Challenges In Prevention And Management Of Cardiovascular Disease Essay.

• Describe a population health problem that needs investigation, from a public health perspective.

• Source some relevant health related data about this situation online, or construct a synthetic dataset (describe or present a subset of data from the dataset).

• Describe an approach that could be taken (or has been taken) by an expert/agency to analyse the dataset.

• Summarise the findings of the analysis including an outline of the quantitative results obtained.

• Include proper references to all your sources. 

Global Prevalence of Cardiovascular Disease

As the world population is increasing, the number of people with CVD risk factors such as obesity, poor nutritional habits and lack of physical activity are increasing. CVD has become a pandemic which is evident from WHO recommendation that accelerated action is needed to prevent CVD. As per the WHO report, out 31.1% deaths worldwide, 17.7 million people die every from CVD (World Health Organization 2018). The most common risk factors that have increased the rate of morbidity and mortality due to CVD include alcohol use, unhealthy diet, physical inactivity and tobacco smoking. Another issue is that mortality due to CVD is increasing in low and middle income countries compared to developed countries (Castellano et al. 2014). Although it is highly preventable condition, however it ranks as the most common cause of death globally. Apart from increasing in sufferings for patient and high burden on the health care system, it is also contributing to economic cost burden on high and middle income countries.   

Various online reports and research studies have reported about challenges in the prevention and management of CVD. Accomplishing the task of reducing morbidity and mortality due to CVD may be difficult because success of preventive strategies will differ depending on the economic and environmental context of each population (Afshin et al. 2015). Dealing with abrupt rise of obesity and diabetes, two common risk factors of CVD and changing food patterns of people is a challenging task for developed countries (Kotseva et al. 2016). In addition, developed countries have not taken many steps towards prevention of hypertension and controlling sodium content in food (Franco et al. 2011). Hence, effective prevention strategies are needed to reduce the burden on the health care system to CVD. This paper aims to source some relevant health related data about CVD prevalence in Australia and summarize the findings of the data sets to make appropriate conclusion.

One online source that gives an idea about the prevalence of CVD in Australia includes the report by National Heart Foundation of Australia (2015) and Waters et al. (2013). The report by National Heart Foundation of Australia (2015) gives a detailed insight into Australian heart disease statistics for 2015. The report gives detail on data related to mortality, history of CVD in Australia, behavioural and medical risk factors of CVD. In addition, the quantitative study by Waters et al. (2013) gives an overview about the trends in CVD hospitalization and death rate by remoteness, socioeconomic group and indigenous status. The subset of data that has been collected from the dataset includes the following:  

1. Statistics on death from CVD and stroke by sex and state or territory of Australia
2. Statistics related to premature deaths from CVD in 2013 by gender in different territories
3. Age specific death rate from CVD for 10 years period
4. Geographic variations in death rate
5. Prevalence of behavioural risk such as smoking and vegetable and fruit consumption

Risk Factors and Economic Burden of Cardiovascular Disease

One approach that can be taken to analyse includes evaluation of the data in terms of details and context provided to improve the situation. For example, if an online data gives detail of CVD statistics, then just reporting about mortality rate is not a effective. However, details regarding deaths in terms of age or gender help to take targeted action to prevent the disease. Hence, evaluation in terms of explicitness, details and reliability of content will be done. If the disease prevalence date is huge, then statistical tools like binomial distribution can also be applied to evaluate epidemiological data. In case of incidence and mortality reporting, use of variables like relative risk and hazard ration can also help in analysis of research data. Confidence interval also helps to evaluate whether the data obtained is statistically significant or not (Ressing, Blettner and Klug 2010). For this paper, completeness of the data will be observed to assess it quality.

Based on the analysis of the data obtained from two datasets, many important results have been obtained. The summary of findings for each source is discussed separately. National Heart Foundation of Australia (2015) gave insight CVD rates and it reported about difference in death from CVD by gender and geographical region. Although the data gives the insight that more number of women die from CVD, however there is lack of details regarding age specific death rate. Even if age-specific data has been provided, it fails to give overview about gender wise difference. However, presentation of deaths by state or geographic region is one of the strength of the dataset because it can help to track progress or deterioration in CVD death rate within 10 years time. This would help to detect regions which have poor control and implement appropriate preventive strategies to control CVD in the region. In contrast to the study by National Heart Foundation of Australia (2015), the advantage of the data presented by Waters et al. (2013) is that by giving an overview about hospitalization trend by race and socioeconomic group, it gives an overview about the burden of CVD in Australian health care system. The quantitative results suggested that hospitalization rate for CVD was highest for men compared to women. The advantage of this dataset is that along with statistics, it also mentions about progress in results with time. For example, the data by Waters et al. (2013) revealed that death rate has decline in past three decades and highest decline was found for people between 35-54 years of age. Hence, the statistics gives the indication that CVD can be prevented if control measure and appropriate preventive steps are taken at young age. Improvement in risk factor can facilitate improvement in CVD mortality and hospital stay statistics.

Findings from Health-related Datasets and Research Studies in Australia

One research literature has been found to present an overview about the challenges faced by Australian pharmacist in caring for clients with established CVD. The research was done by Puspitasari, Aslani and Krass (2014) using in-depth semi-structured interview method to determine whether community pharmacist can play a role in the prevention of chronic disease like CVD. The need for research in this arise also arise because of the sub-optimal use of secondary prevention medicines for CVD in low and middle income countries (Yusuf et al. 2011). Hence, identify the role of Australian pharmacist might give directions for their inclusion in prevention program and increase ongoing support for people with CVD.  Another advantage of considering pharmacist for CVD prevention is that they can reduce health care access related barrier as they are available without an appointment.

Puspitasari, Aslani and Krass (2014) recruited community pharmacist from New South Wales area and the invitation letters were used to purposively include pharmacist in the research. Pharmacists were recruited from both metropolitan and rural areas. Face to face interviews were done with pharmacist living in metropolitan areas and telephone interviews were done with pharmacist living in rural areas to save time. The interview was done by asking questions related to awareness of CVD prevention and type of support provided to people with CVD. They were also asked regarding the facilitators and barriers to CVD secondary prevention. The outcome of the interview revealed that participant’s ability to provide support was influenced by both internal and external factors. The internal factors included attitude, knowledge and skills towards CVD prevention. Most of participants believed that they have a role in prevention and they have adequate knowledge related to CVD management. However, some opposing views were also found as several pharmacist regarded doctor’s role as most important in the management of CVD. The external factors influencing their role of providing support to CVD patient included health system policy, client factor and organizational factors. The review of external factors revealed lack of client motivation to get additional support, poor attitude of doctors and poor documentation system at pharmacy as a challenge to CVD management. Therefore, review of the study findings gives the idea that health care staffs like pharmacist face challenges in CVD management because of complex interplay of people factor and environment factor. Hence, there is need for good collaboration between organizations and better integration of pharmacist within the health care system to reduce the burden of mortality and cost burden due to CVD prevalence.

Role of Pharmacists in Caring for Clients with established Cardiovascular Disease

Based on analysis of the methodological quality of the research evidence, it can be said that the research has been successful in highlight about challenges in dealing with the CVD epidemic as well as indicating about possible solutions to address the issue. The collection of samples from urban and rural area is credible as it helped to identify all types of environmental barriers affecting prevention efforts. The survey questionnaire favoured in-depth analysis of the challenges in CVD prevention and management. Another advantage of the study is that the study was done with wide variety of pharmacist. For example, years of experience, position, gender and location related variations were analysed. Hence, the findings can be useful for CVD prevention efforts in Australia. However, the same result cannot be generalized for other countries as health system and environment in other countries may differ. However, the evidence gives an insight into the consideration of complex work system factors and attitudes of health care staffs to promote cardiovascular health of population at risk of CVD.

References:

Afshin, A., Penalvo, J., Del Gobbo, L., Kashaf, M., Micha, R., Morrish, K., Pearson-Stuttard, J., Rehm, C., Shangguan, S., Smith, J.D. and Mozaffarian, D., 2015. CVD prevention through policy: a review of mass media, food/menu labeling, taxation/subsidies, built environment, school procurement, worksite wellness, and marketing standards to improve diet. Current cardiology reports, 17(11), p.98.

Castellano, J.M., Narula, J., Castillo, J. and Fuster, V., 2014. Promoting cardiovascular health worldwide: strategies, challenges, and opportunities. Revista Española de Cardiología (English Edition), 67(9), pp.724-730.

Franco, M., Cooper, R.S., Bilal, U. and Fuster, V., 2011. Challenges and opportunities for cardiovascular disease prevention. The American journal of medicine, 124(2), pp.95-102.

Kotseva, K., De Bacquer, D., De Backer, G., Rydén, L., Jennings, C., Gyberg, V., Abreu, A., Aguiar, C., Conde, A.C., Davletov, K. and Dilic, M., 2016. Lifestyle and risk factor management in people at high risk of cardiovascular disease. A report from the European Society of Cardiology European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV cross-sectional survey in 14 European regions. European journal of preventive cardiology, 23(18), pp.2007-2018.

National Heart Foundation of Australia 2015. Australian Heart Disease Statistics 2015. Retrieved from: https://www.heartfoundation.org.au/images/uploads/publications/RES-115-Aust_heart_disease_statstics_2015_WEB.PDF

Puspitasari, H.P., Aslani, P. and Krass, I., 2014. Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists. PLoS One, 9(11), p.e113337.

Ressing, M., Blettner, M., and Klug, S. J. 2010. Data Analysis of Epidemiological Studies: Part 11 of a Series on Evaluation of Scientific Publications. Deutsches Arzteblatt International, 107(11), 187–192. https://doi.org/10.3238/arztebl.2010.0187

Waters, A.M., Trinh, L., Chau, T., Bourchier, M. and Moon, L., 2013. Latest statistics on cardiovascular disease in A ustralia. Clinical and Experimental Pharmacology and Physiology, 40(6), pp.347-356.

World Health Organization 2018. Cardiovascular disease. Retrieved from: https://www.who.int/cardiovascular_diseases/en/

Yusuf, S., Islam, S., Chow, C.K., Rangarajan, S., Dagenais, G., Diaz, R., Gupta, R., Kelishadi, R., Iqbal, R., Avezum, A. and Kruger, A., 2011. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. The Lancet, 378(9798), pp.1231-1243.