Incidence of coronary heart disease in a health authority in London: review of a community register

Sutcliffe, Steven; Fox, Kevin; Wood, David; Sutcliffe, Angela; Stock, Kathryn; Wright, Melissa; Akhras, Fawaz; Langford, Ed

doi:10.1136/bmj.326.7379.20

Cited by 22 publications

(14 citation statements)

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“…This incidence was split into incidences of stable (77%) and unstable (23%) angina using the incidence of exertional and unstable angina reported in the study by Sutcliffe et al, 344 which reported incidences of varieties of CHD in people aged 25-74 years in the Bromley Health Authority. Applying this split assumes that the relative incidence of stable and unstable angina is the same for each age group.…”

Section: Incidence Of Stable and Unstable Anginamentioning

confidence: 99%

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Incidence Of Stable and Unstable Anginamentioning

confidence: 99%

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Salisbury

O’Cathain

Thomas

et al. 2017

Programme Grants Appl Res

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“…The BCHDR 7 identifies all symptomatic medical presentations of CHD in one specific population from 1996 to 1998. The incidence per annum of CHD in this community was 537 per 100,000 population.…”

Section: Incidence Rate Of Chdmentioning

confidence: 99%

“…Incident rates for primary CHD events are taken from the BCHDR, 7 and TIA and stroke from the Oxfordshire Community Stroke Project. 15,225 These are combined to derive the distribution across events by age and gender at the modelled risk level (Table 49).…”

Section: Primary Incidence Rates/ratios Across Health States Modelledmentioning

confidence: 99%

“…7 All incident presentations of CHD were registered for Bromley Health District in South-East London (population of 186,053; men and women aged 25-74 years) for the period 1996-1998. The incidence of primary CHD events was reported as being 414 per 100,000 population per year in men and 147 per 100,000 population per year in women.…”

Section: Incidence Of Primary Chdmentioning

confidence: 99%

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A systematic review and economic evaluation of statins for the prevention of coronary events

Ward

Jones²,

Pandor³

et al. 2007

Health Technol Assess

346

312

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“…1 In a significant number of cases, sudden death can be the first and only manifestation of underlying CHD. [2][3][4] Individuals with CHD fortunate enough to reach the hospital are now subject to a range of effective therapeutic modalities that have contributed to observed improvements in case fatality associated with acute myocardial infarction (AMI). 5,6 It is commonly assumed that such improvements largely explain the overall decline in case fatality rates associated with CHD at the population level.…”

mentioning

confidence: 99%

Trends in Out-of-Hospital Deaths Due to Coronary Heart Disease in Sweden (1991 to 2006)

et al. 2011

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Background-Case fatality associated with a first coronary event is often underestimated when only those who survive to reach a hospital are considered. Few studies have examined long-term trends in case fatality associated with a major coronary event that occurs out of the hospital. Methods and Results-Record linkage documented all case subjects 35 to 84 years of age in Sweden during 1991 to 2006 with a first major coronary event (out-of-hospital coronary death or hospitalization for acute myocardial infarction). Of the 384 597 cases identified, 111 319 (28.9%) died out of the hospital, and another 36 552 (9.5%) died in the hospital or within 28 days of hospitalization. From 1991 to 2006, out-of hospital deaths as a proportion of all major coronary events declined from 30.5% to 25.6% (adjusted mean annual decrease 2.2%, 95% confidence interval 2.1% to 2.4%), however, with a larger decline in 28-day case fatality in hospitalized cases (adjusted mean annual decrease 5.8%, 95% confidence interval 5.5% to 6.0%). As a result of the faster decline in in-hospital deaths, the relative contribution of out-of-hospital deaths to overall case fatality increased, particularly among younger individuals (eg, among those 35 to 54 years of age, no more than 10.8% of all deaths occurred in hospitalized cases during [2003][2004][2005][2006]. Although female sex (odds ratio 0.85, 95% confidence interval 0.83 to 0.87) and older age (odds ratio 0.972, 95% confidence interval 0.971 to 0.974 per year) were associated with lower risk for initial out-of-hospital death, each successive calendar year was associated with increased risk (odds ratio 1.041, 95% confidence interval 1.038 to 1.044). Conclusions-The great majority of all fatal coronary events occur outside the hospital, and this proportion is increasing, particularly among younger individuals. (Circulation. 2011;123:46-52.)

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Incidence of coronary heart disease in a health authority in London: review of a community register

Cited by 22 publications

References 2 publications

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

A systematic review and economic evaluation of statins for the prevention of coronary events

Trends in Out-of-Hospital Deaths Due to Coronary Heart Disease in Sweden (1991 to 2006)

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