Director of Public Health Annual Report 2022: Preventing heart disease and stroke in Buckinghamshire

The rate of emergency admissions for cardiovascular disease in Buckinghamshire has been 25% lower than England between 2010/11 and 2020/21. Over this period there has been a 7% rise in emergency admissions in Buckinghamshire, compared to a 2% fall nationally (the latter being predominantly driven by a fall during the pandemic).

The rise in emergency admissions appears to be driven by heart conditions (a 34% rise in heart failure and a 15% rise in heart attacks and angina), with the rate of admissions for stroke/transient ischaemic attack falling by 20% between 2010/11 and 2020/21 in Buckinghamshire. These are all more pronounced than the national trends which have seen a 12% rise in heart failure, a 15% fall in heart attacks and angina and a 13% fall in stroke/TIA.

Despite the much lower death rates and emergency admission rates for cardiovascular disease, the rate of planned admissions for cardiovascular diseases in Buckinghamshire has been higher than the national average in recent years. Pre-pandemic the rate of planned admissions was falling faster nationally than locally (28% nationally versus 15% locally between 2011/12 and 2019/20), but during the pandemic the planned admission rates have fallen similarly (35% nationally and 36% locally).

The rate of emergency admissions for cardiovascular diseases is consistently significantly higher in more deprived areas than in less deprived areas within Buckinghamshire – between 2011/12 and 2020/21 it was on average 1.6 times higher in the most deprived than the least deprived quintile. Acute myocardial infarction/angina and heart failure are both 1.9 times higher and stroke is 1.7 times higher in the most deprived than the least deprived quintile between 2011/12 and 2020/21.

For most of the cardiovascular conditions analysed, the gap between the least and most deprived areas in Buckinghamshire has remained similar over the past 10 years. However, the gap in admission rates between deprivation quintiles has widened for stroke and transient ischaemic attack. The admission rate for stroke/transient ischaemic attack is now 1.9 times

higher in the most deprived than the least deprived quintile, compared to an average of 1.7 times higher over the last ten years.

The rate of planned cardiovascular disease admissions was on average 1.2 times higher in the most deprived than the least deprived quintile between 2011/12 and 2020/21. This is despite emergency cardiovascular disease admission rates being 1.6 times higher, all-age cardiovascular disease death rates being 1.5 times higher and premature cardiovascular disease death rates being 2.6 times higher in the most deprived compared to the least deprived quintile in Buckinghamshire. The reasons for this need to be explored.

The rate of emergency admissions for cardiovascular diseases is consistently significantly higher in men than in women – averaging at 1.6 times higher in men in Buckinghamshire which is similar to the national picture. For both men and women rates of cardiovascular disease emergency admissions are lower in Buckinghamshire than nationally.

However, despite having lower emergency admission rates than the national average, Buckinghamshire men have had a 13% higher rate of planned admissions for cardiovascular disease in Buckinghamshire than the national average in 2020/21. Buckinghamshire women have generally lower or similar rates of planned admissions than the national average. During this time the rate of planned admissions in men has been 2.6 times higher than in women in Buckinghamshire in 2020/21.

The rates of emergency cardiovascular admissions over the three years pre-pandemic (2017/18 to 2019/20) were highest for High Wycombe, Aylesbury and Beeches Community Boards at 1016, 988 and 943 per 100,000 per year – all statistically significantly higher than the Buckinghamshire average of 824 per 100,000 per year.

High Wycombe also has the highest rate of elective cardiovascular disease admissions over the three years pre-pandemic (2017/18 to 2019/20) at 869 per 100,000 per year compared to a Buckinghamshire average of 723 per 100,000. However, during the pandemic the rate of elective cardiovascular disease admissions fell more for High Wycombe to below the Buckinghamshire average during 2020/21 (457 versus 461 per 100,000).