treatment of cardiac diseases

Treatment for cardiovascular disease

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Medicines for cardiovascular disease
Hospitalisations
Hospital procedures
Stroke units
Rehabilitation

Medicines for cardiovascular disease

Cardiovascular medicines are key to preventing and treating cardiovascular disease (CVD). With appropriate medication, patients with CVD or those at risk of the disease can improve their quality of life and increase their life expectancy. 

Antithrombotic medicines

Antithrombotic medicines act by preventing the formation of blood clots or by dissolving existing blood clots.
These medicines are usually taken over a long period to reduce the risk of heart attack and death. They also reduce the risk of subsequent strokes and disability among patients with a history of stroke.
In 2008, the defined daily dose (DDD) per 1,000 people per day for antithrombotic medicines was 37.8, up from 34.5 in 2006 (Table 1) (55KB XLS).

Table 1: Prescription rates for cardiovascular disease medications, defined daily dose per 1,000 people per day, 2006 and 2008

Medicine	Change between 2006 and 2008
Antithrombotic medicines
Blood pressure-lowering medicines
Diuretics
Beta-blockers
Calcium-channel blockers
Renin-angiotensin system agents
Lipid-modifying medicines
Other medicines
Nitrates	steady
Antiarrhythmics

Note: indicates an increase and   a substantial increase.
Source: AIHW analysis of data supplied by the DoHA from the Pharmaceutical Benefits Data System.

Medicines to lower blood pressure

Medicines to lower blood pressure, or antihypertensives, are used to treat high blood pressure and have been shown to significantly reduce the number of deaths from heart attacks and stroke.
Diuretic medicines increase water loss through urination, leading to a reduction in blood volume (and hence blood pressure). The prescription rate for diuretics increased slightly from 44.3 DDD/1,000/day in 2006 to 45.6 DDD/1,000/day in 2008 (Table 6.1) (55KB XLS).
Beta-blocking agents reduce the heart's activity by suppressing certain signals to it that cause it to beat faster and harder.
There was a small increase in the supply of beta-blockers between 2006 and 2008 (25.8 to 26.8 DDD/1,000/day) (Table 6.1) (55KB XLS).
Different calcium-channel blockers act on different parts of the heart and circulation to reduce the force of contraction of the heart. This reduces both blood pressure and the effects of angina.
The rate at which calcium-channel blockers were prescribed increased from 48.4 DDD/1,000/day in 2006 to 53.8 in 2008 (Table 6.1) (55KB XLS).
Renin-angiotensin system agents reduce blood pressure by blocking the effects of the renin-angiotensin system, a hormone system of the body which regulates blood pressure.
Between 2006 and 2008, the supply of renin-angiotensin system agents increased from 165.6 to 193.6 DDD/1,000/day (Table 6.1) (55KB XLS).

Lipid-modifying medicines

Lipid-modifying medicines control blood cholesterol level.
There was a large increase in the use of lipid-modifying medicines between 2006 and 2008 (101.0 to 132.2 DDD/1,000/day) (Table 6.1) (55KB XLS).

Other medicines

Nitrates dilate heart blood vessels and reduce the work done by the heart.
The prescription rate of nitrates remained fairly steady between 2006 and 2008 (13.0 and 12.7 DDD/1,000/day) (Table 6.1) (55KB XLS).
Antiarrhythmic medicines are given either to restore normal heart rhythm or prevent serious abnormal heart rhythms (arrhythmias).
The supply of these medicines increased from 0.6 DDD/1,000/day in 2006 to 1.9 in 2008 (Table 6.1) (55KB XLS).

Hospitalisations

All cardiovascular diseases (CVD)

In 2009–10, there were 482,252 hospitalisations with a principal diagnosis of CVD in Australia.
The rate of CVD hospitalisations increases rapidly with age and in 2009–10 almost eight in 10 (78%) were for people aged 55 years and over.
Males had higher rates of CVD hospitalisations than females in all age groups.
The age-standardised rate for males (2,495 per 100,000 people) was 1.6 times as high as that for females (1,603 per 100,000 people).

Figure: Cardiovascular disease hospitalisation rates, principal diagnosis, by age and sex, 2009–10

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.2) (55KB XLS).

Coronary heart disease (CHD)

In 2009–10, there were 153,833 hospitalisations with a principal diagnosis of CHD (2% of all hospitalisations and 32% of hospitalisations for CVD).
The CHD hospitalisation rate was nearly twice as high for males as it was for females in each age group.
Around 60% of hospitalisations with CHD were among people aged 65 years and over.

Figure: Coronary heart disease hospitalisation rates, principal diagnosis, by age and sex, 2009–10

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.3) (55KB XLS).

Stroke

In 2009–10, there were 35,345 hospitalisations in Australia with a principal diagnosis of stroke (0.4% of all hospitalisations). Stroke accounted for 7% of all CVD hospitalisations.
Stroke hospitalisation rates increased rapidly among the most elderly with rates for those aged 85 years and over almost twice as high as for the 75–84 year age group, and 11 times the rate among those aged 55 to 64 years.
Approximately 65% of stroke hospitalisations occurred among people aged 70 years and over.
Between the ages 45 and 84 years, males had higher rates of stroke hospitalisation than females, after which their rates were similar to females.
Beyond 85 years females accounted for 64% of hospitalisations, reflecting the greater proportion living into old age.

Figure: Stroke hospitalisation rates, principal diagnosis, by age and sex, 2009–10

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.4) (55KB XLS).

Hospital procedures

Coronary angiography

In 2007–08, a total of 110,611 coronary angiography procedures were performed in hospital. The majority of these procedures were performed on males: 73,011 procedures (66%) compared with 37,600 (34%) on females.
The rate of coronary angiography procedures was also higher for males than for females: in 2007–08, the age-adjusted rate was 676 per 100,000 males and 319 per 100,000 females.
The rate of coronary angiography procedures increased with age until 75-84 years, after which the rate decreased.

Figure: Coronary angiography procedure rates, by age and sex, 2007–08

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.5) (55KB XLS).

Computerised tomography (CT) brain scan

A computerised tomography (CT) brain scan is often used for stroke diagnosis but can be used for a number of non-stroke conditions, such as head injury. To exclude such cases, only procedures where the principal diagnosis was stroke or transient ischaemic attack (TIA) are used here.
In 2007–08, 34,441 CT brain scan procedures were performed on patients with a principal diagnosis of stroke or TIA.
The procedures were almost evenly divided between males and females, with males receiving 17,457 procedures (51%) and females 16,984 (49%).
However, the rate for CT brain scans was higher in men than women (171 compared with 131 per 100,000 people).

Percutaneous coronary interventions (PCIs)

In 2007-08, a total of 34,972 percutaneous coronary interventions (PCIs) were performed, three-quarters of which (26,109) were for males.
The rate for PCIs for males was much higher than that for females (241 compared with 74 per 100,000 people).
The rate of PCIs increased steadily with age until the 75–84 years age group and then declined for those 85 years and over.

Figure: Percutaneous coronary intervention rates, by age and sex, 2007-08

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.6) (55KB XLS).

Coronary artery bypass grafting (CABG)

In 2007–08, 13,612 coronary artery bypass grafting (CABG) procedures were performed. These procedures were performed much more often on males (10,648 or 78%) than females (2,964 or 22%).
The rate of CABG procedures increased until the age of 75-84 years. Age specific procedure rates were higher for males than for females across all age groups.

Figure: Coronary artery bypass graft rates, by age and sex, 2007-08

Source: AIHW National Hospital Morbidity Database. Source data (Table 6.7) (55KB XLS).

Carotid endarterectomy

The carotid endarterectomy procedure is used to reduce the risk of stroke caused by blockage in the carotid artery.
In 2007-08 there were 2,441 carotid endarterectomy procedures performed on hospitalised patients.
More patients were male (71%) than female (29%). Similarly, the age-standardised rate of procedures was higher for males (17 procedures per 100,000 of the people) than for females (6 per 100,000 people).

Stroke units

Caring for people in specialised stroke units significantly reduces death and disability after stroke compared with conventional care in a general ward. Hence stroke units are an important part of rehabilitation.
Findings from the National Stroke Audit Acute Services Organisational Survey Report 2011 on stroke units in Australian hospitals include:

• the number of stroke units and stroke beds has increased since 2007, from 54 to 74 stroke units and from 391 to 549 dedicated stroke unit beds.
• of the 74 reported stroke units, 70 (95%) were located in urban areas comprising 56 (76%) in metropolitan and 14 (19%) in regional areas.
• there were 549 dedicated stroke unit beds in Australia in 2011; the majority were in NSW (34%), Victoria (24%) and Queensland (20%).
• despite an increase in the number of stroke units and stroke unit beds, access is low when compared to other countries.
• on the day of the survey only 58% of patients across Australia were reported to be receiving stroke unit care.

Stroke rehabilitation aims to maximise a patient's physical, psychological, social and financial independence, and ideally begins the first day after a stroke. Most patients can function better after rehabilitation, hence significantly improving their overall health and wellbeing.
In 2007, there were 4,937 stroke rehabilitation discharge episodes from subacute inpatient rehabilitation programs. In over 80% of these rehabilitation episodes, the patient was later discharged to the community.

Cardiac rehabilitation

Cardiac rehabilitation refers to all measures that help people who have recently had an acute coronary event or heart surgery return to a normal and productive life.
It aims to minimise recovery time, and maximise the patient's physical, psychological and social functioning. It also encourages behaviours to minimise the risk of further cardiac events.
Outpatient cardiac rehabilitation consists of supervised programs that usually commence soon after discharge from hospital (ideally within a few days) and may continue for 2–3 months.
There are no national data on episodes of outpatient cardiac rehabilitation.