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Heart Diseases

Volume 487: debated on Tuesday 10 February 2009

To ask the Secretary of State for Health how many people were (a) diagnosed with and (b) received treatment for heart disease in (i) England, (ii) the North East, (iii) the Tees Valley district and (iv) Middlesbrough South and East Cleveland constituency in each of the last 10 years. (253426)

Please see the following tables and notes.

Table 1: Number of people diagnosed with heart disease

Financial year

Stockton on Tees Teaching primary care trust (PCT)1

Middlesbrough PCT2

Redcar and Cleveland PCT3

North East total4

England

2007-08

7,943

6,513

6,901

127,972

1,892,432

2006-07

8,007

6,537

6,982

129,478

1,898,565

2005-06

8,063

8,485

5,204

131,123

1,900,640

2004-05

8,079

8,541

5,313

131,668

1,893,184

1 Formerly North Tees PCT. Following the PCT reconfiguration in 2006 2 a part of Middlesbrough PCT joined with others to form Redcar and Cleveland PCT. Middlesbrough PCT remained but as a smaller PCT. 3 Langbaurgh PCT merged with a part of Middlesbrough PCT and became Redcar and Cleveland PCT. 4 For 2007-08 and 2006-07 the North East total is the total for North East Strategic Health Authority (SHA). For 2005-06 and 2004-05 the North East total is the sum of Northumberland, Tyne and Wear SHA and County Durham and Tees Valley SHA.

Table 2: Number of people who received treatment for heart disease—Activity in English NHS Hospitals and English NHS commissioned activity in the independent sector

Financial year

Stockton on Tees Teaching PCT1

Middlesbrough PCT2

Redcar and Cleveland PCT3

North East4

England

2006-07

1,033

639

608

16,374

310,642

2005-06

1,145

885

491

16,363

312,164

2004-05

1,234

1,028

554

16,987

311,532

2003-04

1,134

1,146

609

17,934

310,418

2002-03

1,163

1,188

644

18,465

306,380

2001-02

1,159

1,275

734

18,812

295,050

2000-01

1,124

1,372

738

20,113

293,911

1999-00

1,109

1,474

779

19,723

289,729

1998-99

974

1,500

752

19,691

290,391

1997-98

957

1,352

665

18,289

284,269

1 Formerly North Tees PCT. Following the PCT reconfiguration in 2006 2 a part of Middlesbrough PCT joined with others to form Redcar and Cleveland PCT. Middlesbrough PCT remained but as a smaller PCT. 3 Langbaurgh PCT merged with a part of Middlesbrough PCT and became Redcar and Cleveland PCT. 4 For 2007-08 and 2006-07 the North East total is the total for North East SHA. For previous years the North East total is the sum of the constituent organisations existing at the time. Notes: The Information Centre (IC) have provided data from the national Quality and Outcomes Framework (QOF) to answer part (a) and data from the Hospital Episode Statistics (HES) to answer part (b). (a) The national QOF records the number of people recorded on practice disease registers. A register exists for coronary heart disease (CHD). Register counts are available for the last four financial years. The IC are unable to supply information for all the areas requested as some are not health regions. Where this occurs we have supplied information for the health areas that best fit those requested. Furthermore, some of these health areas have changed under the reconfiguration of PCTs and SHAs in 2006. (b) Figures from the HES give a count of hospital admission episodes with a primary diagnosis of “coronary heart disease” (CHD). This is not a count of people treated as the same person could have been admitted several times and this also excludes treatment taking place in primary care. Definitions Table 1 QOF is the national Quality and Outcomes Framework, introduced as part of the new General Medical Services contract on 1 April 2004. Participation by practices in the QOF is voluntary, though participation rates are very high, with most Personal Medical Services practices also taking part. The published QOF information was derived from the Quality Management Analysis System (QMAS), a national system developed by NHS Connecting for Health. QMAS uses data from general practices to calculate individual practices' QOF achievement. QMAS is a national IT system developed by NHS Connecting for Health to support the QOF.

The system calculates practice achievement against national targets. It gives general practices, PCTs and SHAs objective evidence and feedback on the quality of care delivered to patients. The QMAS captures the number of patients on the various disease registers for each practice. The number of patients on the clinical registers can be used to calculate measures of disease prevalence, expressing the number of patients on each register as a percentage of the number of patients on practices' lists. CHD Register—definition In order to call and recall patients effectively in any disease category and in order to be able to report on indicators for coronary heart disease, practices must be able to identify their patient population with CHD. This will include all patients who have had coronary artery revascularisation procedures such as coronary artery bypass grafting (CABG). Patients with Cardiac Syndrome X should generally not be included in the CHD register. Practices should record those with a past history of myocardial infarction as well as those with a history of CHD.

Table 2Ungrossed data Figures have not been adjusted for shortfalls in data (i.e. the data are ungrossed).

Finished admission episodes (hospital admissions)

A finished admission episode is the first period of inpatient care under one consultant within one health care provider. Finished admission episodes are counted against the year in which the admission episode finishes. Admissions do not represent the number of inpatients, as a person may have more than one admission within the year. Primary diagnosis The primary diagnosis is the first of up to 20 (14 from 2002-03 to 2006-07 and seven prior to 2002-03) diagnosis fields in the HES data set and provides the main reason why the patient was admitted to hospital. The ICD-10 codes used to identify CHD are as follows: 120—Angina pectoris 121—Acute Myocardial infarction 122—Subsequent myocardial infarction 123—Certain current complications following acute myocardial infarction 124—Other acute ischaemic heart diseases. 125—Chronic ischaemic heart disease. Number of episodes in which the patient had a (named) primary diagnosis

These figures represent the number of episodes where the diagnosis was recorded in the primary diagnosis field in a Hospital Episode Statistics (HES) record. Data quality HES are compiled from data sent by more than 300 NHS trusts and PCTs in England. Data are also received from a number of independent sector organisations for activity commissioned by the English NHS. The NHS Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data via HES processes. While this brings about improvement over time, some shortcomings remain.

PCT/SHA data quality

PCT and SHA data were added to historic data years in the HES database using 2002-03 boundaries, as a one-off exercise in 2004. The quality of the data on PCT of treatment and SHA of treatment is poor in 1996-97, 1997-98 and 1998-99, with over a third of all finished episodes having missing values in these years. Data quality of PCT of general practitioner (GP) practice and SHA of GP practice in 1997-98 and 1998-99 is also poor, with a high proportion missing values where practices changed or ceased to exist. There is less change in completeness of the residence-based fields over time, where the majority of unknown values are due to missing postcodes on birth episodes. Users of time series analysis including these years need to be aware of these issues in their interpretation of the data. Assessing growth through time HES figures are available from 1989-90 onwards. The quality and coverage of the data have improved over time. These improvements in information submitted by the NHS have been particularly marked in the earlier years and need to be borne in mind when analysing time series. Some of the increase in figures for later years (particularly 2006-07 onwards) may be due to the improvement in the coverage of independent sector activity. Changes in NHS practice also need to be borne in mind when analysing time series. For example, a number of procedures may now be undertaken in outpatient settings and may no longer be accounted for in the HES data. This may account for any reductions in activity over time. Source: Hospital Episode Statistics (HES), The NHS Information Centre for health and social care.