Let’s make the 'physical examination' of the Heart Health Check fit for purpose

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Pat Williams, the managing director of Edwards Lifesciences Australia, New Zealand and Korea, says more action is required to ensure the best treatment of people with structural heart disease.

According to the British Heart Foundation analysis, more than 96,000 fewer heart procedures across England and Wales were carried out in 2020 and more than 26,000 extra deaths occurred in private homes last year compared to the last five years.

This is just some of the direct impacts COVID-19 has had on patients.

We are lucky Australia’s health system, for the most part, has been spared the seismic impact of the pandemic upon potentially life-saving surgery for patients.

But the treatment of heart diseases like structural heart disease is not a luxury that people can go without.

Structural heart disease has been described as ‘the next cardiac epidemic’.

Common symptoms include shortness of breath, fatigue, lightheadedness and chest pain. However, patients often do not recognise these symptoms and mistake them for general signs of aging.

Structural heart disease impacts 2.5% of Australians, rising to 8.5% of over-65s. Aortic Stenosis (AS) is one of the most prevalent and serious conditions impacting elderly people in Australia. It is estimated that 1 in 8 elderly Australians has AS. Up to 50% of people who develop severe aortic stenosis symptoms will die within an average of two years if they do not have their aortic valve replaced.

Despite the prevalence awareness of this disease remains low with over 8 in 10 Australians over 60 unaware of AS. Worryingly, the survey found 4 in 10 are not more concerned, even after being presented with the prognosis for people diagnosed with AS who do not receive an aortic valve replacement.

In too many cases the illness is undetected, undiagnosed, untreated, or treated too late. This results in avoidable deaths, high costs and significant compromises to people’s quality of life.

Much of this burden could be improved by addressing the gaps that exist along the patient care pathway.

The good news is we have a ready-made solution. A Heart Health Check a 20-minute check-up fully subsidised through Medicare to assess a patient’s risk of having a heart attack or stroke.

All we need now is for the current 'physical examination' part of this Check to align with the current Australian Heart Failure Guidelines.

The guidelines written by both the National Heart Foundation and Cardiac Society of Australia and New Zealand recognise that chronic heart failure is common for both mitral and aortic valve disease patients.[9] It is why it makes it clear the “physical examination” should include assessment of vital signs…and auscultation (apex beat, gallop rhythm, and murmurs)…”

Unfortunately, time-poor GPs are not checking all patients over 65 years old by auscultating the heart of their patients with a stethoscope for an “apex beat, gallop rhythm and or murmurs.”

Our survey found that 4 in 10 Australians say their doctor rarely or never checks their heart with a stethoscope.

Currently, the Government is considering whether funding will be extended beyond April this year.

We have seen through COVID-19 how our health directly impacts the economy so with an ageing population making older Australians remain healthier through preventative measures like a Heart Health Check, it would seem like a wise investment.

All we need now is for Government to commit to ongoing funding for this MBS item and update the current “physical examination” to align with the current Australian Heart Failure Guidelines.