Aboriginal and Torres Strait Islander people and the Heart Health Check

Cardiovascular disease is the biggest contributor to preventable morbidity and mortality among Indigenous Australians.

Emerging evidence shows:

• cardiovascular events such as heart attack and stroke occur 10 to 20 years earlier in Aboriginal and Torres Strait Islander adults than in non-Indigenous Australians
• three out of four Indigenous Australians under 35 years have one or more risk factors for CVD.¹

In March 2020 a consensus statement was published that makes new recommendations for assessing cardiovascular disease risk in Aboriginal and Torres Strait Islander adults aged under 35.¹

Recommendations

1. Aboriginal and Torres Strait Islanders without existing CVD should undergo CVD risk factor screening from the age of 18 years at the latest. This includes diabetes and chronic kidney disease.
2. Aboriginal and Torres Strait Islanders without existing CVD should undergo an absolute CVD risk assessment from age 30 years at the latest (cvdcheck.org.au). This now aligns with the Heart Health Check MBS item eligibility criteria.
3. Assessment should occur as part of an annual health check or opportunistically. Subsequent reviews should be conducted according to the level of risk. 
4. Decisions about management should be made through a shared decision-making framework.
5. Aboriginal and Torres Strait Islanders aged 18–29 years with the following clinical conditions are automatically conferred a high CVD risk status:
   1. type 2 diabetes and microalbuminuria
   2. moderate to severe chronic kidney disease
   3. high blood pressure: systolic blood pressure ≥180 mmHg or diastolic blood pressure ≥110 mmHg
   4. high cholesterol: serum total cholesterol >7.5 mmol/L
   5. family history of high cholesterol.

General practices servicing Aboriginal and Torres Strait Islander communities have the option of conducting a health assessment specific to Indigenous patients (MBS item 715). This item offers wider clinical assessment options, greater age eligibility, and can be repeated every nine months.

An absolute CVD risk calculation should be carried out during the 715 assessment.

How to incorporate absolute CVD risk assessment into the 715 assessment

1. Ensure good continuity of care by registering your Indigenous patients under Closing the Gap targets.
2. Establish systematic practice processes for eligible patients, e.g.
   1. include CVD pathology requirements in recall process
   2. revise practice templates to incorporate absolute CVD risk calculation
   3. allow sufficient time to cover family history
   4. set the next appointment before the patient exits the practice.

TIP: Your local Primary Health Network (PHN) may have an Indigenous health project officer available to assist.

The Heart Health Check compared to the 715 assessment

Key differences between the Heart Health Check (MBS item 699 or 177) and the health assessment for Aboriginal and Torres Strait Islander people (MBS item 715).

Download a PDF of the table

More information

• CVD risk assessment for Aboriginal and Torres Strait Islander adults (Heart Foundation web page)
• Absolute CVD risk calculator – cvdcheck.org.au
• CVD risk assessment in Aboriginal and Torres Strait Islander peoples (Australian National University resource)
• Medicare Benefits Schedule – mbsonline.gov.au

References

1. J Agostino, D Wong, E Paige, V Wade, C Connell, ME Davey, DP Peiris, D Fitzsimmons, CP Burgess, R Mahoney, E Lonsdale, P Fernando, L Malamoo, S Eades, A Brown, G Jennings, RW Lovett and E Banks, ‘Cardiovascular disease risk assessment for Aboriginal and Torres Strait Islander adults aged under 35 years: a consensus statement’, Med J Aust, 2020; 212(9):422-427, doi:10.5694/mja2.50529.

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