A better way to check for cardiovascular disease

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Adjunct Professor John G Kelly AM

Heart Foundation National CEO

Absolute cardiovascular disease risk refers to a person’s likelihood of having a heart attack or stroke within five years. In Australia, there are almost a million people who are at high risk of having a heart attack or stroke but who aren’t getting the right treatment.

A person’s absolute risk of developing cardiovascular disease is calculated by assessing key risk factors (including sex, age, diabetes status, smoking history, blood pressure and cholesterol levels) rather than the traditional method of considering risk factors such as high cholesterol or high blood pressure in isolation.

Australia’s “absolute risk” figures for heart attack and stroke are deeply disturbing. More than 800,000 Australians aged 45-74 are at high risk of having a heart attack or stroke within the next five years. Yet a 2016 Medical Journal of Australia study tells us that three in four of those at high-risk are not receiving the blood pressure or lipid-lowering medications they need.

Why not?

We know that most GPs are familiar with the Heart Foundation’s guidelines for the management of absolute cardiovascular disease risk. Our own figures tell us that four out of five GPs are aware of them, just as they tell us that an estimated half of GPs’ patients are over 45.

These guidelines advise that patients 45 and over should have regular “absolute risk” assessments: a heart and stroke test that should be conducted alongside a type 2 diabetes check and a kidney disease test. This combination of tests recognises the comorbidity of these diseases – that is, that heart disease often co-exists with type 2 diabetes and kidney disease and shares many risk factors.

The UK and New Zealand have more robust approaches and have vigorously promoted such checks, known in the UK as the NHS check and in New Zealand as the heart and diabetes check.

But too many Australian GPs are not conducting these assessments. Our figures tell us that only one in four GPs are actually doing them with the majority of their patients aged 45 and over. Worryingly, almost a third of GPs are conducting these assessments with fewer than four out of ten of their patients who are aged over 45.

There are many reasons for this. Many patients who know how to ask for a flu jab or a cholesterol check don't know to ask for a check to assess their absolute risk of cardiovascular disease. Hard-working GPs find themselves pressed to do multiple risk checks for multiple medical conditions, of which cardiovascular disease is only one. It doesn't help that absolute risk assessments are not supported by the Medicare Benefits Schedule.

It all adds up to many people at high risk missing both detection and the treatment they need to help them stay well, stay out of hospital – and stay alive.

So what can we do about it? The quickest and most effective solution would be for the Government to modify the Medicare Benefits Schedule to support a cardiovascular risk assessment to be done in conjunction with diabetes and kidney checks.

This is not just clinically appropriate, it’s economically sound, and would result in significantly fewer preventable deaths, fewer avoidable hospital admissions and reduced health care costs.

Cardiovascular disease is already the costliest disease to treat. With no rebate for the Integrated Health Check and with hundreds of thousands of Australians likely to have a heart event in the next few years, Australia’s health systems will soon be increasingly challenged by the demand from people living with two or more chronic health conditions. 

In the meantime, I urge all health professionals to raise both their patients’ and the general community’s awareness of the concept of their “absolute risk assessment” of cardiovascular disease and the need for a health check to determine it.