Cardiac Surgery

Lister antiseptic method Pasteur Germ Theory

1860’s

1800’s

Operating Room

1950’s

Gibbon Heart Lung Machine

1960’s

•Computer systems to monitor cardiac patients

1967 First heart transplant

•Valve replacements •Implantable pacemaker

1990’s

•Advanced imaging techniques •Micro devices •LVAD’s •Robotic surgery

2000’s 2010’s

Cardiology

1860’s

1800’s

1950’s

1960’s

•Computer systems to monitor cardiac patients

1990’s

•Advanced imaging techniques •Micro devices •LVAD’s

2000’s 2010’s

Coronary Care Units

Coronary Angiography

Interventional cardiology

Exercise test

ECG

Antihypertensive drugs

Beta blockers Calcium Channel blockers Thrombolytics

Digoxin Nitrates

ACE inhibitors Statins

Stem cells AICD’s Renal denervation Structural heart procedures

Antiplatelet agents Arrythmia ablation

Pacemakers

Cardiac catheters

Why are ESSENCE standards needed? • Life expectancy gap in 2005-7

• 11.5 y in males • 9.7 y in females

• CVD in Aboriginal and Torres Strait Islanders • 27% of the mortality gap • 17% of the disease burden • 26% of the mortality • 2-3 x age standardised mortality • 8-15 x age specific mortality at younger ages • More risk factors and co morbidities

i.e. CVD strikes earlier and harder

0%

5%

10%

15%

20%

25%

30%

Deaths from CVD (I00-I99):SA by age, Indigenous status, 2006-2012

% Aboriginal % Non-Aboriginal

0%

5%

10%

15%

20%

25%

30%

Deaths from cancer (C00-D48): SA by age, Indigenous status, 2006-2012

% Aboriginal % Non- Indigenous

Acknowledgement: The authors with to thank the Registries of Births, Deaths and Marriages, the Coroners and the national Coronial Information System for enabling COD URF data to be used for this publication. Data source: Cause of Death Unit Record File for South Australia provided by the Australian Coordinating Registry (unpublished) extracted for the Landscape Project 22 June 2015.

Acute Coronary Syndromes

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Cardiac procedures Aboriginal people admitted with AMI less likely to get revascularisation

Related to hospital of admission and higher rate of comorbidities such as diabetes and renal failure

Mortality after AMI No difference in 30-day mortality after AMI, but Aboriginal people more likely to die within 1 year

Importance of follow-up care and managing multimorbidity. Possible link to lower procedure rates?

Age at first heart attack

Importance of prevention and management of early heart disease symptoms

Aboriginal people on average 12 years younger at first AMI Greater disparity in young and women

Randall DA, Jorm LR, Lujic S, O'Loughlin AJ, Eades SJ, Leyland AH. Circulation 2013;127:811-9.

What are the ESSENCE Standards? The Essential Service Standards for Equitable National Cardiovascular CarE for Aboriginal and Torres Strait Islander people (ESSENCE) were developed by Professor Alex Brown, Professor Garry Jennings, and a national Steering Committee of experts in Aboriginal and Torres Strait Islander cardiovascular care, under an Australian Government Department of Health and Ageing contract in 2011/2012.

• They articulate what elements of care are necessary to reduce disparity in access and outcomes for five critical cardiovascular conditions:

• Coronary Heart Disease;

• Chronic Heart Failure;

• Stroke;

• Rheumatic Heart Disease

• Hypertension,.

• Focus on the prevention and management across the continuum -primary prevention, risk identification and management in primary care, the management of disease in specialist, acute care and post-acute care settings.

• The ESSENCE set of 61 service standards have been endorsed by the CSANZ, NHF, and are published.

The vision- 6 projects

• 1. Development of appropriate measurement and key performance indicators • 2. Development of resources for the primary care setting to undertake systems

change • 3. Scoping and framework development for a National Acute Coronary Syndrome

and Stroke monitoring framework • 4. Development of a framework, model and plan for regional ESSENCE networks

5. A national gap analysis of existing cardiovascular services 6. Master plan development for the implementation of ESSENCE Standard

The ESSENCE framework

• CVD, CHD, CHF, RHD, Stroke, Hypertension • Regional networks

Overarching Standards

Socioeconomic determinants Comprehensive 10 care Nutrition

Transport & referral CIS Health professional education Data, performance & outcomes

Interpreting services

Education Multidisciplinary care Community rehab Lifestyle Palliative care

Transport Post discharge support Communication & handover

Identify & manage risk Smoking Access to medicines

ESSENCE I - Service Standards

ESSENCE II - Measurement Indicators

• Indicators 16- 33

• 43 indicators (16 indicators 33 measures and 6 outcome indicators 10 measures)

• Prioritization process and expert consensus • Game changers, available indicators, available data available

• Aspirational indicators

COAG Closing the Gap agenda

Better Cardiac Care Forum

ESSENCE II

Heart Foundation/AHHA National Lighthouse Project

Better Cardiac Care Report @ July

AHMAC

Heart Foundation ACS Pathw

ays

CSANZ Inaugural Indigenous

Cardiovascular Health Conference 2009

State / Territory response to BCC

‘Better hospital care for Aboriginal and Torres Strait Islander people experiencing heart attack’ Report

ESSENCE

AHMAC Meeting July 2013

CSANZ 2nd Indigenous Cardiovascular Health

Conference 2011

3rd Aboriginal Health Summit

July 2015

RHD Australia

ACSQHC Standards

Overarching principles for improving CVD care

RHD CHD Heart Failure Hypertension Stroke

Systems of care

Societal health

Maintaining health and

managing risk

Care of acute disease

Care of ongoing disease

Overview

ESSENCE

Better Cardiac Care for Aboriginal and

Torres Strait Islander people

RHD Australia

Guidelines

Lighthouse & ACSQHC ACS

ESSENCE II - Resource Kit for Primary Health Networks – Commissioning Checklist

Better Cardiac Care

Forum March 2014

• Primary Care Working Group • Acute Service Working Group • Secondary Prevention (Post Acute Care) Working Group

• Performance Improvement and Coordination of Care Working Group

Better Cardiac Care

• AHMAC agreement in June 2014 - Report with priority actions was supported

- Each jurisdiction were asked to determine what they will do in this space using the BCC Priority Actions as guidance

- 5 nationally agreed measures - AIHW reporting annually - First report completed – March 2015

Better Cardiac Care Priorities

Better Cardiac Care Indicators

Better Cardiac Care Indicators... continued

Acknowledgement

• ESSENCE Team Professor Alex Brown Leader Wendy Keech Senior Project Manager Katharine McBride Research Officer Tony Lawson Project Officer • ESSENCE I Steering Committee • ESSENCE II Steering Committee • Funding from Australian Department of Health and Ageing • Institute of Urban Indigenous Health

• Medicare Local Adelaide North

ESSENCE II Steering Committee & Project Team