Time for action on heart disease and stroke

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Adjunct Professor John G Kelly, AM

Group CEO, National Heart Foundation of Australia
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John joined the Heart Foundation in August 2016. Previous to that, he led sector reform for aged care as CEO of Aged and Community Services Australia. He has extensive clinical, management and consulting background in the health sector, including previous careers in law and in cardiac nursing and current academic appointments with the Sydney Nursing School and the University of Technology, Sydney.

The National Heart Foundation has received $170,000 to develop a National Strategic Action Plan, with help from the National Stroke Foundation. The plan will outline better ways to diagnose, treat and manage the conditions in Australia.

This is very welcome news and we commend the Health Minister on his foresight. Heart disease and stroke impose a huge financial and emotional burden on our community. They are responsible for almost 30% of all deaths and 15% of our total disease burden.

In 2017, cardiovascular disease was the underlying cause of 43,500 deaths. Meanwhile, every five minutes an Australian experiences a heart attack or stroke, with more than 100,000 heart attacks and strokes occurring in 2017.

As the recent development of the National Strategic Framework for Chronic Conditions demonstrates, the Federal Government acknowledges the need for a comprehensive and integrated approach to the major chronic disease groups.  Accordingly, government strategies and action plans have already been devised to address several other chronic diseases, such as diabetes and asthma.

The need for a cardiovascular plan had become particularly pressing given that the number of people suffering cardiovascular disease is set to rise over coming years, as the population grows, ages and becomes increasingly overweight and obese. At the same time, some risk factors, such as poor nutrition, lack of physical activity, high blood cholesterol and high blood pressure, continue to hover at alarmingly high rates.

The focus of this plan will be on improving the quality of life for the 4.2 million people with cardiovascular disease, and cutting avoidable hospital admissions, therefore reducing the immense economic and social burden created by this disease (it costs the nation $8.8 billion each year).

The Heart Foundation will begin by convening a small group of experts and consumers. They will be given tight terms of reference and a brief committing them to focus on identifying gaps in the current approach to prevention and care. They would then develop cost-effective measures to address them.

The Heart and Stroke Foundations have established a steering committee of experts and consumers, chaired by Professor Emily Banks of the Australian National University, to guide the development of the action plan.

An online survey will be established, a consumer forum convened and two stakeholder consultations will take place in Melbourne (December 4) and Sydney (December 5).

A draft plan will then be prepared and made available for further comment, before the final plan is completed and submitted to the Federal Government in April.

We expect that the support of all governments - federal, state and territory - will be needed to ensure successful implementation.

We anticipate strong support, as the plan is likely to address key priorities already identified by governments of all political persuasions: tackling chronic disease, boosting prevention and early detection of those at high risk, reducing preventable hospitalisation and - most importantly - saving lives.

Some of the current gaps are already obvious. One glaring example:  close to one in five Australians aged 45 to 74 (1.4 million) are at high risk of a heart attack or stroke, with nearly one million not receiving the recommended combination of blood-pressure and lipid-lowering medications.

Tens of thousands of premature deaths could be averted if all Australians in this age group had an absolute cardiovascular risk assessment (heart health check), and those at high risk were then well managed according to current guidelines.

This problem could be addressed by supporting GPs in detecting those at high risk of heart attacks and stroke. This could be done by changing the Medicare Benefits Schedule to support the uptake of an Integrated Health Check for people aged 45 and over.

Australia could invest more in prevention: just 1.7% of our health budgets go to public health prevention, behind New Zealand on 7% and Canada on 5.9%. Meanwhile, too few people who have had heart attacks, or are living with heart failure, get access to live-saving cardiac rehabilitation.

We should also be investing more in cardiovascular research and focussing more on strategies to curtail the exceptionally high rates of cardiovascular disease facing Aboriginal and Torres Strait Islanders.

A comprehensive heart and stroke plan will draw policy-makers’ attention to these crucial issues and end up saving both lives and money.