Cardiovascular disease (CVD) risk assessment and management

Cardiovascular disease (CVD) is the single leading cause of death in Australia. It is largely preventable, with modifiable risk factors accounting for up to 90 per cent of the risk of myocardial infarction. Approximately 1.4 million Australians are at a high risk of having a heart attack or stroke in the next five years, and over half have not had an event previously. 

Australian GPs play a vital role in driving the prevention of CVD by assessing and managing the CVD risk factors of their patients. The 2012 Absolute CVD Risk Guidelines provide Australian health care professionals with the latest evidence on the assessment and management of CVD risk.  

Absolute CVD risk assessment estimates the cumulative risk of multiple, and sometimes synergistic risk factors, to predict a heart attack or stroke event in the next 5 years. A ‘Heart Health Check’ is the patient-friendly term for comprehensive CVD risk assessment and ongoing management, and is now supported by Medicare.  

Modelling over the next five years has indicated that 76,500 cardiovascular disease related events – including heart attacks, strokes and deaths – could be prevented with the uptake of Heart Health Checks. 

What are the changes to Absolute CVD risk assessment and management in primary care? 

Patients at risk of CVD are now able to be reviewed annually to receive supporting referrals, lifestyle interventions and medications to prevent CVD. 

On 1 April 2019, two new interim items were introduced onto the Medicare Benefits Schedule (MBS) to support the delivery of Heart Health Checks in primary care: Items 699 (for GPs) and 177 (for other medical practitioners working in general practice). These items support the ongoing assessment and management of absolute CVD risk in primary care for eligible patients 45 years and over (30 years and over for Aboriginal and Torres Strait Islander patients).  

The 20-minute Heart Health Checks allow GPs (with the support of practice nurses) to: 

• Gather information about the risk factors for cardiovascular and chronic disease, such as: blood pressure, cholesterol, blood glucose, smoking status and lifestyle factors 
• Implement a formal, ongoing preventative management plan over subsequent visits or through referral pathways.  

Download absolute CVD risk assessment factsheet

Clinical approach to assessing and managing CVD risk

Modelling has shown that using an absolute or ‘global’ approach to assessing and managing CVD risk has the potential to prevent twice as many deaths from coronary heart disease when compared with treating individual risk factors, such as blood pressure or cholesterol.  

Absolute CVD risk assessment and management supports the targeted identification of high-risk groups, as these cohorts gain the most benefit from this treatment.  

The first Absolute CVD Risk Clinical Guidelines was launched in Australia in 2009. With targeted implementation activities, policy changes and the development of online tools, absolute CVD risk assessment has become the foundation of treatment decision making for primary prevention of CVD.  

Download clinical approach to absolute CVD risk assessment flowchart

Despite significant progress in this area over the last decade, research suggests that the uptake of absolute CVD risk assessment in Australian primary care is poor. For example, over 70 per cent of high-risk individuals aged 45 to 74 years are not receiving guideline-recommended blood pressure and lipid-lowering therapies.

Absolute CVD risk principles

Practice Incentives Program Quality Improvement (PIP QI) and Heart Health Checks 

From 1 August 2019, the new Practice Incentives Program Quality Improvement (PIP QI) includes a quality improvement measure on eligible patients for CVD risk assessment. The PIP QI is a payment to general practices that participate in quality improvement activities to improve patient outcomes and deliver best practice care.  

The PIP QI provides a maximum payment of $12,500 per quarter or $50,000 per annum. Implementing systematic absolute CVD risk assessments for eligible patients via Heart Health Checks helps your practice implement quality improvements and attract additional funding to support these important activities.  

Find out more about the Heart Health Checks.

Coronary artery calcium scoring

The National Heart Foundation of Australia has published a position statement on coronary artery calcium scoring for the primary prevention of CVD. This position statement provides practical advice for health professionals on the use of coronary artery calcium scoring to assist in defining risk, in conjunction with absolute CVD risk assessment.  

More information