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In the past 20 years death rates for cardiovascular disease (CVD) have fallen markedly, including for coronary heart disease and stroke. But the decline in coronary heart disease death rates may be slowing in the younger age groups.

CVD hospitalisation rates have fallen slowly over the last decade, while rates for most procedures to diagnose and treat people with CVD have increased over that time.

Prescription rates for medicines to control blood pressure and blood cholesterol levels have also increased substantially in the past decade.

There have also been changes in risk factors over time, such as the increase in overweight and obesity and the decline in smoking.

Incidence of major coronary events

The number of major coronary events can be estimated from the number of deaths from heart attacks plus the number of non-fatal hospitalisations. It includes both first and subsequent events.

Incidence rates of major coronary events among 40–90 year olds have declined by almost 40% between 1994 and 2009.

Figure: Rate of major coronary events for people aged 40–90 years, by sex, 1994–2009

Stacked line chart showing, male and females, events per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Sources: AIHW National Hospital Morbidity Database and AIHW National Mortality Database. Source data (Table 3.1) (70KB XLS).

Hospitalisations for cardiovascular disease

Cardiovascular disease (CVD) hospitalisation rates are declining.

The age-standardised rate of hospitalisations with CVD as a principal diagnosis declined between 1993–94 and 2009–10 from 2,312 per 100,000 people to 2,027.

The highest rates (2,441 per 100,000) were reached in 1995–96 and 1997–98.

Male rates were consistently higher than those for females over the same period, with both showing similar falls.

Figure: Cardiovascular disease hospitalisation rates, principal diagnosis, by sex, 1993–94 to 2009–10

Stacked line chart showing, male and females, hospitalisations per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Morbidity Database. Source data (Table 3.2) (70KB XLS).

Coronary heart disease (CHD) hospitalisation rates are declining.

Between 1993–94 and 2009–10, there was steady reduction in the rate of hospitalisations with a principal diagnosis of CHD, from 867 hospitalisations per 100,000 people to 643.

The relative rate of decline was similar for males (76%) and females (73%), although males continued to be hospitalised at much higher rates than females.

Figure: Coronary heart disease hospitalisation rates, principal diagnosis, by sex, 1993–94 to 2009–10

Stacked line chart showing, male and females, hospitalisations per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Morbidity Database. Source data (Table 3.2) (70KB XLS).

Stroke hospitalisation rates are declining.

Between 1998–99 and 2009–10, the age-standardised rate of hospitalisations for stroke fell from 200 to 169 hospitalisations per 100,000 people for males (a 15% decrease), and from 150 to 124 per 100,000 people for females (a fall of 17%).

Figure: Stroke hospitalisation rates, principal diagnosis, by sex, 1998–99 to 2009–10

Stacked line chart showing, male and females, hospitalisations per 100,000 people on y-axis and year on x-axis.

Notes:

  1. Age-standardised to the 2001 Australian population.
  2. Figure begins at 1998–99 for stroke, coinciding with the implementation of ICD-10-AM for hospital coding.

Source: AIHW National Hospital Morbidity Database. Source data (Table 3.2) (70KB XLS).

Deaths from cardiovascular disease

Cardiovascular disease death rates are also declining.

CVD death rates have fallen dramatically since their peak in the late 1960s when CVD was responsible for around 60,000 deaths annually.

Male CVD death rates (1,020 per 100,000) peaked higher than female rates (718 per 100,000) and began to decline a few years later.

Much of the decline in CVD death rates can be attributed to improved prevention, detection and management of CVD in the past 60 years.

Figure: Cardiovascular disease deaths rates, by sex, 1907–2009

Stacked line chart showing, male and females, deaths per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Mortality Database, AIHW GRIM (General Record of the Incidence of Mortality) Books. Source data (Table 3.4) (70KB XLS).

Coronary heart disease death rates are declining but slowing for 35–54 year olds.

Coronary heart disease death rates are declining but the rates of decline are not consistent across age groups, with some age groups showing a slowing in the rate of decline while others continue to decline at accelerated rates.

There was a levelling off among those aged 35–54 between 1999 and 2009 in contrast to those aged 55–74 and 75 and over among whom rates continued to decline.

Figure: Coronary heart disease death rates, underlying cause of death, for people aged less than 55 years, 1987–2009

Stacked line chart showing, age 0-34 and 35-54, deaths per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Sources: AIHW National Hospital Mortality Database, AIHW GRIM (General Record of the Incidence of Mortality) Books. Source data (Table 3.5) (70KB XLS).

Figure: Coronary heart disease death rates, underlying cause of death, for people aged 55 years and above 1987–2009

Stacked line chart showing, age 55-74 and 75 plus, deaths per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Sources: AIHW National Hospital Mortality Database, AIHW GRIM (General Record of the Incidence of Mortality) Books. Source data (Table 3.5) (70KB, XLS)

Survival rates for major coronary events are improving.

Survival rates for major coronary events increased between 1994 and 2009 and are similar for males and females.

In 2009, over 3 in 5 (63%) people who had a heart attack survived, compared with less than half (45%) in 1994. However, the survival rate appears to have plateaued since 2007.

The improved survival rate may be due in part to an increase in the diagnosis of milder forms of acute coronary events, as diagnostic techniques have become increasingly sensitive over time.

Figure: Survival rates for major coronary events for people aged 40–90 years, by sex, 1994–2009 (per cent)

Stacked line chart showing, male and females, per cent on y-axis and year on x-axis.

Note: Standardisation of the case-fatality rates are based on 2001 coronary heart disease (CHD) age-specific CHD events distribution among persons.

Sources: AIHW National Hospital Morbidity Database and AIHW National Mortality Database. Source data (Table 3.1) (70KB, XLS).

Stroke death rates are falling.

Stroke death rates have been declining for several decades.

Between 1987 and 2009 the decline in stroke deaths rates was greatest in those aged 55–74 and 75 years and over.

The rate of decline over the most recent decade has slowed among persons aged 35–54.

The reduced stroke mortality can be attributed, at least partly, to reduced risk factors such as tobacco smoking and hypertension.

Figure: Stroke death rates, underlying cause of death, among people aged less than 55 years 1987–2009

Stacked line chart showing, age 0-34 and 35-54, deaths per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Sources: AIHW National Hospital Mortality Database, AIHW GRIM (General Record of the Incidence of Mortality) Books. Source data (Table 3.6) (70KB XLS).

Figure: Stroke death rates, underlying cause of death, among people aged 55 years and above 1987–2009

Stacked line chart showing, age 55-74 and 75 plus, deaths per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Sources: AIHW National Hospital Mortality Database, AIHW GRIM (General Record of the Incidence of Mortality) Books. Source data (Table 3.6) (70KB XLS).

Hospital procedures for cardiovascular disease

Coronary angiography procedure rates are increasing.

The overall number of coronary angiography procedures increased from 78,981 in 2000–01 to 110,614 in 2007–08: a 40% increase (38% for males and 42% for females).

The rate of procedures increased from 412 per 100,000 people in 2000–01 to 491 per 100,000 in 2007–08.

In 2000–01, there were 574 coronary angiography procedures per 100,000 people for males and 263 for females.

By 2007–08, this rate had increased to 676 procedures for males and 319 for females.

Figure: Coronary angiography procedure rates, by sex, 2000-01 to 2007–08

Stacked line chart showing, male and females, procedures per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Morbidity Database. Source data (Table 3.7) (70KB, XLS).

Percutaneous coronary intervention rates increased but are now stabilising.

Between 2000–01 and 2007–08, the number of percutaneous coronary interventions performed increased by 57%. This increase was greater for males than for females: 58% compared with 52% respectively.

In 2000–01, the age-standardised rate was 117 per 100,000 people. The rate increased to 164 per 100,000 in 2005–06 but then fell slightly to 155 per 100,000 in 2007–08.

The rates for both males and females followed a similar trend over time, although the procedure rates were higher for males than for females in all years.

Figure: Percutaneous coronary intervention rates, by sex, 2000–01 to 2007–08

Stacked line chart showing, male and females, procedures per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Morbidity Database. Source data (Table 3.7) (70KB XLS).

Coronary artery bypass graft rates are declining.

There was a 19% reduction in the overall number of coronary artery bypass grafts (CABGs) performed between 2000–01 and 2007–08, from 16,696 to 13,612. The fall in the number of procedures was higher for females (25%) than for males (16%).

The age-standardised rate of these procedures decreased steadily between 2000–01 and 2007–08, from 87 per 100,000 people to 61 per 100,000.

In 2007–08, the rate for males was 99 per 100,000, compared with 140 in 2000–01. For females, the 2007–08 rate was 25 per 100,000 people compared with 39 in 2000–01.

Figure: Coronary artery bypass graft rates, by sex, 2000–01 to 2007–08

Stacked line chart showing, male and females, procedures per 100,000 people on y-axis and year on x-axis.

Note: Age-standardised to the 2001 Australian population.

Source: AIHW National Hospital Morbidity Database. Source data (Table 3.7) (70KB XLS).

Medication use for cardiovascular disease

The supply of antithrombotic agents is increasing.

Between 1995 and 2009, the supply of antithrombotic agents has increased.

In particular, antiplatelet agents such as aspirin have become common, with a 52-fold increase from 0.6 to 31.9 DDD/1,000/day between 1995 and 2009.

Over the same period, the supply of heparin increased from 0.1 to 1.8 DDD/1,000/day while the supply of vitamin K antagonists increased from 2.7 to 6.2 DDD/1000/day.

Figure: Supply of medicines with antithrombotic effect in the community, 1995–2009

Stacked line chart showing, Vitamin K antagonists, Heparin group and Platelet aggregation inhibiors (excl. heparin), DDD/1,000/day on y-axis and year on x-axis.

Note: Combination medications are excluded.

Sources: AIHW: Senes & Penm 2007 based on data from the Drug Utilisation Sub-Committee database, DoHA; DoHA 2009a; DoHA 2009b; and DoHA 2011. Source data (Table 3.8) (70KB XLS).

The supply of medications to lower blood pressure is increasing.

Between 1995 and 2009, the supply of drugs to lower blood pressure increased by 50% (from 165 to 247 DDD/1000/day) with the biggest increase in the agents acting on the renin-angiotensin system (167%) followed by calcium channel blockers (22%) and beta-blockers (21%). Conversely, the use of diuretics fell by 36%, other antihypertensives fell by 29% and peripheral vasodilators fell by 87%.

Figure: Supply of medicines that lower blood pressure in the community, 1995–2009

Stacked line chart showing, bloood pressure drugs, DDD/1,000/day on y-axis and year on x-axis.

Note: Combination medications are excluded.

Sources: AIHW: Senes & Penm 2007 based on data from the Drug Utilisation Sub-Committee database, DoHA; DoHA 2009a; DoHA 2009b; and DoHA 2011. Source data (Table 3.9) (70KB XLS).

The supply of statins continues to rise.

Between 1995 and 2004, there was a 12-fold increase in the use of statins from 13.5 to 160.4 DDD/1000/day.

The defined daily doses (DDD) for some statins changed between 2006 and 2007, and the DDD/1,000/day based on the new DDDs are available from 2005. The use of statins increased by 38% between 2005 and 2009, from 87 to 120 DDD/1000/day.

There was small increase in the use of other lipid lowering medicines.

Figure: Supply of serum-lipid-reducing agents in the community, 1995–2009

Stacked line chart showing; statins (1995-2004), statins (2005-2009) and other lipid-lowering drugs; DDD/1,000/day on y-axis and year on x-axis.  

Notes:

  1. Combination medications are excluded.
  2. Other serum-lipid-reducing agents include Nicotinic acid and Ezetimibe.
  3. There is a break in the time series for statins because the defined daily dose (DDD) for some statins changed between 2006 and 2007. However, the DDD/1,000/day based on the new DDD are available from 2005 and therefore the break in the time series is shown here from 2005.

Sources: AIHW: Senes & Penm 2007 based on data from the Drug Utilisation Sub-Committee database, DoHA; DoHA 2009a; DoHA 2009b; and DoHA 2011. Source data (Table 3.10) (70KB XLS).

See also Treatment for cardiovascular disease.