Coronary heart disease (CHD) is the leading single cause of disease burden and death in Australia. There are 2 major clinical forms—heart attack (also known as acute myocardial infarction) and angina. A heart attack is a life-threatening event that occurs when a blood vessel supplying the heart is suddenly blocked completely. Angina is a chronic condition in which short episodes of chest pain can occur periodically when the heart has a temporary deficiency in its blood supply.

CHD is largely preventable, as many of its risk factors are modifiable. These include tobacco smoking, biomedical risk factors such as high blood pressure and high blood cholesterol, insufficient physical activity, poor diet and nutrition, and overweight and obesity. As a result of the substantial burden of CHD in the population, a National Strategic Action Plan for Heart Disease and Stroke is under development. The action plan aims to reflect priorities, and identify implementable actions to reduce the impact of CHD in the community.

How common is coronary heart disease?

In 2017–18, an estimated 580,000 Australians aged 18 and over (2.8% of the adult population) had CHD, based on self-reported estimates from the Australian Bureau of Statistics 2017–18 National Health Survey. The prevalence of CHD increases rapidly with age, affecting around 1 in 7 adults (14%) aged 75 and over (ABS 2019a).

In 2017, an estimated 61,800 people aged 25 and over had an acute coronary event in the form of a heart attack or unstable angina—around 169 events every day. This estimate is based on the number of hospitalisations for acute myocardial infarction (heart attack) or unstable angina, and the number of deaths due to acute coronary heart disease (AIHW 2019c, 2019d).

Impact

Deaths

In 2018, CHD was the leading single cause of death in Australia, accounting for 17,500 deaths as the underlying cause of death. This represents 11% of all deaths, and 42% of cardiovascular deaths. Forty-two per cent (7,300) of CHD deaths resulted from a heart attack (AIHW 2019d).

Overall, the CHD death rate has fallen 82% since 1980, or 4.2% a year. While CHD death rates fell substantially in each age group, the rate of decline was more rapid for those aged 75 and over than for younger age groups (Figure 1). The decline in CHD death rates has been attributed to a combination of factors, including reductions in risk factor levels, better treatment and care, and improved secondary prevention (ABS 2018).

See Causes of death.
 

The chart shows the number and rate of deaths from CHD for males and females aged 55-74 years and 75 years and over, from 1980 to 2018. Over this time period, CHD death rates per 100,000 population decreased from 951 to 119 for males aged 55-74, and from 377 to 33 among females aged 55-74. Among those aged 75 and over, the CHD death rate per 100,000 population decreased from 3,474 to 887 for males and from 2,379 to 660 among females.

Burden of disease

In 2015, CHD accounted for 6.9% of the total burden of disease in Australia. It accounted for 11% of the overall fatal burden of disease and 2.8% of the non-fatal burden.

The total burden due to CHD was almost twice as high in males, at 216,800 disability-adjusted life years (DALY), as in females (112,000 DALY), and increased rapidly from age 45 onwards—from 16 DALY per 1,000 among people aged 45⁠–⁠64, to 225 per 1,000 among people aged 95 and over (Figure 2).

See Burden of disease.
 

The chart demonstrates that the burden of CHD increased with increasing age, from 2.3 DALY per 1,000 among those aged 25-44 to a peak of 225 DALY per 1,000 in those aged 95 and over. The burden was consistently higher among males in all age groups.

CHD burden can be attributed to several risk factors. In 2015, dietary risk factors were responsible for the most CHD burden (62%), followed by high blood pressure (43%), high cholesterol (37%), overweight and obesity (25%), tobacco use (14%) and physical inactivity (12%). It is important to note that these risk factors overlap and, as a result, the associated risk does not sum to 100%.

Between 2003 and 2015, the overall burden from CHD reduced by 43%, with a 45% drop in the fatal burden of CHD. The non-fatal burden also fell, by 33% (AIHW 2019a).

Expenditure

In 2015–16, the estimated expenditure on CHD was more than $2.2 billion. The greatest cost was due to private hospital services and public hospital admitted patient services ($813 million and $693 million respectively). The estimated Pharmaceutical Benefits Scheme (PBS) expenditure related to CHD was around $218 million (AIHW 2019b).

See Health expenditure.

Treatment and management

Medicines

In 2017–18, 94.5 million PBS and Repatriation Pharmaceutical Benefits Scheme prescriptions for cardiovascular medicines were dispensed to the Australian community—31% of the total prescription medicines dispensed. 

Almost three-quarters (73%) of the estimated 4 million Australians who reported having a cardiovascular condition in 2017–18 had used a cardiovascular system medicine in the previous fortnight (ABS 2019a).

See Medicines in the health system.

Hospitalisations

In 2017–18, CHD was the principal diagnosis in about 161,800 hospitalisations (1.4% of all hospitalisations). Of these, 36% were for heart attack (57,400) and 24% for angina (38,900). Most admissions for heart attack (79%) and angina (66%) were emergency admissions (AIHW 2019c).

Between 2000–01 and 2017–18, the age-standardised rate of hospitalisations where CHD was the principal diagnosis declined by 33%, from 833 to 557 hospitalisations per 100,000 population. The decline in hospitalisations over this period was greater among females than among males (39% and 31% respectively). CHD was the leading cause of hospitalisation for cardiovascular disease in 2017–18 (28% of all hospitalisations with a principal diagnosis of cardiovascular disease).

Of all CHD hospitalisations (principal and/or additional diagnoses), 58% had a coronary angiography (a diagnostic procedure) and 29% underwent revascularisation (surgical procedures to restore blood supply to the heart) (AIHW 2019c).

See Hospital care.

Primary care

Regular and timely contact with primary health care providers, such as GPs and cardiologists, can contribute to better outcomes for those with CHD.

An analysis of administrative data from 2012 to 2015 demonstrated that, following a hospital admission for CHD, follow-up care with a primary health care provider reduced the risk of a cardiovascular disease (CVD) related emergency readmission by 5%–11%, or CVD-related death by 4%–6%, when compared with those who did not have contact with primary health care services. Further, regular contact with primary health care services was associated with lower risk of readmission or death when compared with those with more sporadic contact (AIHW 2018).

See Primary health care.

Variation between population groups

The impact of CHD varies between population groups. Rates of CHD hospitalisation were 1.5 times as high in Remote and very remote areas as in Major cities, and 1.3 times as high in the lowest socioeconomic areas compared with the highest (Figure 3). The rate of hospitalisations and deaths due to CHD were around twice as high among Aboriginal and Torres Strait Islander people as among non-Indigenous Australians.
 

The figure shows the rate ratio of CHD prevalence, hospitalisation, death and burden of disease among selected population groups in 2017–18.  CHD prevalence, hospitalisations and deaths were 2 times as high, and the burden of disease was around 3 times as high, among Aboriginal and Torres Strait Islander persons when compared with non-Indigenous Australians. The rate of hospitalisations and deaths due to CHD were 1.5 times as high among those living in Remote and Very remote areas compared to those living in Major cities, and 1.3 to 1.6 times as high among those living in the most disadvantaged areas when compared to those living in the least disadvantaged areas.

Where do I go for more information?

For more information on coronary heart disease, see:

Visit Heart, stroke & vascular disease for more information on this topic.

References

ABS (Australian Bureau of Statistics) 2018. Changing patterns of mortality in Australia, 1968–2017. ABS cat. no. 3303.0.55.003. Canberra: ABS.

ABS 2019a. Microdata: National Health Survey, 2017–18. ABS cat. no. 4324.0.55.001. Findings based on detailed Microdata analysis. Canberra: ABS.

ABS 2019b. National Aboriginal and Torres Strait Islander Health Survey, 2018-19. ABS cat. no. 4715.0. Canberra: ABS.

AIHW (Australian Institute of Health and Welfare) 2016. Australian Burden of Disease Study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study series no. 6. Cat. no. BOD 7. Canberra: AIHW.

AIHW 2018. Transition between hospital and community care for patients with coronary heart disease: New South Wales and Victoria, 2012–2015. Cat. no. CDK 9. Canberra: AIHW.

AIHW 2019a. Australian Burden of Disease Study 2015: Interactive data on disease burden, Cat. no. BOD 24. Canberra: AIHW.

AIHW 2019b. Disease Expenditure in Australia. Cat.no. HWE 76. Canberra: AIHW.

AIHW 2019c. National Hospital Morbidity Database. Findings based on unit record analysis. Canberra: AIHW.

AIHW 2019d. National Mortality Database. Findings based on unit record analysis. Canberra: AIHW.