Four patient groups that need GPs’ attention this Heart Week

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.
 
The impact of COVID-19 on routine screening activities, together with the potential heart health consequences of long COVID, means that cardiovascular disease (CVD) screening is more important than ever.
 
GPs have delivered more than 275,000 Heart Health Checks since the 699 and 177 Medicare Benefits Schedule (MBS) items were introduced in 2019.
 
This Heart Week (2–8 May), the Heart Foundation is challenging GPs to ‘take charge’ by focusing on simple, routine Heart Health Checks, particularly in patient groups with known elevated CVD risk.
 
1. People with diabetes
It is estimated that the rate of death from CVD is more than four times higher for people with diabetes compared to those without diabetes.
 
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 >2.5 mg/mmol for males, >3.5 mg/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.
 
General Practice Management Plans and Team Care Arrangements can also improve clinical outcomes for people living with diabetes. 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.
 
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.
 
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.
 
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 Torres Strait Islanders
On average, cardiovascular events such as heart attacks and strokes, and CVD-related mortality occur 10–20 years earlier in the Aboriginal and Torres Strait Islander population than in the non-Indigenous population.
 
Approximately 16% of Aboriginal and Torres Strait Islanders aged 35–74 are at high absolute risk of a future CVD event.
 
The most recent Australian consensus statement recommends that absolute risk assessment should begin from 30 years for Aboriginal and Torres Strait Islanders. Individual risk factor screening should begin from 18 years at the latest.
 
Cardiovascular risk assessment and management should occur as part of an annual health check for these patients.
 
4. People living with mental illness
One in five Australians live with a mental or behavioural condition.
 
Serious mental illness increases the risk of developing coronary heart disease, independent of conventional risk factors, while anxiety, depression, social isolation and loneliness can all increase the risk of having a heart attack or coronary heart disease.
 
Depression has been shown to increase the risk of unhealthy behaviours, including smoking, having an unhealthy diet, physical inactivity and medicine non-adherence.
 
Guidelines recommend assessing for depression and other psychosocial factors when conducting CVD risk assessment, including during a Heart Health Check. A comprehensive Heart Health Check assessment template, which includes mental health considerations, can be found online or built into Best Practice software.
 
This Heart Week, use the Heart Health Check Toolkit to easily assess and manage CVD risk for more patients, helping to lower the morbidity and mortality of CVD in Australia.
 
GPs looking to brush up on the latest evidence can also register for the Heart Week clinical webinar on lipid management (accredited by the RACGP for 2 CPD points; activity no. 337635).
 
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Aboriginal and Torres Strait Islander Health diabetes gestational diabetes Heart Foundation Heart Health Checks mental health