None listed
Conditions
Brief summary
Up to a quarter of deaths from heart disease and strokes may be preventable through better preventative strategies and initiation of appropriate treatments. Mortality from cardiovascular disease is declining in NZ for all ethnicities as per the Health NZ report released early 2024, but Maori and Pacific people are still disproportionately affected. This provides rationale why cardiovascular disease risk assessment (CVD RA) is recommended 15 years earlier in Maori and Pacific people (and South Asian) compared to NZ Europeans. CVD RA is typically performed in primary care by GP practices in NZ. The Health NZ status report showed around 78% of eligible people were receiving CVD RA based on data from 2020/2021, but this data came with significant limitations. This completion rate is well below the target set by the Heart Foundation of 95 % of eligible New Zealanders having risk assessed and managed. Inpatient admission may provide opportunity for CVD RA to be performed in patients that have barriers to accessing primary care.
Interventions
A study trained Pharmacist at Christchurch public hospital will offer Cardiovascular Disease Risk Assessment to Maori and Pacific inpatients who meet the NZ Ministry of Health 2018 Guidelines criteria for risk assessment, but for whom it has not been provided.
Study Pharmacists performing the intervention will be clinically and cultural trained to perform Cardiovascular Disease Risk Assessment in Maori and Pacific People. After consent is gained, the study pharmacist will take a history and ask
A study trained Pharmacist at Christchurch public hospital will offer Cardiovascular Disease Risk Assessment to Maori and Pacific inpatients who meet the NZ Ministry of Health 2018 Guidelines criteria for risk assessment, but for whom it has not been provided. Study Pharmacists performing the intervention will be clinically and cultural trained to perform Cardiovascular Disease Risk Assessment in Maori and Pacific People. After consent is gained, the study pharmacist will take a history and ask hospital team to add additional blood tests (lipids, Hba1c and renal function) if needed. The intervention will be offered once only to participants who met study inclusion/exclusion criteria. Risk Assessment will be undertaken in the hospital using PREDICT based tools available publicly on the internet. Either: https://decisionaid.ca/cvd/ https://www.nzssd.org.nz/cvd/ https://www.heartfoundation.org.nz/your-heart/my-heart-check Calculation of CVD risk will occur when lab results are back (possibly the day after consenting) and likely done remotely from patient. The study pharmacist will then discuss results and management options with the participant (which is expected to take between 30 minutes and 1 hour including calculating of risk when all data is collected). Ideally the same study pharmacist will perform all of consent, risk assessment and management discussions but this may need to be done by different staff. Lifestyle (smoking cessation if applicable, physical activity) and dietary advice will be provided to all participants using standard NZ Heart Foundation resources. Higher risk participants will be offered lipid lowering therapy most likely with statins (and educated on risks/benefits using patient information leaflet from mymedicines.nz) and handed over to primary care for ongoing management. Communication will be primarily through the discharge summary, but a phone call to primary care will take place for some patients. If no primary care provider currently, they can be referred to social work services to facilitate engagement with a primary care provider post discharge. Participants adherence to management will not be followed up post discharge.
Sponsors
Christchurch Hospital Pharmacy Department
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
30 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
o Maori or Pacific Male* aged 30 or above o Maori or Pacific Female* aged 40 or above o Live in greater Christchurch area to ensure appropriate community follow up can be arranged. (*Sex at birth)
Exclusion criteria
High risk CVD features that automatically define risk as > 15% o Heart failure o Coronary or carotid artery disease from imaging (unlikely to have in community) o eGFR < 30 mL/min or < 45mL/min with diabetes o Previous Cardiovascular event o Familial hypercholesterolaemia o Age greater than 75 (as the PREDICT CVD RA tool is only validated for < 75 years) o Pregnant / Breastfeeding o Not appropriate due to clinical or emotional status (too unwell) or prognosis (short life expectancy) Note: If deemed inappropriate due to current clinical status, this can be reassessed at a later date during their admission o Patient had CVD RA completed previously + clearly recalls their risk level AND is not due to repeat assessment (see below) AND appears appropriately treated for risk level. Note: Due to variance in completion rates / quality / timeliness and patient recall of previous CVD RA – better to assess again if any concerns to appropriately manage cardio-vascular disease risk. Recommended interval for repeat CVD risk assessment Risk < 3% – ten years Risk 3–9% – five years Risk 10–14% – two years Risk = 15% – one year Risk 5–15% and prescribed pharmacological interventions – one year Severe mental illness – two years (or one year if risk greater than or equal to 15%)
Outcome results
None listed