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Hamilton S.,University of Western Australia | Mills B.,University of Western Australia | McRae S.,National Heart Foundation of Australia | Thompson S.,University of Western Australia
BMC Cardiovascular Disorders | Year: 2016

Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in Australia. Australian Aboriginal and Torres Strait Islander (Indigenous) people have higher levels of CVD compared with non-Indigenous people. Cardiac Rehabilitation (CR) is an evidence-based intervention that can assist with reducing subsequent cardiovascular events and rehospitalisation. Unfortunately, attendance rates at traditional CR programs, both globally and in Australia, are estimated to be as low as 10-30 % and Indigenous people are known to be particularly under-represented. An in-depth assessment was undertaken to investigate the provision of CR and secondary preveniton services in Western Australia (WA) with a focus on rural, remote and Indigenous populations. This paper reports on the findings for Indigenous people. Methods: Cardiac rehabilitation and Aboriginal Medical Services (n = 38) were identified for interview through the Heart Foundation Directory of Western Australian Cardiac Rehabilitation and Secondary Prevention Services 2012. Semi-structured interviews with CR coordinators were conducted and included questions specific to Indigenous people. Results: Interviews with coordinators from 34 CR services (10 rural, 12 remote, 12 metropolitan) were conducted. Identification of Indigenous status was reported by 65 % of coordinators; referral and attendance rates of Indigenous patients differed greatly across WA. Efforts to meet the cultural needs of Indigenous patients varied and included case management (32 %), specific educational materials (35 %), use of a buddy or mentoring system (27 %), and access to an Aboriginal Health Worker (71 %). Staff cultural awareness training was available for 97 % and CR guidelines were utilised by 77 % of services. Conclusion: The under-representation of Indigenous Australians participating in CR, as reported in the literature and more specifically in this study, mandates a concerted effort to improve services to better meet the needs of Indigenous patients with CVD as part of closing the gap in life expectancy. Improving access to culturally appropriate CR and secondary prevention in WA must be an important component of this effort given the high rates of premature cardiovascular disease affecting Indigenous people. Our findings also highlight the importance of good systematic data collection across services. Health pathways that ensure continuity of care and alternative methods of CR delivery with dedicated resources are needed. © 2016 The Author(s). Source

Banks E.,Australian National University | Banks E.,Sax Institute | Crouch S.R.,University of Melbourne | Korda R.J.,Australian National University | And 4 more authors.
Medical Journal of Australia | Year: 2016

Objective: To quantify absolute cardiovascular disease (CVD) risk and treatment in Australian adults. Design, participants: Cross-sectional representative study of 9564 people aged 18 years or more who had participated in the 2011e12 Australian National Health Measures Survey (response rate for those aged 45e74 years: 46.5%). Main outcome measures: Prior CVD was ascertained and 5-year absolute risk of a primary CVD event calculated (using the Australian National Vascular Disease Prevention Alliance algorithm; categories: low [< 10%], moderate [10e15%], and high [> 15%] risk) on the basis of data on medical history, risk factors and medications, derived from interviews, physical measurements, and blood and urine samples. Results: Absolute CVD risk increased with age and was higher among men than women. Overall, 19.9% (95% CI, 18.5e21.3%) of Australians aged 45e74 years had a high absolute risk of a future CVD event (an estimated 1445000 people): 8.7% (95% CI, 7.8e9.6%) had prior CVD (estimated 634000 people) and 11.2% (95% CI, 10.2e12.2%) had high primary CVD risk (estimated 811000 people). A further 8.6% (95% CI, 7.4e9.8%, estimated 625000) were at moderate primary CVD risk. Among those with prior CVD, 44.2% (95% CI, 36.8e51.6%) were receiving blood pressure-and lipidlowering medications, 35.4% (95% CI, 27.8e43.0%) were receiving only one of these, and 20.4% (95% CI, 13.9e26.9%) were receiving neither. Corresponding figures for high primary CVD risk were 24.3% (95% CI, 18.3e30.3%); 28.7% (95% CI, 22.7e34.7%); and 47.1% (95% CI, 39.9e54.3%). Conclusions: About one-fifth of the Australian population aged 45e74 years (about 1.4 million individuals) were estimated to have a high absolute risk of a future CVD event. Most (estimated 970000) were not receiving currently recommended combination blood pressure-and lipid-lowering therapy, indicating substantial potential for health gains by increasing routine assessment and treatment according to absolute CVD risk. © 2016 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved. Source

Stewart M.,National Heart Foundation of Australia | Page K.,Deakin University | de Jong R.,Heart Health | Lee R.,Heart Health | Grenfell R.,Heart Health
Heart Lung and Circulation | Year: 2015

Introduction: Heart disease is the leading single cause of death for men and women in Australia. There are 685,000 people living with heart disease, approximately 50% will be experiencing signs and symptoms of heart failure. This article aims to articulate the key advocacy activities required to improve the provision of evidence-based secondary prevention including cardiac rehabilitation and multidisciplinary chronic heart failure management services. Method: The Heart Foundation undertook an extensive consultation process with many experts, policy makers, health and public health professionals through forums, evidence reviews and working groups. A range of actions are required to improve access to secondary prevention, but only those that the Heart Foundation could drive and support have been included. Results: The results identified three synergistic advocacy areas between heart failure and cardiac rehabilitation to drive secondary prevention advocacy. These were data, policy and people. Discussion: The priority actions are discrete and tangible to progress rather than revisit established evidence-based recommendations, and to support uptake and implementation at a national and state/territory level. We must consider the current landscape within which secondary prevention sits and identify the intersecting barriers and enablers that can be influenced. There is no single solution or lever for change. Conclusion: Best-practice management of heart disease can be achieved through a co-ordinated effort to implement system change. Focus should be paid to a multi-faceted approach in the key advocacy areas identified here - data, policy and people - as these will provide benefit across the disease continuum, from secondary prevention and cardiac rehabilitation through to heart failure management. © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Source

Clark R.A.,Queensland University of Technology | Tideman P.,A+ Network | Tirimacco R.,A+ Network | Wanguhu K.,Waikerie Medical Center | And 7 more authors.
Heart Lung and Circulation | Year: 2013

Background: Interventions that facilitate access to cardiac rehabilitation and secondary prevention programs are in demand. Methods: This pilot study used a mixed methods design to evaluate the feasibility of an Internet-based, electronic Outpatient Cardiac Rehabilitation (eOCR). Patients who had suffered a cardiac event and their case managers were recruited from rural primary practices. Feasibility was evaluated in terms of the number of patients enrolled and patient and case manager engagement with the eOCR website. Results: Four rural general practices, 16 health professionals (cardiologists, general practitioners, nurses and allied health) and 24 patients participated in the project and 11 (46%) completed the program. Utilisation of the website during the 105 day evaluation period by participating health professionals was moderate to low (mean of 8.25 logins, range 0-28 logins). The mean login rate for patients was 16 (range 1-77 logins), mean time from first login to last (days using the website) was 51 (range 1-105 days). Each patient monitored at least five risk factors and read at least one of the secondary prevention articles. There was low utilisation of other tools such as weekly workbooks and discussion boards. Conclusions: It was important to evaluate how an eOCR website would be used within an existing healthcare setting. These results will help to guide the implementation of future internet based cardiac rehabilitation programs considering barriers such as access and appropriate target groups of participants. © 2012. Source

Nestel P.,Baker IDI Heart and Diabetes Institute | Clifton P.,University of South Australia | Colquhoun D.,University of Queensland | Noakes M.,CSIRO | And 3 more authors.
Heart Lung and Circulation | Year: 2015

Background: The National Heart Foundation of Australia (NHFA) 2008 review on omega-3 long-chain polyunsaturated fatty acids (LCPUFA) made recommendations with respect to supplementation for primary and secondary prevention of cardiovascular disease. Since then, new findings have been published regarding the relationship between omega-3 polyunsaturated fatty acids, including supplementation, and cardiovascular health. Methods: A literature search was undertaken in PubMed and Medline, for literature published between January 1, 2007 and August 31, 2013. Results and Conclusions: A total of eight research questions were developed and, using the National Health and Medical Research Council's evidence assessment framework, conclusions were made in relation to dietary intake of fish and omega-3 LCPUFA for cardiovascular health. In the evidence published since 2007, this summary of evidence concludes that dietary intake of fish was found to be mostly consistent with respect to protection from heart disease and stroke. Higher fish intake was associated with lower incident rates of heart failure in addition to lower sudden cardiac death, stroke and myocardial infarction. In relation to omega-3 LCPUFA supplementation, neither a beneficial nor adverse effect was demonstrated in primary or secondary prevention of coronary heart disease (CHD). Although the evidence continues to be positive for the role of omega-3 LCPUFA in the treatment of hypertriglyceridaemia and a modest positive benefit in heart failure. No further evidence was found to support the consumption of 2. g alpha-linolenic acid (ALA)/day over the current Australian guidelines for 1. g/day. © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Source

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