A cardiovascular assessment model worth following

Auckland District Health Board has run free heart and diabetes check clinics for eligible staff, to demonstrate that it means business when it comes to a gold standard in cardiovascular health checks.

Mona Kauvai (centre) with Heart Foundation nurses Gabrielle Gallagher (left) and Andrea Hofmeister (right).

‘A fitter workforce is beneficial for both our staff and our organisation. By assessing eligible staff we help give them a chance to improve their quality of life, reduce their risk of a cardiovascular event and hospital admission, and set examples to whānau about taking responsibility for their own health,’ says Carolyn Jones.

Carolyn organised the free cardiovascular risk assessments in June 2013 and again in March 2014 when she was planning and strategy manager at Auckland District Health Board. She is now Long Term Conditions Portfolio Manager, Primary Care, at Counties Manukau Health.

There are roughly 11,000 ADHB employees, as well as contractors such as security guards, cleaners and kitchen staff. A number of these employees come from CVD high risk groups, such as Māori, Pacific Islanders and Indians.

‘For these ethnicities an extra 5% is added to their risk level, reflecting the higher incidence and earlier onset of heart disease, diabetes and stroke,’ Carolyn explains.

She says the DHB, primary health organisations and general practices all pushed hard to reach the Ministry of Health’s 90% target of eligible people assessed for cardiovascular risk by June 30, 2014.

‘The last 5% were the hardest to reach because for many reasons they don’t go to the doctor so the assessments had a particular focus on staff that may be at higher risk.’

The ADHB assessments were offered to 4 staff groups: Māori, Pacific Island and Indian males between 35–74 years; Europeans and other males between 45–74 years, Pacific Island, Māori and Indian females between 45–74 years and European and other females between 55 and 74 years. 

The first round of heart and diabetes checks attracted 543 people and the second 452, including staff from the St Luke’s Community Health Unit, Auckland Hospital and Greenlane Clinical Centre. Of the 452 in March 2014, the participants were 24% Pacific Island, 10% Māori, 21% Indian, 10% Asian and 31% New Zealand European or other.

Some staff outside the eligible age, but with a strong family history of heart disease, were also assessed. The March assessments found 41 people with high risk and 18 who had already had a cardiovascular event. 

Attracting people into the programme

Heart Foundation nurse Gabrielle Gallagher didn’t rely on staff emails, e-newsletter and posters alone to get people along. She also visited all areas of the hospital to explain how much difference a check-up could make to people’s health.

‘Māori and Pacific Islanders are very relational so even if they got the email (to invite them for an assessment) they may not have been that interested, but meeting the person running the assessments made all the difference,’ Gabrielle says.

She found numbers increased rapidly. This push included talking to supervisors and workers, some of whom were initially reluctant.

‘However, when I met with them and explained how many heart attacks and strokes are premature and preventable and that this free check would identify what their risk factors were and how they could reduce their risk, then they usually were fine,’ Gabrielle says.

Word of mouth from the first participants was also important.

What was involved

Mike Elliott of Sport New Zealand at his appointment with nurse Sue Fenwick.

Each participant had a half-hour appointment. This included 2 blood pressure readings and blood tests using a ‘point-of-care’ testing machine that delivered immediate results for cholesterol (lipid levels) and HBA1c, a measure of blood sugar.  

These results and other risk factors, such as medical and family history, were used to calculate the person’s risk of a heart attack, stroke or diabetes. An interactive tool, ‘Your Heart Forecast’, was also used to help people understand how a change of lifestyle can change their risk over their lifetime.

‘For example, a 50-year-old may be at the risk level of a 70-year-old for heart attack because of lifestyle choices. Some people were very shocked by what they were seeing. It was quite a wake-up call,’ Gabrielle says.

Results were sent electronically to the participant’s GP, if they had one. If not, they were told about the importance of having a GP.

Nurses also talked about healthy lifestyles and where to find support, and made referrals to Green Prescriptions, dieticians, smoking cessation and Diabetes Auckland. People at high risk were advised strongly to see their GP to discuss medication and lifestyle options.

When tests identified pre-diabetes, the nurses talked about how preventive measures can make a big difference by slowing down the advance of diabetes.

Patient-centred assessments

Carolyn Jones says it was particularly useful for people to get their results during their appointment because the nurses could then discuss the results face-to-face, including the risks and changes needed to reduce risk.

The nurses took the time to encourage people to find ways that they could individually reduce their risk, often using visual aids to ensure discussions were not too medicalised.

Discussions usually focused on ways to make healthier food choices, increase physical activity and become smokefree.

‘People revealed a lot of things. They really took a good look at their family history and own lives. Understanding how our lifestyles and genetics affect our own risk of disease can be a powerful motivator for change,’ Gabrielle Gallagher says.

She adds Taking Control, the Heart Foundation booklet about reducing heart attacks and strokes, was particularly well received.

This story is part of Auckland DHB – staff assessments for cardiovascular disease.

Read the next story in this series: Sione Feki.

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