Improving secondary prevention of coronary heart disease with better disease management

Associate Professor Melinda Carrington, Baker Heart and Diabetes Institute

2020 Vanguard Grant

Years funded: 2021-2022

Coronary heart diseases (CHD) remain the number one killer of Australians and are a persistent disease burden which are among the most expensive disease group to treat owing to costly hospital readmissions. In our contemporary Australian data, 37% of CHD patients were readmitted within 90 days and the greatest proportion (42%) were younger (working age) patients (i.e. <65 years). People from lower socioeconomic groups are more affected by cardiovascular disease than people from higher socioeconomic groups. Predicting higher risk patients with the greatest likelihood of recurrent ischaemic events, permits targeting of chronic disease management to reduce hospital readmissions.

Disease Management Programs (DMP) and cardiac rehabilitation programs achieve effective secondary prevention however they are expensive to implement for every patient, their uptake is astonishingly poor (≈30%) and traditional models are not suited to younger, busy, isolated or disengaged adults. Furthermore, the COVID-19 pandemic has disrupted the typical delivery and access to routine health care. However patients with CHD must continue to receive management and support.

Aim: We aim to improve the access and quality of secondary prevention and prolong survivorship after a CHD event in patients deemed to be at highest risk of a recurrent ischaemic event. This will be assessed by comparing 90-day hospital readmissions (primary endpoint) in patients receiving an intensive DMP utilising e-Health and telehealth strategies (intervention group) versus patients receiving Usual Care (control group). Extended 12 month follow-up and usage of the SmartCR cardiac rehabilitation platform app will be comprehensively evaluated.

We expect our findings to allow targeting of DMPs towards high-risk CHD patients and to provide evidence-based findings for e-Health and telehealth initiatives that can be retained in practice after the COVID-19 pandemic. We have shown a reduction in heart failure readmissions in CHD.