Year: 2025
Type: article
Abstract: All correspondence relating to this paper should be sent to: [email protected] Heart disease, stroke, and vascular disease, collectively referred to as cardiovascular disease (CVD), are substantial health concerns in Australia affecting 1.3 million people—1 in 20 of the population. As well as contributing to mortality and morbidity, CVD places a strain on healthcare budgets, and although CVD prevalence has been declining since the 1980s due to improved interventions and medication, it remains the country’s biggest killer. According to official figures, in 2022, CVD was responsible for 24% of total deaths (Figure 1A). (A) Professor Ben Freedman, Director of External Affairs at the Heart Research Institute where he leads the Heart Rhythm and Stroke Prevention Group. (B) Professor David Brieger, Director of Cardiology at Concord Hospital and professor of cardiology at the University of Sydney Two prominent Australian cardiologists—Ben Freedman and David Brieger—give their perspective on some of the achievements and challenges their country faces in relation to cardiovascular health. Prof. Freedman is the Director of External Affairs at the Heart Research Institute in Sydney where he leads the Heart Rhythm and Stroke Prevention Group. He is an honorary professor of cardiology at the University of Sydney, with research focused on atrial fibrillation and stroke prevention. He believes public perceptions about CVD do not match the reality. ‘Overall people have been lulled into a false sense of security that CVD has been beaten as the number of deaths have gone down, but it’s still the number one cause of mortality in men and number two in women.’ David Brieger is the Director of Cardiology at Concord Hospital and professor of cardiology at the University of Sydney. His clinical interests include coronary artery disease and atrial fibrillation, with research on new antithrombotic drugs for cardiac conditions. According to Prof. Brieger, the decline in CVD rates has been offset by an aging population, obesity, and improved cancer survival, which have contributed to increased diagnoses of CVD. For a nation with a reputation for excelling at sport and enjoying an outdoor lifestyle, Australia has alarmingly high rates of obesity. ‘Contrary to the popular view of a land of sunshine and exercise, we equalled—and at times have exceeded—the United States in rates of obesity, with 66 per cent of our population now overweight or obese. Most of us lead sedentary lives so that 75% fail to meet exercise guidelines. We’re also too fond of our alcohol; the only area where we stand out positively is our lower smoking rates compared to Europe.’ Hypertension, Prof. Freedman notes, is another area that requires attention. ‘Control levels are much lower than we would want to see—often below 50%. While people are aware of risk factors and the importance of healthy eating and an active lifestyle, there are disparities in how these messages are received and socio-economic factors play a significant role.’ First Nations adults—Aboriginal and Torres Strait Islander peoples—are 2.1 times as likely as non-indigenous adults to have heart, stroke, and vascular diseases. Those living in socio-economically disadvantaged and remote areas also experience higher incidences of heart attacks and strokes. ‘These disparities are driven by socio-economic inequity and cultural issues which began with the colonisation of Australia and have resulted in challenges in realising improvements in care.’ Prof. Brieger underlines that there is a 20-year gap in longevity for indigenous peoples who are also susceptible to CVD at a much younger age. ‘These inequities are often compounded for indigenous people in remote areas and significant challenges are likely to remain for the foreseeable future.’ Prof. Freedman points out: ‘The end of the Covid pandemic has seen a surge in new migrants with lower socio-economic profiles concentrated in the outreaches of the major cities. This presents new challenges and further efforts to mitigate the impact of heart disease will be needed’ (Figure 1B). Overall, the Australian healthcare system functions well, according to Prof. Brieger, especially considering the geographic challenges. Medicare is Australia’s healthcare service provider and is funded by the government. The provision of acute care is described as excellent. ‘Life-threatening illnesses are for the most part well-treated across the country. For elective procedures, there’s some strain on the public system, but the private system helps offset this.’ Australia’s population of 27 million is concentrated along the coast which Prof. Brieger describes as ‘a significant factor’ in creating historic disparities of care as hospitals tended to cluster in big cities with patchy coverage in remote interior areas. ‘Things are improving, including transport infrastructure; in New South Wales, the most populous state, there has been a 20% improvement in access to catheterisation laboratories for patients with acute myocardial infarction over the last 5 years. We still have some way to go with newer technologies like Transcatheter Aortic Valve Implantation (TAVI) which remain unevenly distributed.’ Prof. Freedman notes that specialists are still concentrated in major cities. To address the disparity, a series of government initiatives has compelled newly qualified doctors and migrant physicians to work in specific ‘areas of need’. Recent telemedicine and remote initiatives developed during the COVID-19 pandemic have benefited rural communities and allow for wider and better use of training and remote networks. Remote reporting using echocardiography and other diagnostic methods has been successful as have mobile cath labs which could be developed to provide a better service. The type of high-profile government public health campaigns that have successfully increased participation in breast and bowel cancer screening should serve as a model for CVD screening, suggests Prof. Brieger. ‘There was some success in encouraging risk assessments at primary care level, but the real challenge is convincing people to make lifestyle changes. The failure to do this has resulted in high rates of diabetes, and obesity, which we haven’t been able to address properly, and CVD remains a “poor cousin” of cancer in terms of government public health funding. A new lung cancer screening initiative may unintentionally benefit CVD prevention by identifying calcium in coronary arteries, but this is more a matter of luck than strategy.’ Establishing more effective registries could significantly improve outcomes by enhancing understanding of heart health. Prof. Brieger explains: ‘We have had national cancer registries for a long time, but nothing similar for cardiovascular disease, where piecemeal efforts have been led by individuals and professional societies. Recently, there’s been progress with percutaneous device registries—mainly because their high costs caught the Government's attention.’ Improving data infrastructure and establishing robust CVD registries, akin to those in the UK and Scandinavian countries, is essential for measuring quality of care. Australia’s administrative health data are on the brink of being made available to researchers, but Prof. Freedman notes, ‘The data are not robust or enough for detailed evaluations of care.’ Plans to implement a single digital medical record in New South Wales over the next 5 years may simplify data access and analysis and help generate meaningful insights for doctors and researchers. Prof. Freedman also highlights Australia’s lag in linking up health data compared to other countries. ‘It’s a gap we’re trying to fill. Government bodies are making efforts to address this by extracting data from electronic medical records and sharing it monthly with clinicians, but these efforts still fall short of providing truly valuable clinical information.’ All authors declare no disclosure of interest for this contribution.
Source: European Heart Journal
Author: Judith Ozkan
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4409111739