Secondary prevention of coronary heart disease in Australia: a blueprint for reform

Abstract

n Australia, coronary heart disease (CHD) accounts for about 100 000 hospital separations annually. In 2010, the total cost of acute coronary events was over $5 billion.1 A high proportion of coronary events occur in those with known CHD,2,3 and there is strong evidence that secondary prevention reduces hospital readmission and death within the first year after a coronary event by as much as 45% and 25%, respectively.4,5 However, despite abundant evidence and guideline recommendations,6 fewer than half of eligible patients take appropriate preventive medicines or adhere to lifestyle recommendations, and only about a third of those who are eligible attend a prevention program.7,8 A nationally orientated and coordinated approach that underscores the value of secondary prevention, defines the available resources, and monitors uptake and outcomes will be essential in closing these gaps.9 A national consensus meeting to consider an improved approach to secondary prevention was held in December 2011.10 The Summit was attended by 40 representatives from relevant stakeholder groups including government and non-government agencies, consumers and health professionals. Organisations that were represented included the Australian Commission on Safety and Quality in Health Care, the Australian Cardiovascular Health and Rehabilitation Association, the Cardiac Society of Australia and New Zealand, the National Heart Foundation of Australia, Private Healthcare Australia and the Royal Australian College of General Practitioners, among others. We aimed to appraise the essential components of an effective CHD secondary prevention program, performance measures, and barriers and enablers to implementation. The aims are detailed in the full report.10 Six interdependent recommendations emerged (Box) that highlighted the connection between tertiary, secondary and primary care as an area of paramount concern. A series of practical strategies to improve CHD secondary prevention are outlined below.