Experts call for reform to save lives of heart attack survivors
Health care system is "failing" heart attack survivors – half of all heart attacks are "not the first"1 and thousands die from repeat events every year1. The cost of repeat heart attacks exceeds $8.4 billion annually, over half the total acute coronary disease cost burden1 Key heart health groups outline a five point plan for reform to reduce repeat events and reduce overall burden of heart disease2.
A significant step in the quest to beat our nation's biggest killer has today been taken as The George Institute for Global Health and the Heart Foundation call for a major overhaul to the health system and a government-supported National Taskforce to implement reforms that protect the lives of heart attack survivors.
A report published today in the Medical Journal of Australia, titled 'Blueprint for Reform,' outlines five key reforms needed to reduce the alarming number of Australians who have repeat heart attacks, and is the result of a national summit of 30 key organisations from government agencies to health professionals and heart attack survivors who met to address the issue of secondary prevention in this country.
After having a heart attack many patients slip into old habits, stop taking their medication and do not make lifestyle changes3, say co-authors of the report Dr Clara Chow and Dr Julie Redfern of The George Institute and The University of Sydney.
"Most people think a heart attack is a one off - once it happens, it's passed - but heart disease is a chronic life-long health problem that needs to be managed properly and there is no quick fix solution," says Dr Redfern.
"The health system is failing heart attack survivors even though secondary prevention strategies including taking medicines and leading a healthy lifestyle can reduce death and future heart attacks. This report calls for long term, consistent patient management nationally to stop heart attack survivors from falling between the cracks and keep them well long term," said Dr Redfern.
Rob Grenfell, National Director, Cardiovascular Health, Heart Foundation said a national partnership agreement could be the best and quickest vehicle for driving reform on secondary prevention.
"The federal government could provide facilitation payments to get the reform process started and reward payments to state and territory governments on meeting agreed targets. It would be a highly cost-effective process, with great savings to be made by all governments for every heart attack they prevent through effective secondary prevention," Dr Grenfell said.
"There is a misconception that a stent or bypass is as good as a cure for a heart attack, but that's simply not the case. The detrimental impact on a person's quality of life is the untold story. Ongoing management is critical and the current system is simply not geared towards this," he added.
Currently one in four people who have a heart attack will go on to have another or require medical intervention4 and the risk of death from a repeat event is high, 20.7% for women and 13.7% for men1.
Most repeat heart attacks are preventable through the use of Pharmaceutical Benefits Scheme (PBS) - funded medical treatments and behavioural modification. Secondary prevention is the targeted treatment of heart attack survivors to prevent future heart attacks and premature death5. While cardiac rehabilitation programs exist for patients after a heart attack, these are short term programs (lasting only a few weeks) and are used by less than a third of heart attack survivors6.
'Blueprint for Reform' details a series of practical strategies to ensure continuity and consistency of care and calls for them to be implemented immediately, with the formation of a government - supported National Taskforce the first step in raising the profile of the importance of secondary prevention and coordinating provision of information and support services including interactive websites, access to resources, health professional advice and online registries.
Five Point Action Plan
- Develop and implement national approach to secondary heart attack prevention by providing a clear path for patients that can be tailored according to their needs and resources in local areas as well as a structured initial assessment and plan development following a heart attack, ongoing support for modifying risk factors and long term follow up and reassessments.
- Bridge the gap between hospital and primary care by implementing a case management approach that is recognised by Medicare and enables coordination between specialist, GP and allied health services and greater education on secondary prevention, behaviour change techniques and self-management strategies.
- Increase awareness and utilisation of existing services by patients by creation and maintenance of a web based national inventory or map of secondary prevention services.
- Develop a system for monitoring and maintaining performance by establishing performance measures to facilitate clinical practice improvement.
- Implement a communication strategy to facilitate sustainability and ensure state and federal government, private health funders, Medicare locals and consumers are kept abreast of Reform implementation and ongoing developments.
- Deloitte Access Economics (2011) ACS in Perspective: The importance of secondary prevention.
- Chow, C & Redfern, J. Secondary prevention of coronary heart disease in Australia: a blueprint for reform. MJA 2013: 4 February edition.
- ACS Patient Perceptions Survey. June 2011
- Chew DP, et al. Invasive management and late clinical outcomes in contemporary Australian management of acute coronary syndromes: observations from the ACACIA registry. MJA 2008;188:691-697
- Yusuf S, Islam S, Chow CK al on behalf of the Prospective Urban Rural Epidemiology (PURE) Study Investigators. Use of secondary prevention drugs for cardiovascular disease in the community in high- income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet 2011;378:1231–1243.
- Scott IA, Lindsay KA, Harden HE. Utilisation of outpatient cardiac rehabilitation in Queensland. Med J Aust 2003; 179: 341-345. Sponsored by AstraZeneca. ABN 54 009 682 311. 5 Alma Road, North Ryde, NSW 2113. AU-BRI000584
