Heart disease remains the leading single cause of death in Australia and yet mortality is only part of the picture, writes Leanne Philpott
Many men living with long-term cardiovascular disease suffer from reduced quality of life or disability—an area in which pharmacy can play an important role.
On average, one Australian dies as a result of cardiovascular disease every 12 minutes. That’s 119 deaths a day. Through reinforcing the information given by doctors and educating those men with a history of heart disease or associated risk factors on lifestyle changes and strategies to prevent heart attacks, pharmacists can help make a real different in the lives of men.
Knowing the risk factors
Hypertension, elevated LDL cholesterol, and smoking are cardinal risk factors for heart disease. Other Lifestyle choices and medical conditions that pose a higher risk of heart disease amongst both men and women include poor diet, physical inactivity excessive alcohol use, overweight, obesity and diabetes.
According to a national report by the Australian Institute of Health and welfare (AIHW) in to cardiovascular disease (CVD), kidney disease (CKD) and diabetes, the burden of these diseases, in terms of prevalence, continues to grow due to unfavourable risk factor trends combined with an ageing population.
Although smoking rates have and continue to fall, increases in overweight and obesity, physical inactivity and insufficient fruit and vegetable consumption suggest that the burden of CVD, diabetes and CKD will escalate in the future.
Diabetes Australia CEO Professor Greg Johnson outlines how prevalent the link between diabetes and CVD is. He says, “People with diabetes are three times more likely to suffer a heart attack than people without diabetes, and four times more likely to suffer from strokes.
In fact, cardiovascular disease is the leading cause of death in people with diabetes.
“While a number of other diabetes complications, including blindness, kidney damage and limb amputations, are related to the vascular impacts of diabetes.”
He says, “Many of the complications of diabetes can be prevented with good glycaemic control, but most people aren’t reaching the appropriate targets.
“The key marker for successful diabetes management is the HbA1c test measuring average blood glucose levels over a three month period. The Australian Primary Care Collaborative’s research into diabetes prevention and management reported last year that a little over 40% (41.5%) were meeting the HbA1c target <7 mmol/L.
“In other areas the outcomes are also worrying. According to the Australian Health Survey in 2011-12, 37.9% of people with known diabetes met the management target for total cholesterol and 37.2% met blood pressure targets.
“Better results were seen for triglycerides where 70% met management targets.”
Pharmacists can proactively remind patients with diabetes of the clinical targets and offer to monitor their blood glucose and cholesterol levels to help them stay on track and within the recommended guidelines.
According to the Royal Australian College of General Practice Guidelines for the management of type 2 diabetes, the clinical targets are:
- Blood glucose — generally ≤53 mmol/mol (range 48-58), ≤7% (range 6.5–7.5)
- Total Cholesterol — < 4.0 mmol/L
- HDL-Cholesterol — >0 mmol/L
- LDL-Cholesterol — <2 mmol/L
- Non-HDL-Cholesterol — <2.5mmol/L
- Triglycerides — <2.0mmol/L
- Blood Pressure — 130/80
Prof Johnson adds, “Because of the strong links between diabetes, cardiovascular disease and kidney disease, Diabetes Australia (as a member of the National Vascular Disease Prevention Alliance) promotes an integrated health check process that supports the evidence-based detection, assessment, prevention and management of all of these conditions concurrently.
“Integrated health checks should be carried out by GPs but pharmacists can play an important role in community-based risk assessment by utilising risk assessment tools like the Ausdrisk test and referring people at high risk of type 2 diabetes to prevention programs.”
According to figures drawn from the Australian Diabetes Map, maintained by the National Diabetes Service Scheme, there’s a slight gender divide in relation to diabetes (includes all types). While females account for 4.8% of those diagnosed with diabetes in Australia, men account for 5.4%.
Where a key gender gap occurs in relation to CVD is in the cases of acute coronary events. The AIHW reports that in 2012, the rate of acute coronary events was twice as high in men as in women, with an estimated two-thirds (63%) of acute coronary events among those aged 25 and over occurring in men.
Pharmacists should seize every opportunity to engage and counsel male patients at risk of CVD to take a proactive role in their overall health, especially when mortality and morbidity associated with heart attacks in people with coronary heart disease could be greatly reduced if the warning signs are recognised and acted upon quickly.
Heart attack warning signs and what to do
Research conducted by the Heart Foundation reveals that many people, including those with CHD, wait too long before seeking treatment for a heart attack.
Just under 50% of people arrive at hospital emergency departments by ambulance, yet more than 50% of heart attack deaths occur before the person reaches hospital.
By adopting a ‘healthcare team’ approach and educating patients with CVD on the warning signs and the importance of acting quickly, pharmacists can help reduce delays in patient response and improve the health outcomes.
Heart Foundation National CEO Garry Jennings, says, “Knowing the warning signs of a heart attack are vital however, someone who has already had a heart attack may have different symptoms the second time.
“Despite this, knowing the warning signs of heart attack and acting quickly can reduce damage to the heart muscle and increase a person’s chance of survival.
He says, “Heart attacks are not always sudden or severe. Many start slowly with only mild pain or discomfort. Some people do not get any chest pain at all—only discomfort in other parts of their upper body.
“The most common warning signs of a heart attack include discomfort or pain in the centre of the chest— this often feels like a heaviness, tightness or pressure.
“This discomfort may spread to different parts of the upper body such as arms, shoulders, neck, jaw or back. People can experience a choking feeling in the throat or the arms may feel heavy and useless.
“Other signs can include shortness of breath, feeling of nausea, a cold sweat, dizziness or light-headedness.
“Anyone who experiences these symptoms should call triple zero (000) for an ambulance.”
According to the Heart Foundation, some of the main reasons why patients delay calling triple zero include:
- a tendency to ignore he warning signs;
- they don’t recognise their symptoms as indicators of a potential heart attack;
- they think symptoms need to be ‘severe’ to call an ambulance;
- they don’t want to bother the ambulance service or cause others to worry about them;
- they think it’s better to call their GP; and/or
- they worry about the cost of an ambulance.
To help raise awareness of the importance of appropriate and timely treatment, pharmacists can use the following advice, taken from the Heart Foundation’s Heart Attack Fact Sheet for health professionals.
Communicate the following key messages to patients:
- the different warning signs of heart attack;
- the potential to experience different warning signs in a future cardiac event;
- their risk of having a heart attack is now higher than the general population;
- how and when to use short-acting nitrate medicine (if appropriate);
- why it’s important to act quickly and call Triple Zero (000) for an ambulance;
- why it’s important to get early treatment to reduce heart muscle damage and save lives; and
- it’s better to act quickly even if you’re not sure that you’re having a heart attack.
Where possible, include your patient’s immediate family when communicating the key messages.
Enlist the family’s support to reinforce the messages and acknowledge that the patient may need help to act quickly.