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Essay - Examination of a National Health Priority...

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Kate Seery

Student number: 2597 3843

AT6.31

AT6.31: Examination of a National Health Priority Cardiovascular Disease as a National Health Priority Kate Seery Student ID: 2597 3843 Word count: 1,851 words

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Kate Seery

Student number: 2597 3843

AT6.31

Contents Introduction

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Rationale: Why is cardiovascular disease (CVD) a National Health Priority Area (NHPA)?

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Government policy regarding cardiovascular disease

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Pathophysiology

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Exercise as an intervention

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CVD in the media

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Conclusion

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References

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Appendices

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Kate Seery

Student number: 2597 3843

AT6.31

Introduction The National Health Priority Areas (NHPAs) are diseases and conditions that have been identified by the Australian government as significant contributors to the burden of injury and illness that commonly affect Australians. These areas have been chosen specifically as they represent sources of high social and financial cost to Australians. By recognising these conditions, strategies can be developed that encompass the treatments and modifications Australians can implement, thus increasing the health status of the Australian community, as well as decreasing the relative costs of these diseases and conditions. (Australian Insitute of Health and Welfare, 2015)

Rationale: Why is cardiovascular disease (CVD) a National Health Priority Area (NHPA)? Cardiovascular disease (CVD) is characterised as a dysfunction of the heart and / or blood vessels. (Harris, Nagy, & Vardaxis, 2011) Cardiovascular disease is a very common, and very serious, disease which was reported to have affected 3.5 million, or one in six, Australians in 2007-08. (Australian Institute of Health and Welfare, 2011) Cardiovascular disease claimed over 43,000 Australian lives in 2012, which represented 30% of all deaths. Coronary heart disease is the leading cause of cardiovascular related deaths at 49%, followed by stroke at 18%. (National Heart Foundation of Australia, 2012) Troublingly, these deaths were largely preventable, making cardiovascular disease an excellent candidate for a National Health Priority Area. Coronary heart disease is largely attributed to modifiable lifestyle factors, including lack of physical activity, obesity, diabetes, hypertension, hyperlipidaemia, and tobacco smoking. (Australian Institute of Health and Welfare, 2011) The financial cost of cardiovascular disease is equally disturbing. In 2004-05, cardiovascular disease consumed 11% of the total health care expenditure, or $5.9 billion, as shown in table 1. (Australian Institute of Health and Welfare, 2011) Cardiovascular disease is a prominent contributor to hospitalisation in Australia, acting as the main cause of hospitalisation for 500,000 incidences in 2011/12, and played a secondary role in an additional 800,000. (National Heart Foundation of Australia, 2012) This was more than the amount spent on any other disease group, accurately representing its position as the leading cause of death and contributor to the burden of disease in the Australian community. (Australian Institute of Health and Welfare, 2011)

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Kate Seery

Student number: 2597 3843

AT6.31

Government policy regarding Cardiovascular Disease Given that there are many modifiable risk factors contributing to cardiovascular disease, it stands to reason that there are many government initiated campaigns and policies that target cardiovascular disease. “Know Your Numbers” is an initiative developed by the Australian government in conjunction with the National Heart Foundation of Australia and the National Stroke Foundation. This involves screening for risk factors of cardiovascular disease as well as type 2 diabetes – which is a risk factor for cardiovascular disease in itself. A blood pressure check is conducted, as well as type 2 diabetes and cardiovascular disease risk checks. This program aims to detect risk factors early to ultimately prevent cardiovascular disease, or, at the very least, to improve the prognosis of cardiovascular disease through early detection. For every 100,000 check conducted through the Know Your Numbers program, 18,000 people will consult their GP, putting these people on the right track to formulating a management program for any and all risk factors relevant to cardiovascular disease and associated co-morbidities. A conservative estimate of the cost offset of this program is between $22.2 and $74 million, and will avert between 325 and 1,089 strokes per year. This will come through reducing the amount spent on hospitalisations, as well as resources and wages demanded by the treatment and management of cardiovascular disease, and will reduce the overall number of deaths and disabilities caused by cardiovascular disease. (National Heart Foundation of Australia and National Stroke Foundation, 2013) There are many other government funded initiatives that focus on modifying risk factors that affect cardiovascular disease. One such program is the enforcement of plain packaging on cigarette packets in Australia. These plain packs aim to elicit more negative perceptions through the use of confronting images of advanced stage complications of smoking. The images increase awareness of the adverse health effects of smoking. (The Cancer Council, 2012) The program has seen pleasing results. According to the National Drugs Strategy Household Survey in 2013, the number of Australians that smoke is at an all-time low since the implementation of plain packaging, with only 12.8% of people smoking daily.

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Kate Seery

Student number: 2597 3843

AT6.31

Pathophysiology Coronary heart disease accounts for the vast majority of cardiovascular disease deaths in Australia. It has many causes, all of which result in reduced blood supply to the myocardial tissue. Atherosclerosis is one such cause of an occlusion of an artery. Obstructions are formed in the arteries, which prevents the blood supply from getting to the heart, thus causing a myocardial infarction, which then is subjected to necrosis due to ischaemia. Such obstructions are often attributed to excesses of low-density lipoprotein-cholesterol (LDL-C). Lipoproteins are typically brought into cells via endocytosis by binding to LDL-C receptors found on the surface of the cell membrane. Surplus LDL-Cs are transported into the extracellular space so they accumulates just beneath the intima. Here, they (along with other lipids) are engulfed by macrophages – a type of white blood cell – to become foam cells. Macrophages then release cytokines, which promote smooth muscle cell division, leading to a lesion. This early stage lesion is referred to as a fatty streak. As the condition advances, the lipid core expands, causing smooth muscle cells to duplicate. This forms a plaque that protrudes into the lumen of the artery. In the later stages of atherosclerosis, the plaque becomes hardened through calcification. Plaques are considered to be either stable – if they have thick, fibrous caps separating the lipid core from the blood - or vulnerable, which have thin, fibrous caps which are more likely to rupture, exposing collagen and activating platelets, causing a blood clot. Atherosclerosis is considered to be an inflammatory process in which enzymes are released by macrophages, converting stable plaques to unstable plaques. See the attached flow charts (diagram 1, at right, and diagram 2, below). (Silverthorn, Johnson, Ober, Garrison, & Silverthorn, 2013)

Exercise as an intervention Exercise plays an important role in both the prevention of, and recovery from, cardiovascular disease. It has been proven that people that do not participate in regular physical activity are almost twice as likely to die from coronary heart disease as those that do regularly participate in physical activity. (Thompson, et al., 2003) Participating in aerobic exercise can decrease your resting heart rate and blood pressure, increase resting and maximal stroke volume, maximal cardiac output, and VO2 max. (Williams, et al., 2007) There are many risk factors for cardiovascular disease that are combatted by aerobic exercise and resistance training. These include, but are not limited to: hypertension, high LDL levels, insulin resistance and glucose intolerance. Physical activity has also been proven to be of benefit with regard to atherosclerotic risk factors such as myocardial function, coronary artery size, vasodilatory capacity, vascular tone, and vulnerability to atrial fibrillation.

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Kate Seery

Student number: 2597 3843

AT6.31

There are both acute and long-term benefits of being physically fit and active. Vigorous exercise acutely lowers systolic blood pressure and serum triglyceride levels in the blood stream, transiently increases HDL-C levels, and has favourable effects on glucose homeostasis. (Thompson, et al., 2003) Aerobic exercise has quite profound effects on the cardiovascular system. During exercise, VO2 max increases, as well as heart rate and cardiac output. There is a progressive increase in systolic blood pressure, while diastolic blood pressure is maintained. This increased pressure difference decreases the peripheral arterial resistance, reducing the workload of the heart. Furthermore, by exercising regularly, the heart – like any other muscle – becomes stronger and more efficient. Resistance training has been shown to increase left ventricular wall thickness and mass. Unlike in left ventricular hypertrophy as a pathophysiological response, this growth is not fibrotic and does not reduce the volume of the left ventricle. (Williams, et al., 2007) Physiotherapists are poised to play an integral part in providing exercise programs to patients who are at risk of developing CVD, or who are already suffering from CVD. As primary care practitioners, physiotherapists have a responsibility to identify patients that are at risk of developing CVD and implement strategies to pre-emptively target such diseases. (Australian Physiotherapy Association, 2009) Physiotherapists have the knowledge and training to prescribe appropriate exercise programs that can both minimise the risks of developing chronic diseases such as CVD and aid in rehabilitation in recovery from CVD. They should advocate for healthy lifestyles, and have many opportunities to identify at risk patients through their interactions with their clientele, especially because populations that may be at risk of developing CVD may present with other co-morbidities that may require a physiotherapist’s attention. (Thompson, et al., 2003)

CVD in the media Cardiovascular disease receives a great deal of attention in mainstream media, as it affects many people of all different demographics. The World Heart Federation (WHF) contributes significantly to this, seeking to provide education and strategies to people through both events and online resources. One initiative of the World Heart Federation is World Heart Day, held on the 29th of September each year. This day aims to spread awareness and education, bringing people together who have been affected by cardiovascular disease. Here, the importance of living a healthy and active lifestyle are emphasised. Presenters advocate for being physically fit and active, discussing the benefits of being physically active and, perhaps more importantly, the negative impacts on your 6|Page

Kate Seery

Student number: 2597 3843

AT6.31

cardiovascular health if you are not physically active. They offer tips and strategies to making these behavioural changes. An app was developed by Bupa™ in conjunction with the World Heart Foundation to promote healthy heart behaviours. The app allows you to track your steps, speed, and distance throughout the day. The app also connects you with other people, either virtually or by organising to exercise together. This is especially beneficial for the target group – middle aged (40 to 60 years) people. By facilitating communication between people, the app encourages people to be fit and active together, holding them more accountable to regular exercise programs. The app can be downloaded onto iOS and Android smartphones, which makes it easily accessible to the target audience, as so many people these days use smartphones. Having the app on your phone means that it is a constant reminder to exercise regularly, with notifications providing helpful reminders for when you’re on the go. Again, this makes it especially well-suited to middle aged people, as this demographic may find that they need additional reminders or extrinsic motivation from friends or other like-minded Australians on their journey.

Conclusion Cardiovascular disease affects millions of Australians nationwide every year. A significant percentage of all deaths are attributed to cardiovascular diseases every year, which can be prevented by making simple behavioural and lifestyle modifications. Increasing physical activity levels is a simple yet highly effective mode by which we can lower the mortality and morbidity rates of cardiovascular disease, as there are many physiological benefits of being physically fit and active to be reaped. Through implementation of government policy, as well as physiotherapists playing their role in the health care system, cardiovascular disease stands every change of having a reduced impact on the Australian economy and community.

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Kate Seery

Student number: 2597 3843

AT6.31

References Australian Insitute of Health and Welfare. (2015). National health priority areas. Retrieved from Australian Institute of Health and Welfare: www.aihw.gov.au Australian Institute of Health and Welfare. (2011). Cardiovascular disease: Australian facts. Canberra: Australian Institute of Health and Welfare. Australian Physiotherapy Association. (2009). APA Position Statement: Chronic Disease and Physiotherapy. Retrieved from Australian Physiotherapy Association: www.physiotherapy.asn.au Harris, P., Nagy, S., & Vardaxis, N. (2011). Mosby's Dictionary of Medicine, Nursing & Health Professions, 2nd ed. Chatswood: Elsevier. National Heart Foundation of Australia. (2012). Data and Statistics. Retrieved from Heart Foundation: www.heartfoundation.org.au National Heart Foundation of Australia and National Stroke Foundation. (2013, January). Pre-budget submission 2013-14 Federal Budget: Saving lives, reducing avoidable hospital admissions; towards a national action plan for heart attack and stroke. Retrieved from National Heart Foundation of Australia: www.heartfoundation.org.au Poirier, P., Giles, T., Bray, G., Hong, Y., Stern, J., Pi-Sunyer, X., & Eckel, R. (2006). Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss. Circulation, 113(6), 898-918. Silverthorn, D., Johnson, B., Ober, W., Garrison, C., & Silverthorn, A. (2013). Human Physiology: An Integrated Approach. Glenview: Pearson Education, Inc. The Cancer Council. (2012). Plain facts. Retrieved from The Cancer Council: www.cancervic.org.au Thompson, P., Buchner, D., Ileana, L., Balady, G., Williams, M., Marcus, B., . . . Wenger, N. (2003). Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease. Circulation, 103(3), 3109-16. Williams, M., Haskell, W., Ades, P., Amsterdam, E., Bittner, V., Franklin, B., . . . Stewart, K. (2007). Resistance Exercise in Individuals With and Without Cardiovascular Disease: 2007 Update. Circulation, 116(3), 572-84.

Appendices

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Kate Seery

Student number: 2597 3843

Appendix 1

From: Cardiovascular disease: Australian Facts (page 167), Australian Institute of Health and Welfare. Copyright 2011 by the Australian Institute of Health and Welfare.

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AT6.31

Kate Seery

Student number: 2597 3843

AT6.31

Appendix 2

From: Human Physiology: An Integrated Approach (page 536), Silverthorn, Johnson, Ober, Garrison, & Silverthorn. Copyright 2013 by Pearson Education, Inc.

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Student number: 2597 3843

Appendix 3

Mechanism of cardiovascular disease.

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