Opportunity for better care for heart patients

A landmark study has found that three quarters of Australians and New Zealanders admitted to hospital with severe heart conditions are not receiving the basic preventive care needed to reduce their chance of future heart attacks.

“It’s not good enough that the majority of patients leaving hospital miss out on the most basic care they need to avoid repeat heart attacks down the line,” said study leader Associate Professor Julie Redfern, of The George Institute and The University of Sydney.

About 75,000 Australians are hospitalised due to Acute Coronary Syndrome (ACS, commonly heart attacks) annually, with half of the cases reported in 2010 due to repeat events. Repeat events are more likely to be fatal.

International and Australian guidelines universally recommend preventive care for people who have an acute event, in order to avoid a repeat heart attack. Ideally, this preventive package should commence during the initial hospital admission and should comprise a combination of medications, lifestyle advice and referral to a preventive service such as cardiac rehabilitation.

But the study found that only 35 per cent got some form of healthy eating advice, 43 per cent were told something about the importance of staying active, 70 per cent of smokers were told about the importance of stopping smoking, and only 46 per cent were referred for rehabilitation. Also, at discharge, 35 per cent of patients were on three or fewer medications, even though most of them should be on five.

Associate Professor Redfern said these findings shine a light on the real problems with preventive care delivery in our hospitals.

“What’s even more disconcerting is when you think that of the quarter of patients who do get the proper care, only about half of that group actually go on to improve their lifestyle t or continue their medications over the longer-term.

“Given that in 2010, $1.9 billion was spent on direct healthcare for ACS such as inpatient procedures, out-of-hospital medical services, specialised pathology and imaging, this study highlights the potential to save Australia’s health system hundreds of millions of dollars by preventing secondary heart attacks,” A/Prof Redfern said.

Dr Rob Grenfell, National Cardiovascular Health Director from the Heart Foundation said that people often underestimate the impact of being chronically ill from heart disease.

“It greatly diminishes a person’s quality of life, killing off more and more of the heart muscle after each subsequent heart attack, which is why it’s vital that we ensure patients are given the right toolkit to reduce their risk of a secondary event,” Dr Grenfell said.

“These findings are also extremely timely given the current development of an Australian national clinical standard for the treatment of ACS, a federal initiative being lead by the Australian Commission on Safety and Quality on Health Care,” Dr Grenfell added.

Associate Professor Redfern is now leading research that looks at the outcomes for all these patients, what they actually do after the leave hospital and exploring the link between outcomes and discharge care.

The study, published in the prestigious British Medical Journal’s Heart Journal, looked at 4,000 patients admitted to hospital in Australian and New Zealand with a heart disease event, excluding about 200 people who died after their heart attacks.

It is part of the well known SNAPSHOT ACS Study that followed the vast majority of people admitted to an Australian and New Zealand Hospital with an ACS during a two week period in May 2012.

The study was designed by an bi-national academic network of clinicians and researchers and developed as a collaborative quality initiative between the Cardiac Society of Australia and New Zealand (CSANZ), the National Heart Foundation of Australia (NHFA), the Australian Commission for Safety and Quality in Health Care (ACSQHC), with direct support from The George Institute for Global Health, Health networks or State governments of NSW, QLD, Victoria, SA, and WA.