In 2023 the updated Australian guideline and calculator for assessing and managing cardiovascular disease (CVD) risk was released. It builds on previous iterations and offers a more nuanced and individualised risk assessment.
The assessment of multiple factors to calculate absolute cardiovascular risk is an evidence-based approach. It is more accurate than treating individual risk factors alone because it acknowledges cumulative effects.
As the Heart Foundation explains in its Heart Health Check Toolkit, creating even a moderate reduction in several factors is more effective in reducing overall cardiovascular risk than a major reduction in a single risk factor alone.
Why is this important?
The burden of cardiovascular disease in our community is high. In Australia, it:
- causes one in four of all deaths
- claims a life every 12 minutes
- accounts for 1,600 hospitalisations per day.
Many of the risk factors for developing cardiovascular disease are modifiable. GPs are at the forefront of health promotion and screening activities for their patients. Accurate use of the calculator and subsequent interventions can reduce cardiovascular disease burden.
What is the structure of a CVD risk assessment?
The guideline recommends taking a five-step approach to assessing cardiovascular disease risk in people without known CVD histories:
1. Identify people for CVD risk assessment
2. Use calculator to assess CVD risk
3a. Reclassification factors and other considerations
Which patients are suitable for a CVD risk assessment?
The CVD risk guideline recommends priority assessment for these cohorts:
- all people aged 45–79
- people with diabetes aged 35-79
- First Nations people aged 30–79
It also recommends assessing individual CVD risk factors in First Nations people aged 18–29.
Which CVD risk factors are assessed by the calculator?
The Australian CVD risk calculator uses these variables:
- Age, sex
- Smoking status
- Systolic BP
- TC: HDL-C ratio
- Diabetes status
- CVD medicines
- Postcode
- History of AF
For people with diabetes:
- HbA1c
- Time since diagnosis of diabetes
- uACR
- eGFR
- BMI
- Insulin
What risk categories are identified?
Estimated five–year CVD risk
High: ≥10% – Treat now
Intermediate: 5% to <10% – Consider treating now, reassess more regularly
Low: <5% – Reassess in five years
These factors may move an individual’s risk estimate up or down:
- Ethnicity ↑ ↓
- Coronary Artery Calcium score ↑ ↓
- Family history ↑
- eGFR and uACR ↑
- Severe mental illness ↑
What resources are available to communicate risk?
GPs are experts at communicating risk to patients. The calculator has several decision support tools embedded within it. These can be printed or sent to the patient as links.
GPs can also find further decision support by visiting HealthPathways Melbourne. Find the cardiology section here.
What are the next steps to manage cardiovascular risk?
All patients should have appropriate lifestyle advice.
Those with a high risk of a cardiovascular event in the next five years should have active pharmacotherapy treatment in addition to lifestyle advice.
Those at intermediate risk should be considered for pharmacotherapy in addition to lifestyle advice and be reassessed every two years. First Nations patients should be assessed annually. This should be done more frequently if the patient is close to the threshold for high risk, if CVD risk factors worsen, or new risk factors are identified.
Those at low risk should be reassessed in five years. Reassess sooner if close to the threshold for intermediate risk, if CVD risk factors worsen, or new risk factors are identified. First Nations patients should be assessed annually.
Lifestyle factors
- Smoking
- Nutrition
- Physical activity
- Healthy weight
- Alcohol
Pharmacotherapy
- BP-lowering treatment
- Lipid-modifying treatment
Want to learn more? Join in NWMPHN’s cardiovascular disease risk Quality Improvement spotlight
NWMPHN’s next spotlight runs between August and October 2024 and focuses on improving responses to assessing and treating cardiovascular disease risk.
The first phase involved reviewing an online education session titled Mastering CVD risk assessment: essentials for general practice.
- Click here to watch a recording of the session on 8 August 2024
There will then be QI activities to complete and two peer-based online workshops:
- Workshop 1: 6:30pm – 7:30pm, 11 September 2024
- Workshop 2: 6:30pm – 7:30pm, 30 October 2024
Completing the full QI spotlight activity provides GPs with seven CPD hours (comprising one hour Educational Activities, 2.5 hours Reviewing Performance, 3.5 hours Measuring Outcomes).
For more information and to register for the spotlight, click here (.pdf).
What are Quality Improvement spotlights?
Our quality improvement (QI) spotlights are RACGP CPD-accredited, peer-based programs for GPs and the practice team. Each spotlight runs over a set period, focuses on an identified area of improvement in our population, and allows general practices to collaborate with colleagues to support improvement and new ideas.
Benefits
- RACGP CPD accredited, including Reviewing Performance and Measuring Outcomes hours.
- Collaborate with your peers in our catchment to brainstorm ideas, discuss local referral pathways and solutions.
- One-on-one support from your relationship manager throughout the project.
- Written resources provided, can be used to support not only CPD-hours, but also RACGP Accreditation Quality Improvement Module requirements.
- Improve health outcomes for your patients and your community.
Additional resources
- Visit pencs.com.au to download influenza CAT4 recipes for use in your practice’s CAT Plus software. The MBS app on Topbar will also notify you of any presenting patients who are eligible for the Heart Health Check.
- Visit our quality improvement website hub for other QI recipes
Questions?
Our primary health care improvement team is here to help. Please fill this form, phone (03) 9347 1188 or email primarycare@nwmphn.org.au and visit our quality improvement hub for more information.
