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This page contains links useful clinical resources on the following cardiac topics:


Common Heart Conditions

The Heart Foundation is a reliable source for basic information on common heart conditions such as angina, arrhythmias, cardiomyopathy and more.

https://www.heartfoundation.org.au/your-heart/heart-conditions


Cardiovascular Disease Risk Calculators

Heart disease is the leading cause of death in Australia (accounting for 16% of all deaths) and one of the most preventable.

When individual risk is assessed the main factors that are taken into consideration are:

Non-Modifiable

Modifiable

Age Obesity
Sex Sedentary lifestyle
Family History Cholesterol
Blood pressure
Diabetes
Smoking status

Australian risk calculators utilise a combination of modifiable risk factors (eg smoking, cholesterol, diabetes, blood pressure) and non-modifiable risk factors (eg family history, gender) to calculate a 5 year risk of a cardiovascular event.

Clinical decisions based on absolute CVD risk can improve health outcomes by identifying people most at risk and directing them to the right treatment.

The Heart Foundation’s Australian Cardiovascular Risk Charts provides easy-to-interpret tables to illustrate risk to patients based on smoking, diabetes and gender. They also show the impact of other risk factors such as high cholesterol levels and high blood pressure.

You can provide your patient was an individualised risk score using the Australian Absolute Cardiovascular Disease Risk Calculator. This is an initiative of the National Vascular Disease Prevention Alliance, as promoted by the Heart Foundation in association with Diabetes Australia, Kidney Health Australia and the Stroke Foundation.

The Heart Foundation has additional resources on cardiovascular risk for patients:


Cardiac Rehab

If you have had a cardiac event or wish to refer a patient for cardiac rehabilitation, the Australian Cardiovascular Health and Rehabilitation Association is a good source of information.

Cardiologists are strong believers in the importance of Cardiac Rehabilitation access for patients. Dr Christine Burdeniuk is an advocate for access to cardiac rehabilitation to all patients, including rural patients. Click here to read her statement of support.


Assessing Fitness to Drive

Drivers must meet certain medical standards to ensure their health status does not unduly increase their crash risk.

Assessing Fitness to Drive, a joint publication of Austroads and the National Transport Commission (NTC), details the medical standards for driver licensing in use by health professionals and driver licensing authorities.

The Austroads Fitness to Drive document is effective from 1 October 2016.

http://www.austroads.com.au/drivers-vehicles/assessing-fitness-to-drive


Atrial Fibrillation and Stroke Risk Reduction

The CHADS2-VASc score is used to calculate the risk of stroke in patients with atrial fibrillation and to determine who should be prescribed anti-coagulation, in the absence of any absolute contra-indications. The score takes into account the following risk factors:

Risk Factor

C Congestive heart failure (or Left ventricular systolic dysfunction)
H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication)
A2 Age ≥ 75 years
D Diabetes Mellitus
S2 Prior Stroke or TIA or thromboembolism
V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque)
A Age 65–74 years
Sc Sex category (i.e. female sex)

Please follow the links below to the National Institute of Health and Care Excellence (NICE) site for:

Guidelines for AF management: https://www.nice.org.uk/guidance/qs93/chapter/Introduction

NICE Atrial Fibrillation Pathway: https://pathways.nice.org.uk/pathways/atrial-fibrillation


HAS-BLED Risk Score

For patients with atrial fibrillation using oral anticoagulants for stroke risk reduction it is important to assess their bleeding risk using the HAS-BLED score. A HAS-BLED score of 3 or more is indicative of an increased risk of bleeding on oral anticoagulation and should justify cautious use and regular review of these medications.

Often the patients with the highest CHADS2-VASc score have the highest HAS-BLED scores.

Feature

Score (0-9 points)

Hypertension, uncontrolled (SBP ≥ 160mmHg) 1
Abnormal renal and liver function (1 point for each) 1-2
Stroke, previous 1
Bleeding 1
Labile INR 1
Age ≥ 65 years 1
Drugs / alcohol (1 point each) 1-2

Heart Failure

The Australian Heart Foundation has a number of useful resources for both patients and clinicians, including:

The Queensland Government has also published useful resources on how to manage potassium intake in patients with heart and kidney disease:

The NPS published a useful article in the Australian Prescriber on chronic heart failure:


Guidelines for Infective Endocarditis Prophylaxis

The 2008 Australian guidelines recommend antibiotic prophylaxis only for patients with the following cardiac conditions if undergoing a specified dental or medical procedure:

  • Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
  • Previous infective endocarditis
  • Cardiac transplantation with the subsequent development of cardiac valvulopathy
  • Congenital heart disease but only if it involves:
    • Unrepaired cyanotic defects, including palliative shunts and conduits
    • Completely repaired defects with prosthetic material or devices whether placed by surgery or catheter intervention, during the first 6 months after the procedure (after which the prosthetic material is likely to have been endothelialised)
    • Repaired defects with residual defects at or adjacent to the site of a prosthetic patch or device (which inhibit endothelialisation)

These conditions are thought to be associated with the highest risk of adverse outcomes from endocarditis

The medical community acknowledges that the changes in recommendations may be confusing to patients who have been receiving prophylactic antibiotics over their lifetime and are unwilling to change this practice. Some medical and dental practitioners will also be resistant to change and will continue to prescribe antibiotic prophylaxis. The changes may be more of a slow evolution as both patients and clinicians come to appreciate the lack of evidence for a benefit of antibiotic prophylaxis in the broader community.

Further information is available from the following resources: