What is coronary heart disease?

Coronary heart disease (CHD) occurs when there is a narrowing or blockage in the blood vessels that supply blood to the heart muscle. There are 2 major clinical forms – heart attack (also known as acute myocardial infarction) and angina (see Glossary).

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.

CHD is the leading single cause of disease burden and death in Australia. As a result of the substantial impact of CHD on the Australian population, a National Strategic Action Plan for Heart Disease and Stroke has been developed. 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 2020–21, an estimated 571,000 Australians aged 18 and over (2.9% of the adult population) had CHD, based on self-reported data from the Australian Bureau of Statistics 2020–21 National Health Survey (ABS 2022b). The prevalence of CHD increases rapidly with age, affecting around 1 in 9 (11%) adults aged 75 and over.

In 2019, an estimated 57,700 people aged 25 and over had an acute coronary event in the form of a heart attack or unstable angina – around 158 events every day. Of these, 7,400 (13%) were fatal.

The age-standardised rate of acute coronary events fell by more than half (57%) between 2001 and 2019 (from 675 to 290 per 100,000 population). The decline was slightly higher for women (61%, from 460 to 180 per 100,000 population) than men (55%, from 910 to 410 per 100,000 population) (Figure 1).
 

Figure 1: Acute coronary events, persons aged 25 and over, by sex, 2001–2019

The chart shows declines in the number and age-standardised rates of acute coronary events for persons aged 25 and over between 2001 and 2019. Rates fell from 910 to 410 per 100,000 population for men, and from 460 to 180 for women.

Impact

Deaths

In 2020, CHD was the leading single cause of death in Australia, accounting for 16,600 deaths (AIHW 2022c). This represents 10% of all deaths, and 41% of cardiovascular disease deaths. Thirty-nine per cent (6,500) of CHD deaths resulted from a heart attack.

Overall, the CHD death rate has fallen by more than 80% since 1980 – from 414 to 68 deaths per 100,000 population for males, and 209 to 32 per 100,000 population for females. CHD death rates fell substantially in each age group, although the decline has slowed among younger age groups in recent decades (Figure 2).

The decline in CHD death rates has been attributed to a combination of factors, including reductions in some risk factor levels, better treatment and care, and improved secondary prevention (ABS 2018; AIHW 2021c).

See ‘Chapter 4 Changing patterns of mortality in Australia since 1900’ in Australia’s health 2022: data insights.
 

Figure 2: CHD deaths among people aged 55-64, 65-74, 75-84 and 85 and over, by sex, 1980 to 2020

The chart shows the number and rate of deaths from CHD for males and females aged 55-64, 65-74, 75-84 and 85 and over, from 1980 to 2020. CHD death rates fell substantially in each age group – for example, from 1,500 to 160 deaths per 100,000 population for men aged 65–74, and from 640 to 46 for women aged 65–74.

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.

Expenditure

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 care

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 2019–20, over 93,000 Heart Health Checks (males 46,000, females 47,000) were processed by Medicare. Checks were most commonly conducted among people aged 55–64 (34,000) and 65–74 (28,000) (Services Australia 2022).

See Primary health care.

Medicines

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.

Emergency Departments

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.

Hospitalisations

In 2019–20, CHD was the principal diagnosis in about 155,600 hospitalisations (1.4% of all hospitalisations) (AIHW 2022b). Of these, 36% were for heart attack (56,100) and 22% for angina (34,100).

Between 2000–01 and 2019–20, the age-standardised rate of hospitalisations where CHD was the principal diagnosis declined by 39%, from 830 to 510 hospitalisations per 100,000 population. The decline in hospitalisations over this period was greater among females than among males (46% and 36% respectively).

CHD was the leading cause of hospitalisation for cardiovascular disease in 2019–20 (26% of all hospitalisations with a principal diagnosis of cardiovascular disease).

Of all CHD hospitalisations (principal and/or additional diagnoses), 57% had a coronary angiography (a diagnostic procedure) and 31% underwent revascularisation (surgical procedures to restore blood supply to the heart).

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 2019–20 were 1.5 times as high in Remote and very remote areas as in Major cities (727 and 475 per 100,000 population), and 1.3 times as high in the lowest socioeconomic areas as in the highest (576 and 443 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.

Figure 3. Impact of coronary heart disease, by population group

The figure shows the rate ratio of CHD prevalence (2017–18), hospitalisation (2019–20), death (2020) and burden of disease (2018) among selected population groups.

Rates of CHD prevalence, hospitalisations, deaths and burden of disease were 2–3 times as high among Aboriginal and Torres Strait Islander persons when compared with non-Indigenous Australians.

Rates of hospitalisations and deaths due to CHD were 1.5 and 1.3 times as high among those living in Remote and very remote areas compared to those living in Major cities and were 1.3 and 1.7 times as high among those living in the most disadvantaged areas when compared to those living in the least disadvantaged areas.

COVID-19 and coronary heart disease

People with pre-existing chronic conditions such as CHD are at higher risk of contracting COVID-19 and experiencing complications or more severe illnesses as a result.

In 2020–21, there were over 4,700 hospitalisations in Australia that involved a COVID-19 diagnosis. The most common comorbid conditions associated with COVID-19 hospitalisations over this period were cardiovascular disease (which includes coronary heart disease and a range of other heart, stroke and vascular diseases) (20%) and Type 2 diabetes (20%) (AIHW 2022e).

Of those COVID-19 hospitalisations with comorbid diagnosis of cardiovascular disease  in 2020–21, 18% involved time spent in an Intensive Care Unit, 12% involved continuous ventilatory support and 20% had a separation mode indicating the patient died in hospital.

Among COVID-19 deaths that occurred by 30 April 2022, chronic cardiac conditions including coronary atherosclerosis, cardiomyopathies and atrial fibrillation were the most certified comorbidities, present in 37% of deaths (ABS 2022a).

Counts of CHD deaths during 2021 were below the 2015–19 average but were higher than the number certified in 2020 (ABS 2022c).

Where do I go for more information?

For more information on coronary heart disease, see:

Page last updated 07