Assessing cardiovascular risk

16 June 2010

By Rajesh Kumar

Community pharmacy’s role in cardiovascular health has so far been restricted to handing out information brochures to patients who walk in to pick up their scripts for relevant medicines, coupled with advice on how to take those medicines properly.

Stewart Eadie, national cardiac care manager at the National Heart Foundation, told the Pharmaceutical Society’s Auckland symposium on 13 June pharmacists could, in the future, play a more important role in cardiovascular risk assessment and management.

Mr Eadie unveiled an online cardiovascular risk assessment tool that helps visually communicate risks to patients so they can be persuaded to make the necessary lifestyle changes. He says he was initially reluctant for pharmacists to undertake risk assessment because the results were not easily connected with primary care.

In other words, if pharmacists did assess a high level of cardiovascular risk in a patient using the tool yourheartforecast, there was no way to effectively convey the outcome to the patient’s doctor for follow up.

“But that is now changing with connected health IT platforms,” Mr Eadie says.

Patient health portal

ManageMyHealth is one example of such connectivity. It is a new clinical and personal health portal that will allow patients online access to their medical records, lab results and medicines prescribed/dispensed.

Developed by MedTech Global and fully integrated with MedTech practice management software, the portal will eventually enable pharmacists to upload their patients’ risk assessment results onto their personal health account for viewing, if the patients allow it, by health professionals involved in their care.

Subsequently speaking with the Pharmacy Today to elaborate the point, Mr Eadie says pharmacists could download the tool onto their own computers to visually explain to patients the level of their current risk.

Tabs on the unique tool, developed with help from Drs Sue Wells and Andrew Kerr of the University of Auckland, can be manipulated left and right to change the graph showing what will happen to their risk as they get older and make no changes, and conversely, how healthy lifestyle changes, such as smoking cessation, would impact their risk level.

ManageMyHealth was launched in 2008 to allow patients to interact with their general practice online along the same lines as internet banking. It is being now trialled at Ta Pasefika PHO in Counties Manukau, where all its practices and After Hour providers are able to access patient records, including an individual's medications, lab results, and NHI number.

When a patient turns up at the after hours clinic, the GP on duty no longer takes a stab, sending a whole lot of things out of control in the process, Mr Eadie says.

While GPs, nurses and other after hour providers are able to access patient records from their account on the health portal from within the MedTech system, the target is to eventually link it with the secondary care and community pharmacy to enable seamless integration of patient care.

Mr Eadie told Pharmacy Today pharmacists’ ability to use the tool and reinforce the importance of taking medicines regularly and correctly, can make a significant difference in the management of cardiovascular diseases.

If patients know their blood pressure and cholesterol level, they can use a similar tool knowyournumbers  to predict their risk of developing heart disease or stroke in the next five years. The online tool can also help them find out their heart age, while offering a personalised heart health plan to help them make the necessary lifestyle changes.

Biggest killer
Mr Eadie says cardiovascular conditions are the biggest cause of death in New Zealand and account for 40% of all deaths. The disease is the biggest killer of fathers over the age of 35. In Maori and Pacific Island populations, death rates for coronary heart disease are almost twice as high as in Pakeha.

While other parts of the world are envious of what New Zealand has done to increase the uptake of statins through Pharmac, Mr Eadie says more needs to be done due to the level of risk here.
“A wee bit of high blood pressure, a wee bit of obesity and cholesterol, even if individually below the threshold, adds up,” he says.

The risk of developing cardiovascular diseases with high blood pressure doubles if high cholesterol is added and doubles again if the patient is smoker. And if the patient is a male the risk goes up to one in four. If diabetes is added to the mix, the risk will go as high as 33%; and 44% if the patient is aged 60 years or over.

“That’s why we need to have a tool to measure the risk objectively, rather than subjectively,” Mr Eadie says.

The next is the persuading patients to make the necessary changes to their lifestyle to reduce their risk level. Mr Eadie says health professionals need to change their approach to motivational interviewing.

“When we use a hammer (in providing advice), we treat our patient’s unhealthy behaviours as nails. However, most patients and their behaviours are more like nuts and bolts fastened or rusted together. Hammering away can damage the threads of the bolt, so the nut never comes off,” he says.

While stressing the need to find creative ways to convey the message, he says health professionals should find out what is important for the individual patient so they can tailor their message accordingly.

For example, telling a group of male smokers they may become impotent may be more effective than telling them they could develop cardiovascular disease in five years if they continue to smoke.
Literacy is also an important factor to consider.

“Four years ago we embarked on the level of health literacy in the country and I was embarrassed with the results,” Mr Eadie says.

“And I am not talking about people with English as their second language. Some of these people are successful businessmen, but they are very good at covering up,” he says.

Creative ways to communicate to such people are important. For example, the National Heart Foundation trialled a visual aid to convey the message about cholesterol.

“We are now in the process of creating Bro’ Town (inspired) comics on rheumatic fever,” Mr Eadie says.

Younger Group
The problem of risk assessment in the young is existing guidelines are used to decide who benefits from drug treatment in the short term.

"But there is a risk that young patients with poorly controlled risk factors will be falsely reassured by a low score. For example, if a young patient was told he or she had a five percent risk of developing cardiovascular disease in the next five years, it is unlikely to motivate them to change."

The downloadable Your health Age Forecaster Tool (knowyournumbers) was born out of the need to convey the message on long term risk more effectively.

"It is quite realistic, quite achievable and can become a motivational tool," Mr Eadie says.

 

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