Four patient groups that need your attention this Heart Week

Updated: 6 April 2022

With one Australian having a heart attack or stroke every 4 minutes, primary care nurses have the power to change this statistic by focussing on simple, yet life-saving preventative care. Take the opportunity this Heart Week to deliver routine CVD risk assessment and management for more of your at-risk patients.

Two years on from the start of the pandemic, there is growing evidence that COVID-19 is associated with worse cardiovascular outcomes 12 months post-infection.¹ The impact of COVID-19 on routine screening activities, together with the potential heart health consequences of long COVID, means that CVD screening is more important than ever.

But despite the challenges of living with COVID-19, vaccination programs and other uncertainties, primary care has delivered over 275,000 Heart Health Checks since the 699 and 177 MBS items were introduced in 2019, providing life-saving preventative care to at-risk Australians.

Take the opportunity this Heart Week (2–8 May) to focus on these simple, routine practices that can have a measure life-saving impact, particularly in patient groups with known elevated CVD risk.

1. Patients with diabetes

It is estimated that the rate of death from CVD is over four times higher for people with diabetes compared to those without diabetes.^2,3 Coronary heart disease, stroke and peripheral vascular disease typically appear earlier in patients with type 2 diabetes (by approximately 14 years).

Australian guidelines recommend that adults who have diabetes and are aged over 60 years; or diabetes with microalbuminuria (>20 mcg/min or urinary albumin:creatinine ratio >2.5mg/mmol for males, >3.5mg/mmol for females), are ‘clinically determined high risk’. These individuals should be managed as per high risk recommendations: initiate lipid and blood pressure lowering therapy in addition to encouraging lifestyle changes.⁴

General Practice Management Plans and Team Care Arrangements can improve clinical outcomes for people living with diabetes.⁵ You can use CAT4 data recipes to identify patients eligible for a Heart Health Check and Chronic Disease Management Plan.

2. Women with history of gestational diabetes

In 2016–17, approximately 15% of all women who gave birth in hospital were diagnosed with gestational diabetes.⁶ It is estimated that women with a previous diagnosis of gestational diabetes have a twofold increased risk of developing coronary artery calcification, increasing their CVD risk, even if they maintain healthy blood glucose levels postpartum.⁷ Current recommendations place emphasis on lifestyle interventions and recommend an oral glucose tolerance test 6–12 weeks postpartum and regular screening of blood glucose, HbA1c and cardiovascular risk factors.⁸

You can use CAT4 data recipes to identify female patients who are eligible for the Heart Health Check and have had a previous diagnosis of gestational diabetes.

3. Aboriginal and/or Torres Strait Islander Peoples

On average, cardiovascular events such as heart attacks and strokes, and CVD-related mortality occur 10–20 years earlier in the Aboriginal and/or Torres Strait Islander population than in the non-Indigenous population.⁹ Approximately 16% of Aboriginal and/or Torres Strait Islander Peoples aged 35–74 are at high absolute risk of a future CVD event.¹⁰

The most recent Australian consensus statement recommends that absolute risk assessment should begin from 30 years for Aboriginal and/or Torres Strait Islander Peoples. Individual risk factor screening should begin from 18 years at the latest.¹¹

Cardiovascular risk assessment and management should occur as part of an annual health check for these patients – find out more about the 715 Health Check.

4. People living with mental illness

One in 5 Australians live with a mental or behavioural condition.¹²

It is well-established that serious mental illness increases the risk of developing coronary heart disease, independent of conventional risk factors.¹³ Anxiety, depression, social isolation and loneliness can increase the risk of having a heart attack or coronary heart disease.^13-17

Depression has been shown to increase the risk of unhealthy behaviours, including smoking, having an unhealthy diet, physical inactivity and medicine non-adherence.¹⁸

Guidelines recommend assessing for depression and other psychosocial factors when conducting CVD risk assessment, including during a Heart Health Check.⁴ A comprehensive Heart Health Check assessment template, which includes mental health considerations, can be found online or built into Best Practice software.

Resources to streamline your Heart Health Checks

This Heart Week (2–8 May), download your FREE promotional pack to make a splash at your practice and use of the Heart Foundation’s Heart Health Check Toolkit to easily assess and manage CVD risk in your eligible patients.

New resources are being introduced during Heart Week to optimise your management of clinical and lifestyle risk factors, so be sure to browse and bookmark the Toolkit.

As part of Heart Week 2022, you are also invited to join a panel of international and Australian experts on Wednesday 4 May as they discuss the latest evidence on new and emerging lipid lowering therapies, and how this can be translated into practice. Save your spot today.

References

1.             Xie YX, E; Bowe, B; Al-Aly, Z. Long-term cardiovascular outcomes of COVID-19. Nature Medicine. 2022;28:583-590. doi:https://doi.org/10.1038/s41591-022-01689-3

2.             Baker Heart & Diabetes Institute. The dark heart of type 2 diabetes. 2018. https://baker.edu.au/impact/advocacy/dark-heart-diabetes

3.             Glovaci DF, Wnjun & Wong ND. Epidemiology of Diabetes Mellitus and Cardiovascular Disease. Current Cardiology Reports. 2019;21(4):21. doi:https://doi.org/10.1007/s11886-019-1107-y

4.             National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. 2012. https://www.heartfoundation.org.au/getmedia/4342a70f-4487-496e-bbb0-dae33a47fcb2/Absolute-CVD-Risk-Full-Guidelines_2.pdf

5.             Wickramasinghe LS, P; Hibbert, ME; Enticott, JC; Georgeff, MP; Russell, GM. Impact on diabetes management of General Practice Management Plans, Team Care Arrangements and reviews. The Medical Journal of Australia. 2013;199(4):261-265. doi:https://doi.org/10.5694/mja13.10161

6.             Australian Institute of Health and Welfare. Incidence of gestational diabetes in Australia. 2019. Cat no: CVD 85. https://www.aihw.gov.au/reports/diabetes/incidence-of-gestational-diabetes-in-australia/contents/gestational-diabetes-incidence

7.             Gunderson ES, B; Catov, JM; Carnethon, M; Lewis, CE; Allen, NB; Sidney, S; Wellons, M; Rana, JS; Hou, L; Carr, JJ. Gestational Diabetes History and Glucose Tolerance After Pregnancy Associated With Coronary Artery Calcium in Women During Midlife. Circulation. 2021;143(10):974-087. doi:https://doi.org/10.1161/CIRCULATIONAHA.120.047320

8.             The Royal Australian College of General Practitioners. Management of type 2 diabetes: A handbook for general practice. RACGP; 2020. https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/diabetes/introduction

9.             Australian Institute of Health and Welfare. Cardiovascular disease, diabetes and chronic kidney disease - Australian facts: Aboriginal and Torres Strait Islander people. 2015. Series no 5 Cat no CDK 5 https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/cardiovascular-diabetes-chronic-kidney-indigenous/summary

10.          Calabria BK, RJ; Lovett, RW; Fernando, P; Martin, T, Malamoo, L; Welsh, J; Banks E. Absolute cardiovascular disease risk and lipid-lowering therapy among Aboriginal and Torres Strait Islander Australians. The Medical Journal of Australia. 2018;209(1):35-41. doi:https://doi.org/10.5694/mja17.00897

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

12.          Australian Bureau of Statistics. National Health Survey: first results, 2017-2018. 2018. ABS cat no 4364055001. https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release

13.          Hert MD, J; Psy, M; Vancampfort, D. The intriguing relationship between coronary heart disease and mental disorders. Dialogues in Clinical Neuroscience. 2018;20(1):31-40. doi:10.31887/DCNS.2018.20.1/mdehert

14.          Gale CB, GD; Osborn, DPJ; Tynelius, P; Rasmussen, F. Mental disorders across the adult life course and future coronary heart disease: evidence for general susceptibility. Circulation. 2014;129(2):186-193. doi:https://doi.org/10.1161/CIRCULATIONAHA.113.002065

15.          Glozier NT, GH; Colquhoun, DM; Bunker, SJ; Clarke, DM; Hare, DL; Hickie, IB; Tatoulis, J; Thompson, DR; Wilson, A; Branagan, MG. Psychological risk factors for coronary heart disease. The Medical Journal of Australia. 2013;199(3):179-180. doi:10.5694/mja13.10440

16.          Holt-Lunstad JS, TB; Baker, M; Harris, T; Stephenson, D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science: a journal of the Association for Psychological Science. 2015;10(2):227-237. doi:https://doi.org/10.1177/1745691614568352

17.          Hare DT, SR; Johansson, P; Jaarsma, T. Depression and cardiovascular disease: a clinical review. European heart journal. 2014;35(21):1365-1372. doi:https://doi.org/10.1093/eurheartj/eht462

18.          Riba MW, L; Rubenfire, M; Ravindranath, D. Psychiatry and Heart Disease: The Mind, Brain, and Heart. Wiley-Blackwell; 2011.