.9. for females.

Note that due to mortality recording changes introduced for 2011 data, there will be some decreases in CVD numbers, particularly cerebrovascular disease

between 2011 and previous years that are not accounted for in population outcomes, but coding rules.

Trend in cerebrovascular mortality rates (DSRs), all ages, 1996-2011 (predicted to 2014)


Trend in CHD mortality rates (DSRs), all ages, 1996-2011 (predicted to 2014)

In 2014, the mortality rate for CHD in Derby is predicted to be 101.5 for males and 51.3 for females, this is a 10 year decrease of 44.0%

for males and 41.6% for females. In England, the mortality rate is predicted to decrease by 46.1% to 83.8 for males over the same 10

years and by 49.2% to 36.9 for females. The rates in East Midlands are predicted to decrease by 45.4% for males to 85.7 and by 50.2% to

36.9. for females


Trends in mortality rates Source: ONS 2006-based subnational population projections by sex and quinary age

Contribution of CVD deaths to overall mortality

0

50

100

150

200

250

300

350

96 98 00 02 04 06 08 10 12 14

DSR

pe

r 1

00

,00

0

0.0 20.0 40.0 60.0 80.0

100.0

1

Males Derby Males East Midlands Males England

Females Derby Females East Midlands Females England

0

20

40

60

80

100

120

140

96 98 00 02 04 06 08 10 12 14

DSR

pe

r 1

00

,00

0

0

20

40

60

80

100

120

140

160

180

200

96 98 00 02 04 06 08 10 12 14

DSR

pe

r 1

00

,00

0

0

20

40

60

80

100

96 98 00 02 04 06 08 10 12 14

DSR

pe

r 1

00

,00

0



Page 17 of 17

This report has been compiled by

• Kevin Watson

• Andrew Hughes

With acknowledgements• Heather White

• Jamie Waterall

• John Birkhead• Rachel Johnson

With special thanks to Yorkshire and Humber Public Health Observatory whose original

work formed the basis for these reports.

Source:YHPHO

Delivered by:

South East Public Health Observatory

4150 Chancellor Court

Business Park South

Oxford

OX4 2GX

SEPHO will be part of Public Health England from April 2013

Source:YHPHO

Documents

Cardiovascular disease Local Authority health profile · Page 10: Myocardial Infarction management Page 11: Angiography procedures Page 12: Revascularisation procedures Page 13: Revascularisation