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

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20012002

2003

2004 20052006

2007

2008

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30

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50

60

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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