Minister for Health and Aged Care – press conference – Canberra – 20 July 2023

Read the transcript of Minister Butler's press conference about the new cardiovascular disease prevention guidelines.

The Hon Mark Butler MP
Minister for Health and Aged Care

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DAVID LLYOD, CEO HEART FOUNDATION: Thank you everyone for coming to the Next Health Clinic today and to start off, I'd like to introduce the Minister for Health and Aged Care, the Honorable Mark Butler. So please, thank you. 

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thank you, David, so much. And thank you on this nice balmy day here in Canberra – it’s fresh. Thank you for hosting us and taking us through the calculator.

Cardiovascular disease over the last five decades is one of the great public health stories. We've seen death rates from cardiovascular disease plummet by more than 80%. And right through those decades, through better public health and community awareness – particularly in relation to smoking, better medicines, better surgical treatments – the Heart Foundation has been there right through that journey with six decades of advocacy, of research, of lifting community awareness, and lifting health professionals' ability to diagnose early and treat cardiovascular disease.

We've seen this enormous decline in death rates and improving the life expectancy – particularly for men – who so substantially lag the life expectancy of women, when that change started to happen about five decades ago. But we do know, for all of that success, cardiovascular disease is still the biggest killer of Australians, accounting for about one in four deaths, with an Australian losing their lives through cardiovascular disease about every 12 minutes. There is still much to do. We also know from research from the Institute of Health and Welfare, that although the improvement in cardiovascular disease is continuing for older Australians, those improvement rates have slowed substantially for younger Australians of younger age and middle age for both coronary disease and also importantly, for stroke.  

There is still much to do in spite of the enormous success of the last five decades. That is why we're redoubling our efforts around smoking and also taking action on vaping to prevent a new generation becoming addicted to nicotine. It's why we're making medicines for hypertension, for cholesterol and so many other things as well, cheaper and easier to get, which will not only be good for hip pockets, but will improve medication compliance and be good for people's health.

And that's why also we extended beyond 30 June, the Heart Health Assessments that can be conducted by GPs, that otherwise would have expired at that time. But today, I'm delighted to announce the end of some years of painstaking work by the Heart Foundation on behalf on behalf of the Cardiovascular Disease Prevention Alliance, to update our guidelines as a country for the management and an assessment of cardiovascular disease risk. An update that's frankly long overdue, given the existing guidelines were compiled more than a decade ago.  

This is terrific work by the Heart Foundation, it's been done in a thorough, very, very evidence-based way with nine expert advisory groups, including consumer input, as well as obviously those clinicians who will be at the front line – particularly GPs – and it’s a set of guidelines that are substantially going to improve our ability to detect early and therefore intervene early on people who have a high or intermediate risk of cardiovascular disease. I'm delighted to see these guidelines are not only being produced in a way that clinicians are going to be able to go through a very thorough process, but also have been incorporated into an easy-to-use, handy risk calculator that we've just gone through, with Paresh, and a range of other people as well. This is a terrific advance. But it is obviously an advance that will only make a difference if we're able to implement it. So, in the Budget in May this year, we allocated funding to allow the Heart Foundation to start that process of implementation, including us working with software companies to make sure that that risk calculator is incorporated into the practice management software that GP’s use as well.  

In closing, can I just congratulate the Heart Foundation for this work. As I said, this has been a long journey for the Foundation, over six decades to turn around what were truly awful rates of cardiovascular disease, particularly in that post-war period when you had rates of 75 per cent of adult males smoking on a daily basis and so much more. They recognise, though, that in spite of, as I said, getting those death rates down by more than 80 per cent in the last 50 years, there is still more to do. There is still an enormous burden on our community and on our health system through cardiovascular disease.

And we can never rest on our laurels. We always have to make sure that the guidelines that we're using in our health system to assess early and to support patients being able to look after their own health are cutting edge and are based on the most modern evidence. And the Heart Foundation has been able to do that with those guidelines that we're releasing today.

Thank you very much for coming along today and thank you to the Heart Foundation for the work that you've been doing. 

 DAVID LLYOD: Thank you, Minister, we really do appreciate you being here to launch the guidelines. I will say it's, thank you so much for acknowledging the work of the Heart Foundation, we've been the choreographers, rather than the dancers in this, we've brought the, I think, the profession around the country together and made sure that the very best that's thought and known about cardiovascular disease is incorporated in these guidelines.

I think your historical perspective is very apt as well, Minister, if I may say, when we often at the Heart Foundation, look back over that 60-year history of when we started, I think the peak was in 1978, and nobody really knew what was going on with heart disease at the time. But if we look at this from the vantage point of where we are now, it's a little like a snow slope, you see, that we were gradually getting better and better. But there are certain initiatives, statin, some cardiac care units, better blood pressure monitoring and care, you see the steepest slope is going to get us to where we are today.  

The reason, I think, that perspective is so important is that we are very firmly of the view, at the Heart Foundation, that if you look back at our journey against heart disease, from the vantage point of the mid 2030s, we really do believe that this is going to be the start of another one of those deep slopes, this is a very, very significant point for us. And we're thrilled that we've been supported by the government to not just publish a beautiful document that is, as I said, the best that's thought or known about cardiovascular disease in Australia for the Australian population at the moment, but also have the job of implementing these guidelines. We cannot let this sit on the shelf, it's really important that these guidelines are used, that they're in GP software, that they're known in every corner of this country and used so that cardiovascular risk could be better identified, better monitored, better controlled, and so that we can go down that next deep slope to remove cardiovascular disease and the harm that it does around the whole country. This is all about patients, though. And we take advice from lots of people around the Heart Foundation, particularly from patients and I'm thrilled today that Rowena Newman, who has got a wonderful story – I say wonderful – a confronting but useful, I think, story above all else about her own journey with heart disease, to share with us on this occasion. So, Rowena, we are very grateful to you for being here. Thank you.   

ROWENA NEWMAN, SUDDEN CARDIAC ARREST SURVIVOR: Thank you, everybody. I do have a confronting story, I didn't ever consider myself to be high risk of heart disease, I was very healthy, always a very healthy weight, always very healthy and fit, you know, ate well, had none of the risk factors, you know that traditionally, you would think of. No family history that was significant either. And on 6 November in 2020, in my home in Sydney, I had a sudden cardiac arrest at three o'clock in the morning, I had eight minutes of CPR and was taken to the hospital. I was very lucky to have survived. I think the survival rates are less than 5 per cent. I woke up in Royal Prince Alfred Hospital in Sydney about six days later, I had no memory of what had happened. And the doctors were trying to fill me in on all the gaps that I'd missed in that time.  

They told me that I'd had three cardiac arrests. And at that time, I didn't know the difference between a cardiac arrest and a heart attack. Heart attacks can cause cardiac arrest. But mine was kind of more complex than that. It turns out it had been caused by spasms in my vessels in my heart, in combination with a discovery that they'd made while I was in ICU and unconscious, where they'd done an angiogram and they'd found that I had an 80% blockage in my right coronary artery, which was a shock to the doctors, they were not expecting to find that. So, you know, when I came to, I realised that I had, a) been very, very lucky to survive and b) that I was a sufferer of heart disease that was very significant and could have, you know, in very little time, escalated and become a catastrophic heart attack.

So, you know, for me then it was working out what that meant for my life from that point onwards. And cardiovascular disease and heart disease is something that is a lifelong condition, is something that I need to make sure every day that I'm managing my diet, you know, walking five kilometres a day, five days a week, reading the food labels and making sure that saturated fat is low, taking lots of medications where I had previously not had to take any. But also to try and wrap my head around the fact that how – I was so diligent with all of my screening – so I had done all of the breast cancer screening, all of the everything where I thought there were risks, but I hadn't done any heart screening. Because I just didn't see myself as being that middle aged, overweight man that you see in the movies, chain smoking, and having a giant stress attack and having a heart attack as a result.  

When I look back – and hindsight is a magical thing – there were signs that I was suffering from such a degree of heart disease. For example, six weeks before my cardiac arrest, I was suffering terrible jaw pain, and so I went to the dentist, his investigations revealed nothing. And we decided that it was stress, teeth grinding, everybody moved on, it was all happy days. I did a walk about 10 days prior to my cardiac arrest, it was a 30 kilometre walk, and I struggled with it. I'm used to doing long walks, but when my friends suggested that because the weather was bad, we pack it in at 20 kilometres, I was relieved because it was such an effort, and I just wanted to kind of sit down and take it easy.

And then seven days before the cardiac arrest, I was doing boot camp in the mornings – I do it a couple of times a week – and I'd gone in to do a lunge and found that my legs just really didn't have the juice to get me standing up again, so I had to call it quits and go home. That worried me enough that I went to the GP that day, he wrote me a referral to the cardiologist, but he did an ECG, he did a whole bunch of other testing, and looked at my blood pressure and really said that it wasn't an urgent thing at that time.

So, I might have got there, I might have got to the screening before I had that catastrophic heart attack that was coming down the line. But it would be great, and I really welcome these guidelines from the Heart Foundation, the fact that they include women within the data set that's factored in, I really welcome them, because I think we all need to consider that we could be high risk. It can often be silent: you don't know that it's there. So, I would urge people: if it can happen to me, it can happen to anybody. I would urge everybody: to GPs, please use the new calculator, and patients, please ask your GP so that you can use the gap calculator and assess what your real risk is. Thank you. 

DAVID LLYOD: Thank you Rowena, it's wonderful of you to share that story with us. We really appreciate it. Thank you, Minister, for your words, as you've heard, we're working with a government that takes cardiovascular disease and our fight against it seriously, which is a wonderful, truly a wonderful thing for us. I think we're ready for questions now.  

JOURNALIST: Just one on federal politics first. Has Kathryn Campbell been suspended without pay from Defence? 

BUTLER: I'll leave it to others with portfolio responsibility to talk about that. I've seen the reports. But that's not really a matter for me as Health Minister to talk about. 

JOURNALIST: Back on the topic of today, why was there a need to change the heart disease risk guidelines? 

BUTLER: I might see whether David or Garry want to add to this, but as I said, these guidelines that we currently have are now more than a decade old. That might not seem a particularly long time in other contexts, but in a turbocharged period of discovery, new evidence, new research, new understandings of even an old disease, like cardiovascular disease, are constantly being updated and it's critically important that our health professionals but also the community more broadly have access to the most up to date, cutting edge ideas about how to intervene early to assess and manage cardiovascular risk. And I'm delighted the Heart Foundation has put us in a position as a country where we are going to have a set of guidelines that reflects the most cutting-edge understanding. 

JOURNALIST: How will these new guidelines save lives? 

BUTLER: What they'll be able to do, as Rowena has so poignantly said, is to give the tools to members of the community and importantly to their health professionals, particularly to GPs and general practice teams, to go through a relatively straightforwardly – with Heart Health Assessments, and this risk calculator – and be in a position to help people manage that risk and intervene as early as possible and prevent the catastrophic events that Rowena talked about so clearly. 

JOURNALIST: Just one last one, do you think Kathryn Campbell should be suspended? 

BUTLER: I don't have anything else to add to my last answer.  

JOURNALIST: My question is related to coronary calcium scoring. So, the guideline go some way towards recommending coronary calcium scoring as a potential reclassification tool for certain people that fall maybe in borderline risk, but they don't recommend testing for people at high risk who are already on medications, even though some of those people might have a score of zero. Why is that? Why isn't there more across the board recommendations relating to coronary calcium scoring, which really can save a lot of lives? And are you prepared to fund it on Medicare, now that it is in the guidelines, Minister? 

BUTLER: I'm going to pass to Garry Jennings, the Medical Director of the Heart Foundation to talk a bit more about calcium scoring within the context of these guidelines. As you say, Natasha, they are mentioned in the calculator I've just been able to go through with the Foundation. In terms of reimbursement through Medicare, as you well understand, that will require an application to the Medicare Services Advisory Committee, which as I understand, has not ever been made, which will usually be made – not always, but usually be made – by the relevant professional college. But I might pass to Garry to just talk a bit about how calcium scoring fits within the guidelines and the risk calculator. 

GARRY JENNINGS, CHIEF MEDICAL ADVISOR HEART FOUNDATION: Firstly, to answer your question about why it isn’t recommended for high-risk people: we had an independent evidence review and we had an expert committee which consisted of cardiologists with international reputations in the field and essentially it didn't stand up strongly enough for there to be a third recommendation for that particular group. That doesn't mean it wouldn't be a good thing, it just means that the evidence isn't there. And we need to certainly have more research in this area to support these new technologies to make sure the right people get them for the right reason, and they use them in the right way. They can easily be overused, they can easily be underused, we want evidence to support the appropriate recommendation. Thank you.  

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