Introduction

Cardiovascular health is one of the 9 National Health Priority Areas (NHPAs) agreed by the

Australian Health Ministers’ Advisory Council between 1996 and 2012 (AIHW, 2019).

Cardiovascular health can be seen as a test case for Australia’s future well-being. In recent years

the government and other public health personnel have made major advances in preventing heart

stroke and vascular disease and treating it once it occurs. Despite this, cardiovascular diseases

are leading causes of mortality and morbidity in Australia. Most of the premature deaths and

much of the morbidity caused by cardiovascular diseases are preventable. Further, since these

diseases share risk factors with several other conditions including diabetes and some major types

of cancer, addressing these risk factors will produce wider health gains than just those flowing

directly from a reduction in cardiovascular diseases. According to Australian Institute of health

and welfare, chronic diseases such as cancer, cardiovascular diseases, and musculoskeletal

conditions contributed the most burden in Australia in 2015 (AIHW , 2015). To come up with

programs and strategies risk factors for developing CVD are to be highlighted as reference.

Non-Modifiable Risk Factors

The main non-modifiable risk factors are:

• Age; all CVD risk increases with advancing age, and risk of stroke doubles every

decade after 55.

• Gender; men are far more likely to suffer from CVD than pre-menopausal

women. After the menopause, risk is equal between genders

• Family History; Risk is increased if a first degree relative has had coronary

heart disease or stroke before the age of 55 (if male) or 65 (if female)
 • Ethnicity;

Modifiable Risk Factors

Modifiable risk factors are also relevant for calculating individual risk but are

additionally important for mitigating it. Interventions to reduce risk are important on

national, local and individual levels.

Population
Australia
Risk Factor Attributable
Prevalence
Risk
Abdominal Obesity 63.4% 40%
Abnormal lipids (cholesterol) 44.6% 34.5%
Psychosocial factors 38.9% 15%
Lack of regular physical activity 38.4% 66%
Smoking or tobacco use 29.3% 20%
High blood pressure 21.9% 30.2%
Alcohol consumption; drinking
over recommended levels at 18.7% 34%
least 1 day/week
Diabetes 15.0% 7.3%
Diet, including food high in fat, 12.4% 74%
salt and sugar
(AIHW, 2015)

Analysis approach for CVD in national and state level

National trends

In Australia, Cardiovascular Disease (CVD) have attributed 43,477 deaths in 2017. The most

common and serious types of CVD include Coronary heart disease (CHD), stroke and heart

failure. CHD occurred more commonly in older age groups and it was 10 times as high in people

aged 75 and over as in people aged 45–54 (AIHW,2016). In 2017, an average of 21 Australians
died from a heart attack each day, this is equivalent to one death from a heart attack every 67

minutes (Heartfoundation.org, 2017). When it comes to Strokes an estimated 394,000 people

199,000 males and 195,000 females had experienced a stroke at some time in their lives in 2015,

based on self-reported data from the Australian Bureau of Statistics 2015 Survey of Disability,

Ageing and Carers (ABS 2016). In addition, in 2017 there were more than 475,000 people living

with the effects of stroke as such this is predicted to increase to one million by 2050

(Strokefoundation.org, 2017). In these debilitating reports, there has been 8.8 million AUD

healthcare expenses each year (Heartfoundation.org, 2019). Consequently, according to the

Australian Bureau of Statistics (2019), cardiovascular disease has a high prevalence rate in the

population, making it a public health concern. In addition, this disease takes a lot of toll for

Australian causing extreme burden like illness, disability and economic cost for them. This

analysis and needs assessment will explore principles of needs assessment and analysis that leads

to prioritization of needs for ageing population.

State level

In terms of risk factors in state level, there are various data in every state in Australia. For example,

Death rates for coronary heart disease do not show much variation among the States but were

significantly different from the national average for the two Territories. In some state, the lowest

and the highest death rates for the disease were recorded in the Australian Capital Territory and

the Northern Territory respectively. Furthermore, there is not much difference between the States

and Territories in the rates for tobacco smoking, except in the Northern Territory where the

proportion of men who smoke regularly is higher. Additionally, the proportion of overweight

women increased substantially in the Australian Capital Territory. Women in New South Wales,
South Australia, Western Australia and Victoria also recorded notable increases between the two

periods.

Given all the reports and statistics there are challenges or gap that have encountered in

undertaking the needs analysis. Firstly, data and statistics that were collected from literature and

from statistic websites are not to date and some of it were self-reported. It is practical that to

come up with intervention up to date data are necessary, thus according to literature Assessing

the health and social needs of local populations accurate and appropriate information on which to

base priorities and ensures that decisions are based on solid information and evidence (Naidoo,

2009). Secondly, Difficulty gaining information about available services for stroke and CHD

patients. Thirdly, perceived poor end-of-life care for heart failure patients, with difficulty getting

them into palliative services. Lastly, Difficulty navigating social care systems, particularly for

stroke patients who have communication or mobility issues (RWAV, 2017).

Many treatments and treatment strategies are proven to reduce the risk of major cardiovascular

events. Interventions that modify lifestyle factors are among the most effective but are poorly

adhered to. Secondary prevention is an effective way to reduce the burden of cardiovascular

disease and is a current priority of the World Heart Federation. Currently there are large gaps in

utilization of preventive drugs, control of risk factors, and uptake of lifestyle-changing

behaviors. This is often because of failure in the initiation of secondary prevention (Chow,

2017). There is also substantial underutilization of existing programs internationally, with at best

one-third of patients participating in cardiac rehabilitation programs after an acute coronary

syndrome event.6 Barriers to use include distance to services and time pressures caused by the

need for face-to-face in-hospital or clinical setting attendance. There is therefore a need to

develop simple, low-cost, widely available alternatives to improve the adoption of healthy
lifestyles, particularly in patients at highest risk of cardiovascular events called The Tobacco,

Exercise and Diet Messages (TEXT ME). A mobile phone text messages to remind, encourage,

and motivate patients might be useful in this regard, but there has been limited robust scientific

evaluation of these interventions.

SWOT analysis

Strength Weaknesses

Simple and automated program Limited robust scientific evaluation

Overwhelming number of participants in the Needs large study or sample size

intervention group perceiving to be effective Delivered only in English language

Opportunity Threat

Low cost Skepticism towards e-health or mobile health

High level of acceptability of the intervention by other clinicians.

Complement other programs like cardiac

rehabilitation programs and provide ongoing

support
However, according to their report a great number of randomized clinical trials have

demonstrated the effectiveness of mobile phone text messaging to promote smoking cessation,

and several small randomized clinical trials have shown improvements in weight loss and

physical activity (Franklin, 2017).

Program Priorities

Even though this program has not been fully utilized, programs that target the risk factors of

CVD should be implemented and it is called Absolute Cardiovascular Risk Assessment. There is

good evidence that the overall burden of disability and premature death can be reduced through a

dual approach to tackling cardiovascular risks, involving:

• Prevention – reducing risk factors, targeted screening for absolute risk of CVD, and proactive

management for people at risk; and

• Treatment and management for people who have already had a relevant health-event (for

instance a heart attack or stroke).

Comprehensive support for Absolute Cardiovascular Risk Assessment will enable accurate

measurement of individual risks and support clinical decision-making regarding treatment. This

will ensure that those at highest risk are treated appropriately and effectively with lifestyle

modification, drugs or other medical interventions, and will reduce medical over-treatment of

those at lower risk. For people with CVD risks, medical intervention alone will not suffice.

Lifestyle and behavioral changes are also essential for overall risk management and health

improvement –in particular, quitting smoking, reducing harmful alcohol consumption, increasing

physical activity and reducing body weight. The close links between CVD and other chronic

conditions mean that reducing CVD risk should also reduce the risks of other chronic conditions
such as dementia, arthritis and cancer. Screening of low risk CVD individuals will reduce

unnecessary treatments and ensure effective use of healthcare resources and budget. Absolute

Cardiovascular Risk Assessment will raise awareness of the importance of lifestyle behaviors in

influencing health and will provide a platform for enhanced national education about health-

related behaviors and choices. Evidence-based therapy such as social prescribing (a GP referral

to non-clinical services) can lead to a range of positive health and wellbeing outcomes. Lessons

can be learnt from the United Kingdom and NZ through the Green Prescriptions initiative.

Conclusion

Presently, CVD is at lead compared to other diseases and its prevalence is increasing in the

different regions of the globe. There are various determinants playing their part in increasing the

CVD. Though human or biological determinant; cannot be changed. However, through proper

implementation of policies, programs, resources and modification in the behaviors, environment

and lifestyle could lead us to reduce the CVD.