Coronary heart disease statistics

This is the sixteenth edition of Coronary Heart Disease Statistics produced by the British Heart Foundation.

It is divided into 13 chapters.

* The first two chapters on mortality and morbidity deal with demographic trends in CHD and related diseases of the circulatory system.
* Following a section on treatment of CHD there are chapters on the main modifiable risk factors for the disease: smoking, an unhealthy diet, lack of physical activity, a high alcohol consumption, poor psychosocial wellbeing, raised blood pressure, raised blood cholesterol, obesity and diabetes.
* The final chapter provides information about the economic costs of CHD.

The compendium was published by the British Heart Foundation in July 2008.

Stroke statistics

This publication is the latest edition of a series of statistical compendia and supplements that document the burden of cardiovascular disease in the United Kingdom. This series of publications, published by the British Heart Foundation, usually focuses on coronary heart disease, but Stroke Statistics is jointly published by the British Heart Foundation and The Stroke Association and focuses on the important and substantial burden of stroke in the United Kingdom.

Stroke Statistics is designed for policy makers, health professionals, medical researchers and anyone else with an interest in stroke or cardiovascular disease. It aims to provide the most recent statistics related to the burden of stroke and to document the geographic, social and ethnic inequalities in the experience of stroke.

Stroke Statistics is divided into five chapters. Chapter 1 documents trends and patterns in stroke mortality and premature mortality. Chapter 2 reports on the morbidity burden of stroke, both in terms of prevalence (the rate of people who have had a stroke in the past) and incidence (the rate of first ever strokes). Chapter 3 describes the burden of stroke on the National Health Service, in terms of drug therapy, hospitalisations and surgical procedures. Chapter 4 provides estimates of the prevalence of risk factors for stroke, broken down by age, sex, socioeconomic status and ethnicity. Details about Government targets to tackle the risk factor status of the population are also provided where available. Chapter 5 provides new estimates, calculated specifically for Stroke Statistics, of the economic cost of stroke to the National Health Service and to the United Kingdom economy.

Regional and social differences in coronary heart disease

This publication provides statistics on regional and social differences in relation to CHD mortality, morbidity, treatment and risk.

An evidence-based practice approach to improving nursing care of acute stroke in an Australian emergency department

Aims. The aim of this study was to improve the emergency nursing care of acute stroke by enhancing the use of evidence regarding prevention of early complications.
Background. Preventing complications in the first 24–48 hours decreases stroke-related mortality. Many patients spend considerable part of the first 24 hours following stroke in the Emergency Department therefore emergency nurses play a key role in patient outcomes following stroke.
Design. A pre-test/post-test design was used and the study intervention was a guideline for Emergency Department nursing management of acute stroke.
Methods. The following outcomes were measured before and after guideline implementation: triage category, waiting time, Emergency Department length of stay, time to specialist assessment, assessment and monitoring of vital signs, temperature and blood glucose and venous-thromboembolism and pressure injury risk assessment and interventions.
Results. There was significant improvement in triage decisions (21Æ4% increase in triage category 2, p = 0Æ009; 15Æ6% decrease in triage category 4, p = 0Æ048). Frequency of assessments of respiratory rate (p = 0Æ009), heart rate (p = 0Æ022), blood pressure (p = 0Æ032) and oxygen saturation (p = 0Æ001) increased. In terms of risk management, documentation of pressure area
interventions increased by 28Æ8% (p = 0Æ006), documentation of nil orally status increased by 13Æ8% (ns), swallow assessment prior to oral intake increased by 41Æ3% (p = 0Æ003), speech pathology assessment in Emergency Department increased by 6Æ1% (ns) and there was 93Æ5 minute decrease in time to speech pathology assessment for admitted patients (ns).
Relevance to clinical practice. An evidence-based guideline can improve emergency nursing care of acute stroke and optimise patient outcomes following stroke. As the continuum of stroke care begins in the Emergency Department, detailed recommendations for evidence-based emergency nursing care should be included in all multidisciplinary guidelines for the management of acute stroke.

Exercise and Sports Science Australia position statement on exercise training and chronic heart failure

Chronic heart failure (CHF) is a complex syndrome characterised by progressive decline in left ventricular function, low exercise tolerance and raised mortality and morbidity. Regular exercise participation has been shown to be a safe and effective treatment modality in the majority of CHF patients, partially reversing some of the maladaptations evident in myocardial and skeletal muscle function, and resulting in improvements in physical fitness and quality of life, and perhaps reduced mortality. The volume and intensity of exercise that is recommended depends on the syndrome severity, however in most patients it should consist of a combination of low-to-moderate intensity aerobic (endurance) exercise on most days of the week and individually prescribed low-to-moderate intensity resistance (strength) training at least twice per week. Additionally, all patients should be closely monitored prior to and during exercise for contraindications by an appropriately trained health professional. The purpose of this statement is to inform and guide exercise practitioners and health professionals in the safe and effective prescription and supervision of exercise for patients with CHF.

A phase II multicentered, single-blind, randomized, controlled trial of the stroke self-management program

Background and Purpose—The benefits of chronic disease self-management programs for stroke survivors are uncertain because individuals with severe impairments have been excluded from previous research. We undertook a phase II randomized controlled trial to determine whether a self-management program designed for survivors (SSMP; 8 weeks) was safe and feasible compared to standard care (control) or a generic self-management program (generic; 6 weeks).
Methods—Stroke survivors were recruited from 7 South Australian hospitals via a letter or indirectly (eg, newspapers). Eligible participants were randomized at a 1:1:1 ratio of 50 per group. Primary outcomes were recruitment, participation, and participant safety. Secondary outcomes were positive and active engagement in life using the Health Education Impact Questionnaire and characteristics of quality of life and mood at 6 months from program completion.
Results—Of 315 people screened, 149 were eligible and 143 were randomized (48 SSMP, 47 generic, 48 control); mean age was 69 years (SD, 11) and 59% were female. Demographic features were similar between groups and 41% had severe cognitive impairment; 57% accessed the interventions, with 52% SSMP and 38% generic completing >50% of sessions (P=0.18). Thirty-two participants reported adverse events (7 control, 12 generic, 13 SSMP; P=0.3; 34% severe); however, none was attributable to the interventions. Potential benefits for improved mood were found.
Conclusions—SSMP was safe and feasible. Benefits of the stroke-specific program over the generic program included greater participation and completion rates. An efficacy trial is warranted given the forecast growth in the stroke population and improved survival trends.

Exploring health care providers' perceptions of the needs of stroke carers: informing development of an optimal health program.

Health care provider experiences of the carer have been researched, but little is written about how these can inform development of support programs.

The study protocol of: 'initiating end of life care in stroke: clinical decision- making around prognosis'

 Background: The initiation of end of life care in an acute stroke context should be focused on those patients and families with greatest need. This requires clinicians to synthesise information on prognosis, patterns (trajectories) of dying and patient and family preferences. Within acute stroke, prognostic models are available to identify risks of dying, but variability in dying trajectories makes it difficult for clinicians to know when to commence palliative interventions. This study aims to investigate clinicians’ use of different types of evidence in decisions to initiate end of life care within trajectories typical of the acute stroke population.
Methods/design: This two-phase, mixed methods study comprises investigation of dying trajectories in acute stroke (Phase 1), and the use of clinical scenarios to investigate clinical decision-making in the initiation of palliative care (Phase 2). It will be conducted in four acute stroke services in North Wales and North West England. Patient and public involvement is integral to this research, with service users involved at each stage.
Discussion: This study will be the first to examine whether patterns of dying reported in other diagnostic groups are transferable to acute stroke care. The strengths and limitations of the study will be considered. This research will produce comprehensive understanding of the nature of clinical decision-making around end of life care in an acute stroke context, which in turn will inform the development of interventions to further build staff knowledge, skills and confidence in this challenging aspect of acute stroke care.

Social competence following pediatric stroke: contributions of brain insult and family environment

Limited information is available regarding predictors of psychosocial difficulties in children following stroke. This study aimed to (i) compare social competence of children with arterial ischemic stroke (AIS) to those with chronic illness and healthy controls and (ii) investigate the contribution of stroke pathology, neurological outcome and environment. Thirty-six children with AIS > 12 months prior to recruitment were compared with children with chronic illness (asthma) (n = 15) and healthy controls (n = 43). Children underwent intellectual assessment, and children and parents completed questionnaires to assess social competence. Children with AIS underwent MRI scan and neurological evaluation. Child AIS was associated with poorer social adjustment and participation, and children with AIS were rated as having more social problems than controls. Lesion volume was not associated with social outcome, but subcortical stroke was linked to reduced social participation and younger stroke onset predicted better social interaction and higher self-esteem. Family function was the sole predictor of social adjustment. Findings highlight the risk of social impairment following pediatric stroke, with both stroke and environmental factors influencing children's social competence in the chronic stages of recovery. They indicate the potential for intervention targeting support at the family level.

The role of serious games in robot exoskeleton-assisted rehabilitation of stroke patients

his chapter describes how serious games can be used to improve the rehabilitation of stroke patients. Determining ideal training conditions for rehabilitation is difficult, as no objective measures exist and the psychological state of patients during therapy is often neglected. What is missing is a way to vary the difficulty of the tasks during a therapy session in response to the patient needs, in order to adapt the training specifically to the individual. In this chapter, we describe such a method. A serious game is used to present challenges to the patient, including motor and cognitive tasks. The psychological state of the patient is inferred from measures computed from heart rate variability (HRV) as well as breathing frequency, skin conductance response, and skin temperature. Once the psychological state of the patient can be determined from these measures, it is possible to vary the tasks in real time by adjusting parameters of the game. The serious game aspect of the training allows the virtual environment to become adaptive in real time, leading to improved matching of the activity to the needs of the patient. This is likely to lead to improved training outcomes and has the potential to lead to faster and more complete recovery, as it enables training that is challenging yet does not overstress the patient.