An integrated national approach represents the greatest opportunity to further reduce cardiovascular disease burden
In Australia, coronary heart disease (CHD) accounts for about 100 000 hospital separations annually. In 2010, the total cost of acute coronary events was over $5 billion.1 A high proportion of coronary events occur in those with known CHD,2,3 and there is strong evidence that secondary prevention reduces hospital readmission and death within the first year after a coronary event by as much as 45% and 25%, respectively.4,5 However, despite abundant evidence and guideline recommendations,6 fewer than half of eligible patients take appropriate preventive medicines or adhere to lifestyle recommendations, and only about a third of those who are eligible attend a prevention program.7,8 A nationally orientated and coordinated approach that underscores the value of secondary prevention, defines the available resources, and monitors uptake and outcomes will be essential in closing these gaps.9
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- 2. Briffa TG, Hobbs MS, Tonkin A, et al. Population trends of current coronary heart disease event rates remain high. Circ Cardiovasc Qual Outcomes 2011; 4: 107-113.
- 3. Chew DP, Amerena JV, Coverdale SG, et al; ACACIA investigators. Invasive management and late clinical outcomes in contemporary Australian management of acute coronary syndromes: observations from the ACACIA registry. Med J Aust 2008; 188: 691-697. <MJA full text>
- 4. Clark AM, Hartling L, Vandermeer B, McAlister FA. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143: 659-672.
- 5. Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA 2007; 297: 177-186.
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- 8. Chow CK, Jolly S, Rao-Melacini P, et al. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation 2010; 121: 750-758.
- 9. Redfern J, Maiorana A, Neubeck L, et al. Achieving coordinated secondary prevention of coronary heart disease for all in need (SPAN). Int J Cardiol 2011; 146: 1-3.
- 10. Redfern J, Chow CK, Brieger D, et al; National Secondary Prevention of Coronary Disease Summit participants. National secondary prevention of coronary disease summit. Technical report July 2012. http://www.georgeinstitute.org.au/sites/default/files/pdfs/Comprehensive_Summit_Report_Website.pdf (accessed Nov 2012).
We thank the Executive Committee — David Brieger (Concord Hospital), Tom Briffa (University of Western Australia), Derek Chew (Flinders University), Cate Ferry (NSW Division of the National Heart Foundation), Stephen Leeder (University of Sydney), David Peiris (The George Institute for Global Health) and Fiona Turnbull (The George Institute for Global Health) as well as all consensus meeting participants (listed in the technical report10) for their active contributions throughout this process. Julie Redfern is funded by a postdoctoral fellowship cofunded by the National Health and Medical Research Council and National Heart Foundation (632933). Clara Chow is funded by a career development fellowship cofunded by the NHMRC and National Heart Foundation (1033478) and a Sydney Medical Foundation Chapman Fellowship. The consensus meeting was endorsed by the NSW Division of the Heart Foundation, the Australian Cardiovascular Health and Rehabilitation Association, the Australian Cardiovascular Nursing Council and Heart Support Australia.
* Equal first authors.
We were Co-chairs for the National Secondary Prevention of Coronary Disease Summit. This initiative received financial support from AstraZeneca to pay for participant attendance (accommodation, travel and parking), venue hire and organisational expenses for the consensus meeting. Speakers and participants did not receive any direct payments or honoraria. This initiative also received indirect support from the Heart Foundation for media and public relations services.