Review of Cardiovascular Disease Programs

10.4 Identifying linked components of the CVD journey

Identifying linked components of the CVD journey - Framework for recommendations - Review of Cardiovascular Disease Programs

Page last updated: 03 May 2012

Using the model of the CVD, components of the CVD journey that logically link together or overlap have been mapped. These form part of the rationale for the prioritisation and grouping of recommendations.


10.4.1 Foundation elements

Foundation elements (highlighted below) underpin the entire CVD system, covering the triad of clinical governance, information (including research) and performance measurement. A strong and wellfunctioning system requires:
  • sound clinical governance;
  • collection, access to and ongoing use of reliable information (at individual and system level); and
  • application of key performance measures to support optimal system performance.
Foundation recommendations (“F”) are considered essential to build strong foundations and support capacity building throughout the CVD service system. Although some recommendations relating to these elements will take considerable time to fully implement, consideration should be given to commencing work on them immediately.

Figure 6 - Foundation elements of the CVD journey
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Figure 6 illustrates foundation elements – aspects of our health system that are necessary at all levels in order for it to work well, from primary and community care through to acute care and palliation. These elements include sound clinical governance, collection and use of reliable information and research evidence, and the application of key performance measures to support optimal performance.


10.4.2 Population health

Population health initiatives effect change at a population level and must be considered as a part but not the whole of a system improvement strategy. These initiatives will not necessarily improve individual outcomes; their success is measured against population-wide demographic data. The impact of population health actions can take time to become evident, which translates into a long lead time before a return on investment is noted. For this reason, it makes sense to evaluate the success of early stages of population health strategies through the use of secondary indicators.

The diagram below highlights the point in the CVD journey at which community awareness and healthy living strategies are most effective (highlighted). These can both support individual change and impact on population morbidity and mortality. There is an argument about whether public education strategies are foundation elements of any high quality CVD program. In principle this argument is valid. However, the evidence base around marketing and promotion of CVD lifestyle indicators suggests that very significant investments need to be made to achieve a behavioural change and these investments are more effective if some or all of the foundation priorities are already in place.

Figure 7 - Population health
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Figure 7 illustrates the most effective point for community awareness activities in the CVD journey – this is the point at which, having been educated about the risk factors and warning signs of CVD, individuals are able to make informed choices about whether to see their GP for assessment or treatment, or to call an ambulance.


10.4.3 Reducing risk through general practice and primary health care

Primary health care includes primary prevention, often community-based, and secondary prevention, more often provided in clinical settings. General Practice is a key element of the primary health care service system and GPs have traditionally been the first contact for many people experiencing illness. There is now an increasing emphasis on the role General Practice plays in primary and secondary prevention of chronic disease, particularly early identification and management of chronic conditions. The diagram below highlights the two points in the CVD journey where implementation of targeted strategies will improve risk reduction in CVD.

Figure 8 - Reducing risk in the CVD journey through primary health care
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Figure 8 highlights community awareness and primary health care as two points in the CVD journey at which the implementation of targeted strategies can support prevention, and early identification and management of CVD.


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10.4.4 Improving the CVD journey through acute and urgent care

For some, their first contact with the health service system and the first indication that something is wrong is an acute event such as heart attack, TIA or stroke. Others, even if their risk has been identified and is being properly managed, may still experience an acute event. Acute events are life threatening and treatment can determine the survival and/or longer term disease trajectory for an individual. Acute assessment and treatment is specifically tailored for the specific acute event. Assessment and treatment of an acute cardiac infarct requires different action to that of a stroke. Appropriate and timely acute and postacute care can maximise quality of life and long term functioning.

The diagram below highlights the points in the CVD journey which can make a difference to the long term outcomes for individuals as a result of an acute event.

Figure 9 - CVD journey through acute and post-acute care
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Figure 9 illustrates the importance of timely response to acute CVD events such as a heart attack or stroke, highlighting the role of ‘first responders’ in an emergency, such as the ambulance service, as well as hospital-based care. These particular points in the CVD journey can make a significant difference to the long term outcomes of people who have suffered an acute CVD event.


10.4.5 Improving morbidity and quality of life on the CVD journey though post-acute
care, general practice and primary health care

Ongoing care for people with CVD occurs in a variety of settings dependent on the progress of their disease. Diseases have different prognoses and can include acute or sub-acute exacerbations and/or a gradual decline in functioning and increase in illness and disability. Effective strategies to improve outcomes for this component of the CVD journey must be linked across the range of service system elements in order to achieve maximum efficiency and effectiveness. The value of integrating care across multidisciplinary teams and in the community setting wherever possible is supported by research and international experience, and is being tested through a number of initiatives at jurisdictional level, for example HealthOne NSW and GP Plus (SA). These initiatives integrate primary care through General Practice with primary health care through the broader community care sector.

The diagram below highlights those stages of the CVD journey that link for the better ongoing care.

Figure 10 - CVD journey through post-acute to long term care
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Figure 10 illustrates the variety of settings in which ongoing care is provided to people with CVD, including hospital, general practice, community health, rehabilitation services and palliative care, highlighting the importance of integrating and coordinating care across settings.


10.4.6 Better end-of-life care

For some people experiencing CVD, the disease will progress to the point where they require end-of-life care and support. Currently, palliative care services are more likely to be configured to meet the specific needs of patients with cancer than the broader range of people with chronic disease. End of life care occurs across and within a number of environments, including in-patient and community settings, often coordinated through general practice. The diagram below highlights the part of the CVD journey and the linkages between services that relate specifically to end-of-life care.

Figure 11 - Better end-of-life care
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Figure 11 illustrates the linkages between services that specifically relate to palliative care, highlighting the role of general practice, primary health care, hospital care and community health in delivering care and support to patients nearing the end of life.


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