Burden of disease
Burden of disease refers to the quantified impact of living with and dying prematurely from a disease or injury and is measured using disability-adjusted life years (DALY). One DALY is equivalent to one year of healthy life lost.
In 2018, CHD accounted for 6.3% of the total burden of disease in Australia (AIHW 2021a). It comprised 10% of the fatal burden and 2.6% of the non-fatal burden.
The total burden due to CHD was twice as high in males, at 208,000 DALY, as in females (104,000 DALY). It increased rapidly from age 45 onwards – from 8.6 DALY per 1,000 among people aged 45–49, to 210 per 1,000 among people aged 95–99.
Between 2003 and 2018, there was a 26% fall in CHD burden (-112,000 DALY), and the CHD DALY rate reduced by 50%, from 21 to 10 DALY per 100,000 population. The rate of fatal burden of CHD fell by 53%, and the non-fatal burden by 40%. The fall has been attributed to a number of factors, including population growth (+22%), population ageing (+15%) and change in the amount of disease (-63%). See Burden of cardiovascular disease.
In 2018–19, the estimated expenditure on CHD was $2.4 billion. The greatest cost was due to private hospital services and public hospital admitted patient services ($892.2 million and $823.4 million respectively). The estimated Pharmaceutical Benefits Scheme (PBS) expenditure related to CHD was $156.3 million (AIHW 2021b).
See Health expenditure.
Treatment and management
Primary health care professionals, including general practitioners (GPs), practice nurses, nurse practitioners and Aboriginal and Torres Strait Islander health workers, are often the first point-of-care for people who have non-acute cardiovascular disease.
Common actions by primary health care professionals when managing cardiovascular problems include undertaking checks, prescribing medicines, ordering pathology or imaging tests, and referral to specialists.
- In a 2019–20 survey of GP practices, high blood pressure was the single most common chronic condition newly recorded for patients (5.9% of patients) (NPS MedicineWise 2021). Abnormal blood lipids were newly recorded for 3.1% of patients, and cardiovascular disease conditions (including coronary heart disease) for 1.2% of patients.
- In 2021–22, over 112,000 Heart Health Checks (males 55,600, females 57,000) were processed by Medicare. Checks were most commonly conducted among people aged 55–64 (36,600) and 65–74 (33,400) (Services Australia 2022).
See Primary health care.
Almost 112 million PBS prescriptions for cardiovascular system medicines were supplied to the Australian community in 2020–21. These comprised more than one-third (36%) of total PBS prescriptions (Department of Health 2021).
More than three-quarters (79%) of the estimated 1.2 million Australian adults aged 18 and over who had heart, stroke or vascular disease in 2017–18 used a cardiovascular system medicine in the 2 weeks prior to survey (AIHW analysis of ABS 2019b).
See Medicines for cardiovascular disease.
There were 75,900 presentations to Australian public hospital Emergency Departments (EDs) with a principal diagnosis of CHD in 2020–21 – a rate of 295 presentations per 100,000 population (AIHW 2022d).
Of these, 58,200 (77%) were admitted to the hospital to which they presented, 9,600 (13%) departed without being admitted or referred, and 7,300 (10%) were referred to another hospital for admission.
In 2020–21, CHD was the principal diagnosis in about 160,000 hospitalisations (1.4% of all hospitalisations, and 27% of all CVD hospitalisations) (AIHW 2022b). Of these, 36% were for heart attack (57,100) and 22% for angina (35,300).
Hospitalisation rates with CHD as the principal diagnosis were 2.5 times as high for males as for females (740 and 293 per 100,000 population) after adjusting for age. Age-specific rates were higher among males across all age groups.
Between 2000–01 and 2020–21, the age-standardised rate of hospitalisations where CHD was the principal diagnosis declined by 39%, from 833 to 508 hospitalisations per 100,000 population. The decline in hospitalisations over this period was greater among females than among males (45% and 36% respectively).
See Hospital care and procedures
Variation between population groups
The impact of CHD varies between population groups. To account for differences in the age structures of these groups, the data presented below is based on age-standardised rates.
Age-standardised rates of CHD hospitalisation in 2020–21 were 1.5 times as high in Remote and very remote areas as in Major cities (745 and 486 per 100,000 population), and 1.2 times as high in the lowest socioeconomic areas as in the highest (558 and 472 per 100,000 population) (Figure 3).
The age-standardised rate of hospitalisations, deaths and total burden due to CHD were more than twice as high among Aboriginal and Torres Strait Islander people as among non-Indigenous Australians.