Absolute Cardiovascular Disease (CVD) risk and implementation

Around 80% of heart attacks and strokes can be prevented with optimal care. Cardiovascular disease (CVD) remains a leading contributor to Aboriginal and Torres Strait Islander mortality despite a 40% decrease in deaths in the past two decades and significant decreases in smoking prevalence. High risk of CVD begins early among Aboriginal and Torres Strait Islander peoples, mainly in people with diabetes and/or renal disease.

Our program of work, funded by the Australian Government Department of Health, is focused on improving prevention of cardiovascular disease for Aboriginal and Torres Strait Islander peoples through:

  • Revision and alignment of clinical practice guidelines
  • Revision and enhanced Medicare Benefits Schedule items for prevention of chronic disease
  • Workforce education and engagement

 

New recommendations for CVD risk assessment and management in Aboriginal and Torres Strait Islander adults aged under 35 years

New recommendations for CVD risk assessment and management were published on 16th March in the Medical Journal of Australia. The recommendations were endorsed by the National Aboriginal Community Controlled Health Organisation, Royal Australian College of General Practitioners, Central Australian Rural Practitioners Association and the Australian Chronic Disease Prevention Alliance, led by the Heart Foundation. The approach to early screening was developed in partnership with the Australian National University’s Aboriginal Reference Group (Thiitu Tharrmay) and other Aboriginal and Torres Strait Islander leaders in CVD prevention.

Main changes

The updated recommendations are for Aboriginal and Torres Strait Islander individuals to receive:

  • Combined early screening for diabetes, chronic kidney disease and other CVD risk factors from the age of 18 years at latest
  • Assessment of using an Australian CVD risk calculator from the age of 30 years at the latest.

Key messages

  1. Most heart attacks and strokes can be prevented, and in the last 20 years, the rate of deaths from CVD in Aboriginal and Torres Strait Islanders peoples has almost halved.
  2. High risk of cardiovascular disease begins early among Aboriginal and Torres Strait Islander peoples and is mainly due to diabetes and renal disease
    1. It is recommended that there should be combined early screening for diabetes, chronic kidney disease and cardiovascular disease risk factors from the age of 18 years, with use of an Australian CVD risk calculator from the age of 30 years.
  3. What you can do: Assessment of CVD risk as part of a health check. The most important part of this check-up is working with your doctor to manage your risk factors to improve your heart health and help you live a healthier, longer life.

 

Healing Heart: Communities

Cardiovascular disease risk communication with Aboriginal and Torres Strait Islander Peoples: toolkit for health professionals

The project team is creating a toolkit to enhance knowledge and skills in CVD risk assessment and management. The Healing Heart: Communities toolkit has been designed as a resource for all clinical staff in primary care, and aims to support conversations about CVD risk. During development, the team has consulted the Australian National University’s Aboriginal Reference Group (Thiitu Tharrmay) and partnered with We are Saltwater People, an Indigenous-owned graphic design company based in QLD to create original artwork, design and layout.

The toolkit is designed for use across a variety of primary healthcare settings, and as a complementary resource to CVD Risk Communication Workshops that can be conducted within these settings.

Preliminary pilot resources are available below and incorporate the new recommendations within the MJA consensus statement described above.

If you have any questions or feedback on these resources, please email Dr Andrea Timothy.

 

Absolute CVD risk and Aboriginal and Torres Strait Islander peoples

This two page resource provides an overview of Absolute CVD risk and Aboriginal and Torres Strait Islander peoples, including statistics highlighting the differences from CVD risk in the general population. This can be used for your own reference, and these facts can be included in your discussions with your patients about their own CVD risk.

Absolute CVD Risk

 

Visual guide for explaining CVD risk to patients

This one page resource is a visual explanation for your patient about their CVD risk and what it means for them, and can complement the use of motivational interviewing techniques.

After conducting the health assessment with your patient, which will include the use of a CVD risk calculator, this resource is a template that you can write on to help you talk through what CVD risk is, what your patients’ specific risk factors are, and how they contribute to their risk of heart attack or stroke in the next 5 years.

CVD Risk Check

How to use this template:

  1. Circle patients’ specific risk factors
  2. Based on the CVD risk calculator’s output, insert whether your patient is at HIGH, MODERATE or LOW risk in the heart graphic
  3. Convert this risk score to a proportion and enter the appropriate number in the corresponding statement, e.g. if your patient’s risk score is 10%, the statement should read “This means that if there were 100 people like you, we would expect 10 of them to have a heart attack or stroke within the next 5 years”
  4. Indicate on the risk spectrum where they currently fall
  5. Discuss what changes can be made to reduce their risk
  6. Indicate on the risk spectrum where they would fall if they made these specific changes
  7. Refer your patient to appropriate services