Statins for ischaemic heart disease: Excellence and equity
Hackney, Newham & Tower Hamlets
Tower Hamlets
HackneyNewham
CHD Mortality<75yrs x Deprivation (IMD): English LA 2006-8
London PCTs: CHD mortality and deprivation score: 2005-7 directly standardised rate /100,000 persons all ages
Declining CHD: Increasing obesityHackney, Newham, Tower Hamlets PCTs
I % with IHD on statin 3 PCTs 2004- 2010 n≈15,000
Lower cost and greater gainSimvaststin vs atorvastatin
2005Low cost statin agreed.Local guideline
Lower cost and greater gainGeneric statins as % all statins London 2009
1999
2000
20012002
2003
2004 20052006
2007
2008
0
10
20
30
40
50
60
70
80
90
100
0 20 40 60 80 100
%cholesterol<5mmol/l
People with CHD: % on statin
CHD register: cholesterol <5mmol/l and % statins3 E London PCTs ~ 12,000 people
Statins for CHD = better outcomes
Statin prescription effect on cholesterol by ethnic group
% on statin and % cholesterol <5mmol/l by ethnic group: 3 PCTs 2007-2009
• 4000 extra people with IHD on statins
• Without statins 150 MI/CVD deaths/ yr
• Statins prevent 37 MI/CVD deaths/ yr
• East London PCTs above average generic prescribing – lower cost
• South Asian people highest statins
• Still room for improvement
Gains from improvement
• The Clinical Effectiveness Group is funded by Hackney, Newham and Tower Hamlets PCTs
• The three year project on health equity was funded by The Health Foundation
• CEG guidelines are available on-line http://www.ihse.qmul.ac.uk/chs/ceg/clinical_guidelines/index.html
Funding and guidelines