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The level of need in the population

Adults :: CVD :: The level of need in the population


Overall CVD Prevalence

There are 21,409 people estimated to have CVD in Medway, based on the Eastern Region Public Health Observatory (ERPHO) modelling. This represents 10.4% of the population aged 16 years and over in 2011 in Medway and is lower than the prevalence estimate for the South East (11.8%) and England (11.7%).[1] Table 1 shows the recorded and modelled prevalence estimates of CVD for 2016.

  Estimated prevalence (Medway) Recorded prevalence 2016 (Medway) Recorded prevalence 2016 (South region) Recorded prevalence 2016 (England)
Atrial Fibrillation n/a 1.46 2.00 1.71
Coronary Heart Disease 4.76 2.62 3.16 3.20
Heart failure n/a 0.75 0.74 0.76
Hypertension 23.55 14.05 14.05 13.81
Peripheral Arterial Disease n/a 0.45 0.59 0.61
Stroke and Transient Ischaemic Attack (TIA) 2.09 1.22 1.87 1.74
Table 1: Recorded and modelled prevalence estimates of CVD[1],[2],[3]

Inequalities in life expectancy

Over the period 2012-2014, the life expectancy at birth of both males and females in Medway is lower than the England average by -0.9 and 1.0 years respectively[4].

The mortality rate from CVD is slightly lower in Medway females than England females so does not contribute to this gap. In contrast, in males the mortality rate is higher and contributes just over 4% of the gap in life expectancy. For information, the main causes of death which contribute to the gap in both sexes are cancer and respiratory disease[4].

However, deaths from CVD are a much greater contributor to the life expectancy gap between the most deprived and least deprived areas in Medway; 24% in men and 27% in women. This is the most significant contribution of a single disease group to the life expectancy gap. In 2012–14, 103 deaths in the most deprived quintile in Medway due to circulatory disease were considered excess deaths[4].


Overall mortality

CVD is the second most common cause of mortality in Medway. In 2015, 23.6% of deaths in Medway were caused by CVD, representing a decrease of 37.1% from 2004 (Figure 1). The proportion in 2015 is significantly lower than the England average (26.2%), and is the second lowest proportion across all local authorities in the South East[5]. This is whilst the proportion caused by cancer has increased slightly and is now the most common cause of death in Medway (rising from 27.3% in 2004 to 30.2% in 2015)[5].

Figure 1: Trends in proportion of deaths due to CVD
Figure 1: Trends in proportion of all deaths where underlying cause is CVD[5]

Premature mortality

CVD is the also the second largest cause of premature mortality. Eighteen per cent of premature deaths in women and 28% in men are due to circulatory disease. In Medway, the CVD mortality rate for all persons under 75 is 79.6 per 100,000 (2013–2015). This is not significantly different from the CVD mortality rate in England (74.7 per 100,000)[6]. The under 75 CVD mortality rate in Medway is significantly higher for males (108.8 per 100,000) than for females (51.3 per 100,000).[6] The trend with the latest available data is shown in Figure 2.

Figure 2: Circulatory disease mortality rate
Figure 2: Under-75 mortality rate from circulatory disease[6]

Preventable mortality

Preventable mortality rates give an indication of the number of deaths that could potentially be avoided by the implementation of public health interventions. During the period 2013–2015, the under 75 mortality rate from CVD considered preventable in Medway was 55.7 per 100,000, representing 357 deaths. This is significantly greater than the England average figure of 48.1 per 100,000[6].

Hospital admissions


In 2015/16, there were 4,616 CVD admissions among Medway residents; 1,950 elective (42.2%) and 2,666 (57.8%) emergency admissions. Overall, admissions have increased by 25.4% between 2006/07 and 2015/16. The increase in elective admissions is 25.6%, compared to 25.3% in emergency admissions. There has been a sharp increase in emergency admissions for CVD over the past three years. Figure 3 highlights the trends in the five most common types of CVD in patients aged less than 75 years. Table 2 shows the breakdown of these five types for the latest year (2015/16).

Figure 2: Emergency hospital admissions
Figure 2: Under-75 emergency hospital admissions[7]
  Overall number of emergency admissions Percentage aged under 75
Atrial fibrillation 271 57.9
Coronary heart disease 686 67.1
Heart failure 315 38.7
Peripheral arterial disease 31 54.8
Stroke / TIA 408 54.7
Table 2: Emergency hospital admissions for cardiovascular disease 2015/16[7]


[1]   Eastern Region Public Health Observatory. Model Disease estimates for PCTs in England 2011; Association of Public Health Observatories.
[2]   National Cardiovascular Intelligence Network. Hypertension prevalence in England 2014 October, 2016; Public Health England. .
[3]   NHS Digital. Quality and Outcomes Framework
[4]   Public Health England. The Segment Tool: Segmenting life expectancy gaps by cause of death 2016;
[5]   National End of Life Care Intelligence Network. End of Life Care Profiles
[6]   Public Health England. Public Health Outcomes Framework data tool
[7]   Medway Public Health Intelligence team. Secondary Uses Service Hospital activity analysis