The Ministry has supported the development of a cardiovascular disease risk assessment (CVDRA) consensus statement.
Morbidity and mortality from Cardiovascular Disease continues to be one of the largest burdens of disease for New Zealanders. More people are surviving acute events, and there have been advances in the prevention and treatment of CVD, however, CVD is still responsible for 40 percent of deaths (often premature and preventable) in New Zealand.
The consensus statement builds on the significant investment in the More heart and diabetes checks health target. While part of the health targets programme 1.2 million Kiwis (90 percent of the eligible population) were risk assessed. The sector is now in an excellent position to focus on risk factor management. CVD risk assessment has become part of normal general practice and local pathways for risk management are regularly promoted and used.
Reason for the consensus statement
New cardiovascular (CVD) risk equations are now available. We now have the ability to estimate risk and predict future cardiovascular events based on contemporary New Zealand data.
Cardiovascular disease risk assessment
The goal of a cardiovascular disease risk assessment is to reduce CVD risk for individuals and provide appropriate advice about reducing the risk of developing diabetes. A cardiovascular disease risk assessment informs people about their risk of cardiovascular events, as well as strategies to improve their heart health. It also helps to identify people with diabetes to receive care and learn about helpful lifestyle changes. The overarching principle remains that the intensity of recommended intervention should be proportional to the estimated combined CVD risk.
There remains a significant disparity between Māori and non-Māori access to primary care services and risk assessments making an equity focus for assessment coverage and risk management imperative.
The Heart Foundation was commissioned by the Ministry of Health in 2015 to review the relevant evidence and other guidelines in key relevant areas.
In June 2016 following the launch of the NZ Health Strategy a series of roadshows were facilitated by subject matter experts from the Heart Foundation and the University of Auckland to discuss the evidential review, new equation development and potential impacts. In attendance were consumer advocates, clinicians, DHB/PHO representatives, and NGO/professional association delegates.
The goal of the roadshows was to provide discussion and feedback fora about the guideline update processes and rationale. Discussions focused on:
- the evidence and methodology behind the new equations and implications for moving from Framingham to PREDICT
- the international treatment threshold landscape as well as the joint mental illness review with Te Pou. (Read a summary of the review - Te Pou website)
- potential timelines for this work and the formation of steering and IT groups to oversee guideline implementation.
Questions around the process for guideline development were raised at an open invitation stakeholder workshop in December 2016. A formal guideline development process was not possible. Therefore the process was to develop a stakeholder consensus statement for cardiovascular disease risk assessment and risk factor management to complement the upcoming release of CVD risk equations.
Who was involved?
The Ministry of Health facilitated the discussion and consensus. Primary care, specialist and consumer advisors provided feedback. For comorbidities the Ministry sought input from lead agencies/organisations for example Te Pou for mental health and the National Diabetes Leadership Group. Researchers were consulted on for the new CVD risk equations (including equations for the diabetes cohort).
The Ministry of Health is looking at how to integrate the new equations into usual practice.