Public health

If the Minister for Health walked through the door now … What is the one thing cardiologists would ask him to do?


Australia’s peak cardiology bodies have drawn up a wishlist of key actions, structures and tools needed to improve the country’s cardiovascular health.

On 10 March, the Cardiac Society of Australia and New Zealand (CSANZ), National Heart Foundation and Australian Cardiovascular Alliance joined with state and government representatives, researchers, primary care, pharmacists, nurses, consumers and industry in a quest to identify ways to enhance cardiovascular and stroke outcomes.

Attendees were asked to come up with “ambitious goals” and “outline the necessary changes in service provision and policies that were required to achieve these goals”, the draft report said.

In the report, convenor Professor Don Nutbeam framed the discussion by saying: “If the Minister for Health walked through the door now….. What is the one thing you would ask him to do?”

The top goal was to reduce cardiovascular disease (CVD) mortality, morbidity and inequalities by 30% in 2030, 40% in 2040 and 50% in 2050.

Achieving this would take greater investment in national CVD and stroke awareness, screening and prevention programs; implementing evidence-based care in practice and policy; a national CVD surveillance platform; and innovative use of digital technology; among other initiatives, the report said.

Listening to the roundtable briefing on Friday (13 May), the limbic found quick and easy wins were considered key to spurring progress.

“It’s so hard with these very complex multidimensional, multilayer issues and I think that’s what we’re trying to [tackle] here, [and it] can get so complicated that you can’t move forward,” Professor Julie Redfern CSANZ Clinical and Preventative Cardiology Council co-chair told attendees.

“So, I think small steps with what we think might be big wins [are] what [we’re] really trying to advocate here. We can’t do everything at once [and] we don’t want to hinder our forward movement with complexity,” she said.

Already, there are moves to develop a national CVD and stroke surveillance platform that leverages existing systems including general practices’ electronic medical records, local population health management systems and the federally-funded Primary Health Insights database.

However, implementation research is needed to guide data standardisation, harmonisation and linkage for this platform, Professor Kim Greaves, cardiologist and clinician scientist at Sunshine Coast University told briefing attendees.

Current systems are siloed, lack standardised data input and output, and often use “different and ambiguous terminologies” to “describe the same conditions”, he said.

“There’s also incorrect definitions for CVD, misinterpretation of national guidelines; there’s even incorrect CVD risk calculator algorithms — so, some of the larger providers actually have the wrong calculator in their systems and patients are being compromised as a result,” he added.

Additionally, there are data sharing and governance concerns to overcome.

Once the database is in place, however, clinicians and researchers will be able to monitor national CVD and stroke burden over time and potentially develop an Australian-specific risk calculator, Professor Greaves said.

Wishlist and next steps

With the surveillance database came requests for:

  • Heart health checks to join routine care in general practice — ideally supported by increased Heart Health Check Toolkit uptake, Medicare rebate-use optimisation and other incentives.
  • New or, in the case of “Make the invisible, visible”, renewed, education and awareness campaigns around cardiovascular risk, atrial fibrillation, stroke and blood pressure control.
  • A population-wide atrial fibrillation screening program.
  • Support for healthcare professionals to adhere to blood pressure guidelines through quality improvement programs such as PIPQI.
  • Clinical and patient education on best-practice ambulatory and at-home blood pressure monitoring.

Such measures would hopefully drive ideals where all Australians know and understand their absolute CV risk, blood pressure control rates double to 70% and all Australians with AF are identified, the report said.

Regarding acute care and treatment, participants asked that:

  • Gender gaps close in acute care — with the help of gender-specific information in existing treatment guidelines, improved awareness against unconscious bias, and flagged gender disparities in the national surveillance platform.
  •  Clinicians better adhere to best-practice guidelines and explore living guidelines as a model for maintaining currency and increasing uptake.
  • “All Australians in all postcodes have access to acute stroke care” via a coordinated national rollout of mobile stroke units.

Finally, there were calls for increased rehabilitation program access and uptake through more extensive telehealth use and tailored interventions based on gender, cultural appropriateness and patient feedback.

Once fine-tuned, the report will highlight data gaps for implementation research; identify capacity and capability gaps, which may be addressed through new or existing programs, refine policy changes necessary to accelerate implementation and provide an advocacy agenda to support this work, the roundtable concluded.

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