102 A 17 Year Review Of Discharges On Medical Grounds Due To Cardiovascular Disease In The United Kingdom Armed Forces

Abstract

Background Epidemiology studies of cardiovascular disease in young athletic populations usually concentrate on mortality due to methodological convenience, but cardiovascular disability is also likely to be prevalent.Medical discharges from the UK Armed Forces may provide an insight to the underlying burden of cardiovascular disease. Methods All discharges on medical grounds were reported to Defence Statistics and categorised using the WHO ICD-10 system.Discharges due to cardiovascular disease between April 1995 to March 2012 were compiled with crude rates recorded per 100,000 Service years. Results 651 cardiovascular discharges were recorded over 2,935,430 Service years (rate 22.18 per 100,000). Males comprised 91.3% of the population but only 88.8% of discharges. Cardiac causes accounted for 37.2% of cases (242 discharges, rate 13.93 per 100,000), with ischaemic heart disease the most frequent diagnosis (92 discharges, rate 3.13 per 100,000). Other important cardiac diagnoses were cardiomyopathy, arrhythmia, conduction and congenital abnormalities, valve dysfunction and infectious diseases. Extra-cardiac disease accounted for 63% of diagnoses (409 discharges, rate 13.93 per 100,000) with Reynaud’s syndrome (85 discharges, rate 2.90 per 100,000) stroke (83 discharges, rate 2.83 per 100,000) and venous diseases, including thromboembolism (61 discharges, rate 2.08 per 100,000) the most frequent. Discussion Cardiovascular disease causes a significant and unrecognised morbidity burden on the UK military. Much is due to stroke and ischaemic heart disease and policies directed at reducing disease development may be preventative. Effective screening for inherited or congenital disorders at the point of recruit entry would allow early identification and intervention in these disorders.

The Hearts of Heroes: the epidemiology of cardiac disease in the UK Armed Forces

“…A unique measure within the UK Armed Forces is the rate of discharge from the Armed Forces on medical grounds. Scrutiny of the causes for discharge indicate that over a 17-year period, discharges due to disabling CVD occurred in 242 cases at a rate of 13.93 per 100 000 service years 28. The main diagnosis was again CAD (3.13 per 100 000 service years), but other important complaints were cardiomyopathies, disabling arrhythmias, conduction and congenital abnormalities, valve dysfunction and infectious diseases.…”

Managing the military patient with syncope

“…A further peak occurs after 70 years of age, but this is irrelevant in the military population 6. A 17 year review of discharges due to cardiovascular disease, from the UK Armed Forces, showed syncope was the cause of 16% of discharges (107/651—rate 3.6 per 100 000 Service years) 7. While commonly benign, syncope has been recognised as a frequent first symptom (18%) in soldiers that suddenly die 8…”

Coronary artery disease in the military patient

“…In the UK Armed Forces (UKAF) CAD remains the most common cause of sudden cardiac death (SCD),2 and is the most frequent cause of cardiovascular medical discharge from service 3. The mechanism of SCD in CAD is thrombotic obstruction to coronary artery blood flow, due to plaque rupture or erosion, culminating in ventricular arrhythmia typically degenerating into ventricular fibrillation and later asystole 4.…”