Hospital care and procedures

This section provides an overview of hospital care for all cardiovascular diseases (CVD) in the Australian population. For information on hospitalisations for particular CVD subtypes, refer to the relevant page.

A hospitalisation for CVD may be for medical, surgical, or other acute care, for subacute care (for example rehabilitation) or for non-acute care (for example, maintenance care for a person with limitations due to a cardiovascular condition).

Many patients who are hospitalised with acute cardiovascular events will be cared for in a specialist unit:

  • in 2019, there were 101 coronary care units in Australian public hospitals and a further 38 cardiac surgery units (AIHW 2020)
  • in 2019, there were 91 specialised stroke units (Stroke Foundation 2019).

Hospitalisation for all cardiovascular disease

In 2018–19, there were 591,000 hospitalisations where CVD was recorded as the principal diagnosis. This represented 5.2% of all hospitalisations in Australia in 2018–19.

Of these, 530,000 (90%) were for acute care—that is, care in which the intent is to perform surgery, diagnostic or therapeutic procedures in the treatment of illness or injury).

Of all hospitalisations for CVD in 2018–19:

  • 27% had a principal diagnosis of coronary heart disease, followed by
  • atrial fibrillation (12%)
  • heart failure and cardiomyopathy (12%)
  • stroke (11%)
  • peripheral arterial disease (5.5%)
  • hypertensive disease (2.4%)
  • rheumatic heart disease (0.7%) (Figure 1).

Figure 1: Major causes of cardiovascular disease hospitalisations (principal diagnosis), by sex, 2018–19

The bar chart shows the number of hospitalisations for selected cardiovascular diseases in 2018–19, ranging from 161,000 for a principal diagnosis of coronary heart disease to 4,400 for rheumatic heart disease.

Age and sex

In 2018–19, rates of hospitalisation with CVD as the principal diagnosis:

  • were 1.6 times as high for males compared with females (2,500 and 1,600 per 100,000 population), after adjusting for age. Age-specific rates were higher among males than females across all age groups (Figure 2)
  • increased with age, with over 4 in 5 (83%) CVD hospitalisations occurring in those aged 55 and over. CVD hospitalisation rates for males and females were highest in the 85 and over age group (20,700 and 16,200 per 100,000 population)—1.4 times as high as those in the 75–84 age group for males and 1.6 times as high among females (15,000 and 10,200 per 100,000) (Figure 2).

Figure 2: Cardiovascular disease hospitalisation rates, principal diagnosis, by age and sex, 2018–19

The bar chart shows cardiovascular disease hospitalisation rates by age group in 2018–19. These were highest among men and women aged 85 and over (21,000 and 16,000 per 100,000 population).

Trends

The number of acute care hospitalisations with CVD as the principal diagnosis increased by 35% between 2000–01 and 2018–19, from 391,000 to 530,000 hospitalisations.

Despite increases in the number of hospitalisations, the age-standardised rate declined by 13% over this period, from 2,100 to 1,800 per 100,000 population.

The rate of CVD hospitalisations for males was higher than for females across the period, with both showing similar declines (Figure 3).

Figure 3: Acute care cardiovascular disease hospitalisations rates, principal diagnosis, by sex, 2000–01 to 2018–19

The line chart shows declines in age-standardised rates of male and female acute care CVD hospitalisations between 2000–01 and 2018–19, from 2,570 to 2,219 per 100,000 population for males, and from 1,614 to 1,398 for females.

Length of stay in hospital

The length of time that people spend in hospital for CVD has decreased over the past 3 decades. Among those hospitalised for 1 night or more with CVD as a principal diagnosis, the average length of stay declined from 9.6 days in 1993–94 to 7.9 days in 2007–08 and 6.0 days in 2018–19. In 2018–19, 28% of people admitted to hospital with CVD were discharged the same day.

Of those hospitalised with CVD in 2018–19, patients with stroke tended to stay longest—an average of 11.9 days, followed by patients with congenital heart disease (8.2 days) peripheral arterial disease (6.9 days), and coronary heart disease (4.4 days).

Average length of stay in hospital increases with age. Those aged 85 and over stayed an average of 7.2 days, compared with 4.9 days for those aged 25–34 years. The longer lengths of stay among older people reflect the increased complexity and multiplicity of their conditions.

Variation among population groups

Aboriginal and Torres Strait Islander people

In 2018–19, there were around 16,100 hospitalisations with a principal diagnosis of CVD among Aboriginal and Torres Strait Islander people.

After adjusting for differences in the age structure of the populations:

  • the rate among Indigenous Australians was 1.7 times as high as the non-Indigenous rate (3,300 and 1,900 per 100,000 population)
  • the disparity between Indigenous and non-Indigenous Australians was greater for females—2.0 times as high (3,000 and 1,500 per 100,000 population) compared with 1.5 times as high for males (3,600 and 2,400 per 100,000 population).

Socioeconomic group

In 2018–19, CVD hospitalisation rates were almost 20% higher for people living in the lowest socioeconomic areas compared with those in the highest socioeconomic areas—2,200 and 1,800 per 100,000 population.

The disparity between the lowest and highest socioeconomic areas was greater for females than males (1.24 and 1.16 times as high) (Figure 4).

Remoteness area

In 2018–19, CVD hospitalisation rates were around 30% higher among those living in Remote and very remote areas compared with those in Major cities (2,500 and 1,900 per 100,000 population).

This largely reflects disparities in female rates―2,200 and 1,500 per 100,000 population―for males, the difference was smaller (2,700 and 2,400 per 100,000).

Higher hospitalisation rates in Remote and very remote areas are likely to be influenced by the higher proportion of Aboriginal and Torres Strait Islander people living in these areas, who have higher rates of CVD than other Australians.

CVD patients are often transferred from a local regional hospital to a larger urban hospital where more intense or critical care can be provided. In 2018–19, 17% of CVD hospitalisations (principal and/or additional diagnosis) in Remote and very remote areas were transferred to another acute hospital, compared with 16% in Outer regional areas, 14% in Inner regional areas and 10% in Major cities.

The higher rates of transfers are often necessary because certain cardiac procedures, such as angiograms and cardiac revascularisation, are generally performed in large hospitals, which are predominantly located in urban areas.

Figure 4: Cardiovascular disease hospitalisation rates, principal diagnosis, by population group and sex, 2018–19

The horizontal bar chart shows that male and female CVD hospitalisation rates in 2018–19 were higher among Indigenous Australians, people living in the lowest socioeconomic areas, and people living in remote and very remote areas.

Hospital procedures

This section reports on a range of common procedures which diagnose or treat CVD, and are performed on patients admitted to hospital.

Coronary angiography

Coronary angiography is a diagnostic procedure which provides a picture of the coronary arteries—those that supply blood to the heart itself—to determine whether they may be narrowed or blocked. A catheter is guided to the heart where a special dye is released into the coronary arteries before X-rays are taken.

Coronary angiography provides medical professionals with the information to decide on treatment options, such as the need for coronary revascularisation procedures.

  • In 2018–19, there were 141,000 coronary angiography procedures reported for patients admitted to hospital—93,400 (66%) for males and 47,500 (34%) for females.
  • Between 2000–01 and 2018–19, the age-standardised rate of coronary angiography procedures increased from 572 to 662 per 100,000 population (15%) in males, and from 263 to 305 per 100,000 population (16%) in females.

Echocardiography

Echocardiography is a diagnostic procedure which takes moving pictures of the heart using high frequency sound waves (ultrasound).

With these it is possible to measure the size of the various heart chambers, to study the appearance and motions of the heart valves, and to assess blood flow through the heart.

Imaging services, including intraoperative ultrasounds are not usually coded on hospital records, although transoesophageal echocardiogram (TOE) are an exception and are generally coded. Note, however, that the numbers reported here may be underestimates.

  • In 2018–19, there were 47,000 echocardiography procedures reported for patients admitted to hospital—31,800 (68%) for males and 15,100 (32%) for females.
  • The age-standardised rate of echocardiography procedures was 228 per 100,000 population in males, and 101 per 100,000 population in females.

Percutaneous coronary interventions

Percutaneous coronary interventions (PCIs) restore blood flow to blocked coronary arteries. There are two types: coronary angioplasty without stent, and coronary stenting.

Coronary angioplasty involves inserting a catheter with a small balloon into a coronary artery, which is inflated to clear the blockage. Coronary stenting is similar, but involves inserting a stent (an expandable mesh tube) into the affected coronary arteries.

  • In 2018–19, 45,900 PCIs were performed on patients admitted to hospital, of which 34,800 (76%) were for males and 11,200 (24%) for females (Figure 1).
  • Between 2000–01 and 2018–19, the age-standardised  rate of PCIs increased from 178 to 247 per 100,000 population (39%) in males, and from 57 to 71 per 100,000 population (25%) in females.

Coronary artery bypass grafting

Coronary artery bypass grafting (CABG) is a surgical procedure that uses blood vessel grafts to bypass blockages in the coronary arteries and restore adequate blood flow to the heart muscle. The surgery involves taking a blood vessel from a patient’s inner chest, arm or leg and attaching it to the vessels on the outside of the heart to bypass a blocked artery.

  • In 2018–19, there were 12,600 CABG procedures performed on patients admitted to hospital—10,400 (83%) for males and 2,200 (17%) for females (Figure 1).
  • Between 2000–01 and 2018–19, the age-standardised rate of CABG decreased from 141 to 72 per 100,000 population (–49%) in males, and from 39 to 14 per 100,000 population (–64%) in females.
  • Although rates of CABG have declined, the procedure remains a recommended treatment for certain patients with complex cardiovascular conditions (NHF & CSANZ 2016).

Figure 1: Percutaneous coronary interventions and coronary artery bypass grafts, by sex, 2000–01 to 2018–19

The line chart shows that the number of percutaneous coronary interventions for both males and females increased between 2000–01 and 2018–19, whereas the number of coronary artery bypass grafts declined.

Heart valve repair or replacement

Heart valve repair or replacement procedures are performed when the normal flow of blood through the heart is disrupted by damaged valves, making it harder for the heart to pump blood effectively. This can lead to heart failure. The damage to heart valves may be caused by acute rheumatic fever or rheumatic heart disease, coronary heart disease, or forms of congenital heart disease.

  • In 2018–19, there were 11,400 heart valve repair or replacement procedures performed on patients admitted to hospital—7,300 (64%) for males and 4,100 (36%) for females.
  • The age-standardised rate of heart valve repair or replacement procedures was 53 per 100,000 population in males, and 26 per 100,000 population in females.

Pacemaker insertion

Pacemakers are small devices that are placed in the chest or abdomen to help control abnormal heart rhythms. These devices use electrical pulses to prompt the heart to beat at a normal rate.

  • In 2018–19, there were 18,100 pacemaker insertion procedures performed on patients admitted to hospital—10,700 (59%) for males and 7,400 (41%) for females.
  • The age-standardised rate of pacemaker insertion procedures was 77 per 100,000 population in males, and 44 per 100,000 population in females.

Cardiac defibrillator implant

A cardiac defibrillator implant is a device implanted into a patient’s chest that monitors the heart rhythm and delivers electric shocks to the heart when required to eliminate abnormal rhythms. They are effective in preventing sudden cardiac death in people at high risk of the life-threatening cardiac arrhythmia known as ventricular fibrillation.

  • In 2018–19, there were 4,000 cardiac defibrillator implant procedures performed on patients admitted to hospital—3,100 (78%) for males and 867 (22%) for females.
  • The age-standardised rate of cardiac defibrillator implant procedures was 22.4 per 100,000 population in males, and 5.9 per 100,000 population in females.

Carotid endarterectomy

Carotid endarterectomy is a procedure where atherosclerotic plaques are surgically removed from the carotid arteries in the neck, which supply blood to the brain. This procedure is used to reduce the risk of stroke caused by blockage.

  • In 2018–19, there were 2,000 carotid endarterectomy procedures performed on patients admitted to hospital—1,500 (74%) for males and 500 (26%) for females.
  • The age-standardised rate of carotid endarterectomy procedures was 10.5 per 100,000 population in males, and 3.3 per 100,000 population in females.

Heart transplants

A heart transplant involves implanting a working heart from a recently deceased organ donor into a patient. It is usually used to treat severe forms of heart failure or coronary artery disease.

  • In 2018–19, there were 123 heart transplants performed—78 (63%) for males and 45 (37%) for females.
  • The age-standardised rate of heart transplants was 0.6 per 100,000 population in males, and 0.4 per 100,000 population in females.

The Australian and New Zealand Organ Donation Registry (ANZOD) records and reports on organ donation within Australia and New Zealand. Of the 548 deceased organ donors in 2019 in Australia, 123 (22%) had a heart retrieved. From these heart donors there were 113 heart transplant recipients. Of these, 2 received heart/double lung transplants and 4 received a combined heart/kidney transplant (ANZOD 2020).