Cardiovascular disease (CVD), including acute and chronic heart disease, stroke and peripheral vascular disease, is a complex and multifactorial issue that affects 16.6% of the Australian population.1,2 It is the leading cause of death in Australia and accounts for 26% of all deaths.3 CVD also costs the Australian economy over $5 billion each year, more than any other disease.4
CVD mortality rates for Aboriginal and Torres Strait Islander adults (older than 25 years) are double that of non-Indigenous Australians, and seven times higher in those aged 40–54 years.5 Early intervention in the form of screening and risk factor modification is therefore vital. Screening for CVD in Aboriginal and Torres Strait Islander peoples is recommended from 18 years of age, and screening for CVD risk factors is recommended to start as early as 12 years of age.5
General practitioners (GPs) are well placed to advise patients on how to modify their risk factor profiles through the promotion of healthy lifestyle choices. Risk factors include smoking tobacco, high body mass index (BMI), physical inactivity, elevated cholesterol, elevated blood pressure, excessive alcohol intake, and low fruit and vegetable consumption. These are considered the most effective areas to focus on for CVD prevention.5
Atrial fibrillation is another common cardiac condition that significantly increases the risk of developing heart failure or stroke, making diagnosis and timely management vital.6 These patients are often managed entirely by GPs, with an emphasis on managing symptoms, preventing disease progression and avoiding hospitalisations.
Some cardiovascular conditions also affect children and can have long-term negative health outcomes. These include congenital heart defects and infectious diseases, such as rheumatic fever. The rates of acute rheumatic fever are higher in Aboriginal and Torres Strait Islander children, especially in rural and remote areas.7 If left undiagnosed and untreated, rheumatic fever can lead to rheumatic heart disease.8 It is the GP’s role to identify those at risk and provide appropriate treatment in the context of their community. Other types of sclerotic valvular pathologies are often picked up by GPs by undertaking opportunistic cardiovascular examinations when patients present for other reasons. GPs are also responsible for identifying and appropriately managing these to prevent later morbidity and mortality.
Deaths from heart disease are more than 50% higher for Australians in rural and remote areas of Australia compared with metropolitan areas.8 Research shows that this is due to multiple issues related to access, including the ability to pay, transport and geographical distances, delays in patients seeking care, access to diagnostic testing and timely treatment in an appropriate facility. Workforce shortages or lack of access to relevant non-GP specialists, cultural differences and complexities that arise from comorbidities and geographical isolation also amplify the challenges.9 GPs therefore play a key role in advocating for equitable access to cardiovascular and other general health services for patients in rural and remote areas. GPs working in rural and remote regions should also be supported to provide comprehensive cardiovascular healthcare with the resources they have available locally.