CHD, a significant cause of poor health, is an avoidable disease, killing more than 6,000 people in the Highlands each year. The disease occurs when the blood vessels in the heart start to narrow or become clogged and are no longer capable of supplying an adequate supply of blood to one of our major organs, the heart. This causes the person to have a heart attack, angina or chest pain. In this article, we take a look at trends, possible causes and contributing factors, and health interventions.
Even though the overall death rates from CHD have declined since the 1970's in the Highlands, mortality and morbidity due to heart failure is on the rise and carries an even worse diagnosis compared to cancers. The overall quality of a person's life is significantly affected and declines rapidly with an increase in the seriousness of the condition.
CHD is accountable for more than 20% of overall death rates and has become a common cause of hospital admissions in people age 60 and above. There is an increase in the elderly population, which is presenting a massive health issue in the Highlands, causing major problems such as mortality, disability and increased expenditure in health care costs. Furthermore, evidence shows that there will be a further rise in CHD prevalence rates over the next two decades.
According to Scottish Intercollegiate Guidelines (SIGN), patients often need to be hospitalised because of chronic heart failure, and studies reveal that the contributing factors are:
- Poor diet, non-compliance with medication or both;
- Hypertension that isn’t controlled;
- Not seeking medical care after gaining weight (fluid retention);
- Respiratory infection;
- A lack of adequate information and knowledge of risk factors and patient ownership of their condition.
- Inadequate discharge and follow up plans.
- High cholesterol and blood pressure
- In adequate exercise
- Obesity or being overweight
- Excessive alcohol consumption
The above risk factors have been proven to contribute to CHD in Scotland and other parts of the world.
Let’s take some of the major factors in consideration and see how they apply to the overall Scottish population.
The average blood concentration in men and women in Scotland are higher when compared to international standards. The government's health target is to get the levels down to below 5.0 mm in those who are higher risk of CHD. Surprisingly, cholesterol levels are not distributed unequally according to social class. In contrast, it is associated as a positive CHD status, especially amongst women. In a previous Health Survey in the Highlands, 18.2% of males and 35% of females with Ischemic Heart Disease had higher cholesterol in comparison to 16.9% and 18% in non-CHD gender study groups.
Physical activity seems to decrease in men and women with age, therefore, most people aged 75 plus do not take part in moderate activity levels lasting 20 minutes or more. The recommended levels are at least 30 minutes of moderate to high intensity exercise 5 days a week. In Scotland, just 37% of the male population and 25% of the female population actually meet this set criteria, and the percentage reduces with age to 18% and 13% correspondingly amongst 65 to 74 year olds. There isn’t a noteworthy trend in levels of physical exercise according to socioeconomic groups.
A SBP >140 or DBP >90 mmHg has recently been classified as a high blood pressure. In Scotland and the Highlands, the average SBP is around 132 mmHg for men and around 127 mmHg for women. Blood pressure tends to increase with age and prevalence rates are higher in men compared to women up to 65 when afterwards the rates are similar between the genders. A recent survey found 33.1% of men and 28.5% of women had high blood pressure. There is only a slight variation of blood pressure levels according to social class amongst women but no difference has been found in men.
Even though there has been a decrease in overall smoking rates in Scotland and Highlands, the rates amongst teenagers has seen an increase, especially amongst young girls. Smoking prevalence rates also vary according to social class, particularly amongst unemployed people, manual workers, those living in cramped housing conditions, single parents, divorced or separated couples.
The BMJ defines obesity as having a body-mass-index that is equal to or higher than 30, and almost 35% of the population seem to fall into this category. Obesity is age related and the highest rates in Scotland can be found in people between the ages of 55 to 74 years, and it is the highest in women. Obesity varies according to socio-economic groups, the highest proportion is amongst the most financially deprived, which is clearly evident in women. It’s not that clear yet if obesity is associated with an increased risk of diabetes, blood cholesterol and blood pressure. Nevertheless, those who are generally obese or overweight, also have these conditions.
Research shows higher rates of CHD in economically deprived communities; this is usually related to several factors to include behaviour, health status, earlier life factors, access or uptake of healthcare services, social positioning as well as material differences. Even though death rates from CHD are declining, the variations amongst different socio-economical groups are still preserved.
Improving the Condition
Health Care professionals strongly believe that the condition can be well managed and controlled with pharmaceutical and lifestyle interventions. The following are considered to be the core elements of appropriate lifestyle interventions:
- Good education and knowledge about CHD and how to manage the condition at home.
- Regular exercise
- A great deal of attention being paid to all the therapeutic details
- Easy access to a health care professional should the condition worsen
Despite an inadequate diagnosis of heart failure, there is limited research or evidence to indicate that health professionals have a proper discussion with their suffering patients in an open and timely manner, which is almost always taken for granted with cancer suffers. Patients who are dying as a result of heart failure should be offered an equivalent level of access to specialist palliative care as cancer patients, with an emphasis being placed on general wellbeing and proper symptom control.
There is an extensive amount of evidence from various countries around the world that shows that introducing specialist nurses to heart failure shows notable improvements like a 50% reduction in hospital readmission rates and time spent in hospital by patients; a huge improvement in overall quality of life; a reduction of mortality rates between 12 to 18 months of implementing a programme and a massive reduction in NHS expenditure.