Australians falling behind in cholesterol screening

More than 61,000 Australian patients aged 45 and over are not having their cardiovascular disease risk assessed in line with guidelines, according to new research.

Primary care data unveiled by the Heart Foundation today show that more than a third of eligible patients (36% or 61,450 people) failed to have their blood pressure and cholesterol recorded within the guideline recommended timeframes. 

The data revealed 15 per cent of patients did not have their blood pressure checked within the last two years, and nearly double that proportion, 29 per cent, did not have their cholesterol levels assessed within the last five years.

Heart Foundation Risk Reduction Manager Natalie Raffoul said the data also showed that nearly one in four eligible Australians (24% or 26,084 people) who had their blood pressure and cholesterol recorded were found to be at ‘clinically determined high-risk’ of CVD due to their conditions and or age.

“Identifying high risk patients up-front is important as it prevents CVD risk being underestimated by risk calculators, which are not required for this population. People at high risk should receive blood pressure and cholesterol lowering medicine where appropriate, in addition to being supported with lifestyle changes,” Ms Raffoul said.

The Heart Foundation is unveiling the results today at the virtual GP20 conference, the annual conference for GPs run by the Royal Australian College of General Practitioners (RACGP).

Ms Raffoul said it’s critical that more Australians see their doctor for a Heart Health Check, clinically known as absolute CVD risk assessment, to ensure their risk factors for CVD are assessed frequently and are used to inform management strategies.

“We are falling behind in particular with cholesterol screening, which is an essential component of a Heart Health Check,” she said. 

The Heart Foundation recommends all Australians aged 45 and over, and 30 and over for Aboriginal and Torres Strait Islander Australians, see their GP for a Heart Health Check covered by Medicare.

“Identifying people at high risk of CVD and engaging them in their management takes time, but the Heart Health Check MBS item provides health professionals in primary care the chance to systematically assess and manage absolute CVD risk in an ongoing way.

“Other supportive factors such as the national quality improvement financial incentives and the contribution of practice nurses during a Heart Health Check can assist with prioritising this type of activity at your practice.”

The Heart Foundation will soon be releasing a Heart Health Check toolkit that will provide GPs and practice staff with tools to integrate Heart Health Checks into routine care in the simplest way possible.

Absolute CVD risk looks at the combined risk of multiple CVD risk factors to estimate the likelihood of a heart attack or stroke in the next five years. It involves recording a patient’s physical or lifestyle-related CVD risk factors, measuring clinical risk factors such as lipids, blood pressure and blood glucose levels, measuring their risk using a validated calculator and providing ongoing care and advice regarding modifiable risk factors such as nutrition, exercise and weight control.  

The results, drawn from an analysis of national general practice MedicineInsight data, looked at 172,366 deidentified patient records to assess the number of Australians whose necessary risk factors were recorded to enable absolute CVD risk calculation.

The Heart Foundation’s exhibition page at the GP20 conference can be viewed here.

Key findings:

• 85% of eligible adults (n=147,051) had a systolic blood pressure recorded in the last 2 years (as per RACGP Redbook guidelines).

• 71% (n=121,865) had a total cholesterol and HDL-cholesterol recorded in the last 5 years.

• 36% (61,450) of eligible patients did not have both a systolic blood pressure and total cholesterol and HDL cholesterol recorded within guideline recommended timeframes.

• Almost 1 in 4 eligible Australians (24%, 26,084) with the available cholesterol and blood pressure levels were found to be at ‘clinically determined high risk’ by virtue of their conditions and/or age[1]:

  • 7,456 had very high total cholesterol levels (TC > 7.5 mmol/L)

  • 7,501 had very high systolic blood pressure levels (BP ≥ 180 mmHg)

  • 6,328 had diabetes and microalbuminuria

  • 9,285 had diabetes and were aged over 60 years

  • 3,887 had moderate or severe kidney disease with an estimated Glomerular Filtration Rate (eGFR) < 45 mL/min.