Primary health care

Primary health care professionals, including general practitioners (GPs), practice nurses, nurse practitioners and Aboriginal and Torres Strait Islander health workers are often the first point-of-care for people who have non-acute cardiovascular disease. Primary health care professionals deliver a range of services, from health checks, diagnosis and treatment to prevention and rehabilitation activities.

Primary health care professionals can also direct patients through the health system, including to specialised care when necessary.

Common actions by primary health care professionals when managing cardiovascular problems include undertaking checks, prescribing medicines, ordering pathology or imaging tests, and referral to specialists (AIHW 2011).

What CVD problems do GPs manage?

GPs manage a range of risk factors and conditions related to heart, stroke and vascular disease.

  In a 2018–19 survey of GP practices, high blood pressure (hypertension) was the single most common chronic condition newly recorded for patients (5.7% of patients) (NPS MedicineWise 2020).

Abnormal blood lipids was newly recorded for 3.2% of patients, and cardiovascular disease (CVD) conditions (including coronary heart disease, PVD, AF, heart failure, stroke or TIA) for 1.1% of patients (Table 1).

The survey also measured condition prevalence, defined as patients who were recorded as having a condition at any time before or during 2018–19 (NPS MedicineWise 2020). Hypertension was the most common condition, with 16.3% of patients having a diagnosis of hypertension ever recorded at any time in their medical record. Dyslipidaemia was recorded for 13.7% of patients. The patient prevalence estimate for CVD was 4.9%, including atrial fibrillation (2.2%), heart failure (1.0%) and stroke (1.0%).

For every 100 GP clinical encounters during 2018–19:

  • 10 were with a patient with hypertension recorded in 2018–19, and 30 were with a patient with hypertension ever recorded
  • 5 were with a patient with dyslipidaemia recorded in 2018–19, and 24 were with a patient with dyslipidaemia ever recorded
  • 3 were with a patient with CVD recorded in 2018–19, and 12 were with a patient with CVD ever recorded (NPS MedicineWise 2020).

Table 1: Selected CVD conditions managed by GPs, 2018–19

 

% patients, recorded in 2018–19
(95% CI)

% patients, ever recorded
(95% CI)

Per 100 GP encounters, recorded in 2018-19
(95% CI)

Per 100 GP encounters, ever recorded
(95% CI)

Hypertension

5.7
(5.3, 6.0)

16.3
(15.5, 17.1)

10.3
(9.3, 11.3)

29.7
(27.1, 32.4)

Dyslipidaemia

3.2
(3.0, 3.4)

13.7
(13.0, 14.4)

5.3
(4.7, 5.9)

24.0
(21.8, 26.2)

CVD

1.1
(1.1, 1.2)

4.8
(4.4, 5.1)

2.9
(2.7, 3.2)

11.5
(10.5, 12.5)

Atrial fibrillation

0.7
(0.7, 0.8)

2.2
(2.0, 2.3)

2.0
(1.8, 2.2)

5.7
(5.2, 6.2)

Heart failure

0.4
(0.3, 0.4)

1.0
(1.0, 1.1)

1.4
(1.2, 1.5)

3.4
(3.1, 3.7)

Stroke

0.2
(0.2, 0.2)

1.0
(0.9, 1.1)

0.5
(0.5, 0.6)

2.5
(2.3, 2.7)

Notes

  1. CI: confidence interval.

  2. CVD includes coronary heart disease, peripheral vascular disease, atrial fibrillation, heart failure, stroke and transient ischaemic attack.

Source: NPS MedicineWise 2020.

Heart Health Checks

A Heart Health Check is a comprehensive assessment of CVD risk and management conducted by a GP or by a medical practitioner working in primary care. The 20-minute consultation includes the recording of patient’s blood pressure, cholesterol levels and blood sugar, a discussion of health history and lifestyle, an absolute risk assessment, and if needed a management plan to improve risk factor levels, which may include blood pressure and cholesterol lowering medication for high risk patients.

Heart Health Checks help to address the high disease burden posed by CVD. They assist patients to better understand and lower their risk of heart attack or stroke. The Checks also promote the use of absolute risk calculators by health professionals, and the regular assessment and optimal treatment of at-risk patients.

Heart Health Checks have been covered by Medicare since April 2019 for eligible patients aged 45 and over and for Aboriginal and Torres Strait Islander people aged 30 and over.

In 2019–20, almost 100,000 Heart Health Checks (males 49,000, females 49,000) were processed by Medicare. Checks were most commonly conducted among people aged 55–64 (35,200) and 65–74 (28,900) (Services Australia 2021).

As at June 2020, 34% of regular clients of Indigenous primary health care aged 35–74 had a CVD risk assessment result that classified them as being at high risk (AIHW 2021).

Prescriptions ordered by GPs

In a 2018–19 survey of GP practices, medicines for the cardiovascular system accounted for the largest proportion of prescriptions ordered for patients (31%) (Table 2). Note that medicines in this class may be used to help manage other conditions besides heart, stroke and vascular disease. The survey also found:

  • medicines to treat hypertension (ATC class C07A, C08C, C09A, C09B, C09C, C09D) together accounted for 17% of the total volume of prescriptions ordered for patients
  • lipid-lowering medicines (ATC class C10A and C10B) accounted for 11% of total prescriptions ordered for patients.

For every 100 GP encounters in 2018–19, 14 cardiovascular system prescriptions were ordered. When repeat prescriptions are added, the total rises to 76 per 100 GP encounters (NPS MedicineWise 2020).

Table 2: Selected CVD medicines prescribed by GPs, 2018–19

ATC medicine class

% issued prescriptions
(95% CI)

% total (issued + repeat)
prescriptions
(95% CI)

C – Cardiovascular system

17.8
(17.3, 18.4)

31.2
(30.6, 31.7)

C10A – Lipid modifying agents, single agent

5.0
(4.9, 5.2)

9.8
(9.6, 10.0)

C09C – Angiotensin II receptor blockers, single agents

2.2
(2.1, 2.3)

4.1
(4.0, 4.2)

C09A – ACE inhibitors, single ingredient

2.0
(2.0, 2.1)

3.8
(3.7, 3.9)

C07A – Beta blocking agents

1.7
(1.6, 1.8)

2.9
(2.9, 3.0)

C09D – Angiotensin II receptor blockers, combinations

1.4
(1.4, 1.5)

2.7
(2.6, 2.8)

C08C – Selective calcium channel blockers with mainly vascular effects

1.3
(1.3, 1.4)

2.4
(2.3, 2.5)

C09B – ACE inhibitors, combinations

0.7
(0.7, 0.7)

1.3
(1.3, 1.4)

C10B – Lipid modifying agents, combinations

0.5
(0.5, 0.6)

1.0
(1.0, 1.1)

Notes

  1. CI: Confidence interval
  2. Total prescriptions include issued and repeat prescriptions.
  3. Includes blood pressure-lowering and lipid-modifying medicines only.

Source: NPS MedicineWise 2020.