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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 Data source: Cause of Death Unit Record File for South Australia provided by the Australian Coordinating Registry (unpublished) extracted for the Landscape Project 22 June 2015.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
Whe
re a
re th
e ga
ps?
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