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Abstract

Background: Inherited and congenital cardiac diseases are found in the general UK population and these conditions cause both disability and death. In those aged <35 years these diseases are the most frequent cause of sudden death and in a majority of cases present for the first time with a fatal event. As the population ages the risk of death from ischaemic heart disease (IHD) increases exponentially to become the most common cause of death. Neither the prevalence of cardiovascular disease (CVD), nor their impact more generally on the UK Armed Forces, is known.

Part 1: Investigating the mortality and morbidity burden from cardiovascular disease in the UK Armed Forces. This first part of this thesis investigates the epidemiology of CVD in the UK Armed Forces. It investigates the hypothesis, through three separate research studies, that the same CVDs that occur in the general population may also be found in the UK Armed Forces and that they cause a foreseeable and potentially preventable burden of morbidity and mortality.

Results: These studies show that 8.1% of admissions to the Role 3 Hospital in Afghanistan are due to confirmed CVD or symptoms suggestive of cardiovascular disease. They demonstrate that 9.2% of deaths (rate 7.41 per 100,000 Serviceperson years) in the UK Armed Forces result from CVD and that the incidence of medical discharges from service due to CVD occurs at a rate of 19.6 per 100,000 Serviceperson years.

Conclusions: These data provide compelling evidence that identifying these diseases before symptoms develop would identify individuals at a high risk of death or disability and present an opportunity for life-saving interventions to be delivered.

Section 2: Optimising cardiac screening of potential recruits to the British Army. Despite the deficiency in our understanding of the epidemiology of CVD in the Armed Forces there has long been a system in place to screen for occult CVD at the point of enlistment. The current system utilises a clinical history and examination to detect and exclude individuals in whom certain specified conditions are diagnosed. Evaluating the British Army’s screening system is the first research project in this section of the thesis. Prospectively evaluating an alternative system, that includes an additional electrocardiogram (ECG) and when indicated, an echocardiogram (echo), is the second research project. This alternative system is hypothesised to be more sensitive and specific for CVD than the current system that does not utilise an ECG.

Results: The studies show that the current system misses a significant number of cases of potentially fatal or life-changing disease. Furthermore an additional ECG and echo, when indicated, reduce the false positive rate with screening and reduces the need for onward referral.

Conclusions: The addition of an ECG and echo when indicated results in an optimised screening system. A direct outcome of this research is the adoption of the research protocol for the routine screening of potential recruits into the British Army.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine
Departments:	School of Health & Medical Sciences > Cardiovascular and Genomics Research Institute School of Health & Medical Sciences > School of Health & Medical Sciences Doctoral Theses Doctoral Theses

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