MDHB News

Cardiovascular Disease

Why is Cardiovascular Disease one of MidCentral DHB’s Health Priority Areas?

Cardiovascular disease is a priority because it is the most common cause of death (43%) for MidCentral residents and the leading cause of all hospitalisations excluding pregnancy and childbirth.

More information about MDHB's planning around cardiovascular disease is available in the Cardiovascular Service Plan.

Running Legs

Hospitalisations as a Result of Cardiovascular Disease

Ischaemic heart disease is the most common cardiovascular disease causing hospitalisation as it is responsible for about 45% of hospitalisation for people aged 65-years and older. Ischaemic heart disease also accounts for 40% of all hospitalisations for adults younger than 65.

Stroke hospitalisations are further increasing.

New Cardiovascular Initiatives and Services Implemented in the District

MidCentral DHB’s strategies to the address the incidence and impact of cardiovascular disease:

The risk of cardiovascular disease can be reduced by reducing obesity, increasing exercise, controlling blood pressure and controlling cholesterol.
The following strategies will improve the quality of life for people with cardiovascular disease, and the health and wellbeing of Maori and as a result more people will enjoy a healthy lifestyle within a healthy environment.

Increase investment in promoting healthy lifestyles, with an emphasis on high risk groups.
Increase awareness of cardiovascular disease and its associated risk factors.
Increase investment in general, targeted and opportunistic screening programmes
Develop increased workforce expertise and capacity in cardiovascular treatment and care
Develop community-based cardiology, stroke and other specialist services
Provide increased accessed to psychological support

Investment

Additional funds will be used to purchase services in order to reduce the incidence and impact of cardiovascular disease on an ongoing basis. This will commence in the short to medium term and will have an annual investment value of $2 million.

New Cardiovascular Initiatives and Services Implemented in the District

Cardiac Rehabilitation
Community Cardiology Services
Community Heart Failure Service
Community Defibrillators for Areas of High Public Use
Stroke Services

Cardiac Rehabilitation

Essentially, cardiac rehabilitation is the effort to return each cardiac patient to their best level of function in the community, and to reduce the risk or impact of continuing cardiac disease. In particular:

cardiac rehabilitation significantly improves health-related quality of life (HRQL) scores and exercise tolerance in the first few months
comprehensive cardiac rehabilitation with exercise after myocardial infarction (heart attack) has been shown by meta-analysis to reduce total and cardiovascular mortality by about 20% (evident at one year and persisting) to 27% .
the number needed to treat (NNT) to prevent one death has been estimated in meta-analyses to be between 32 to 72

Funding has been approved to offer community-based services, centred around 2.5 FTE (full-time equivalents) cardiac rehabilitation nurse positions, established to provide Phase 2 cardiac rehabilitation services in each region, free of cost to patients.

The service will form close links with hospital-based services, GP teams, iwi/Maori providers, community groups such as the Heart Foundation, and relevant PHO-based services including community cardiology services, diabetes nurses, dietician, smoking cessation and physical activity advisors.

Community Cardiology Services

As a whole, circulatory system diseases are the commonest cause of death in New Zealand, causing 40% of deaths in 2000 . The greatest circulatory system problem in New Zealand is ischaemic heart disease (IHD), which causes 22% of all deaths nationally. The death rate from IHD is about 28% higher in New Zealand than in Australia.

Funding approval has been given for community-based services to be established to enable the accurate initial diagnosis and assessment of cardiology patients, with particular emphasis on those patients suspected of having ischaemic heart disease, and to speed the entry of at-risk patients into secondary and tertiary treatment services.

The service will offer echocardiograms and other key tests in the primary care setting to enable better general practice management.

The intention is to improve access to these initial evaluation services by providing them in each region, free of cost, in a timely manner, and in close association with PHO-based services such as dietician, smoking cessation and physical activity advisors.

Community Heart Failure Service

Heart failure is a malignant condition – half of all patients die within 5 years, and over half of patients with severe heart failure die within 1 year, a prognosis worse than many types of cancer.

Funding approval has been given for community-based
services to be established to enable the accurate initial diagnosis and assessment of patients suspected of having heart failure, and to facilitate the assessment of patients who are presenting management difficulties in primary care. The intention is to improve access to these services by providing them in each region, free of cost, in a timely manner, and in close association with PHO-based services such as dietician, smoking cessation and physical activity advisors.

Community Defibrillators for Areas of High Public Use

More than 1000 people have been trained in emergency first response under the Community Defibrillator Project. The scheme is the first large-scale public access programme in New Zealand, with the DHB funding placement of the lifesaving devices across the region, as well as ongoing support and training.

The Zoll automatic external defibrillators are used to deliver a shock to people who have suffered cardiac arrest.
Sudden cardiac arrest (SCA) claims the lives of 8000 New Zealanders every year, with a person’s chance of survival decreasing by ten percent for every minute defibrillation is delayed.

A MidCentral resuscitation officer is managing the rollout, with MidCentral DHB the first in New Zealand to fund both the state-of-the-art defibrillators and free training in their use and emergency care.

The New Zealand Resuscitation Council has endorsed the project, with its general manager congratulating MDHB for taking action to ensure survival rates from SCA were improved.

The project, which aligns with both the board’s Primary Health Care Strategy and the Cardiovascular Service plan, is funded from the personal health stream at a cost of $197,000 for the two-year pilot.

Installation is complete at twenty sites around the District including Palmerston North’s Downtown Complex and The Plaza; Levin’s Horowhenua Aquatic centre and Feilding’s Makino Aquatic centre; Dannevirke’s The Warehouse store; Otaki Medical centre; Tokomaru fire service; Levin Fire Service; Waiterere Beach Fire Service and Eketahuna Fire Service.

Stroke Services

Implementation of a stroke service at MidCentral Health is expected to begin late 2007.

The following additional professional FTE resources are now dedicated to stroke and TIA management at Palmerston North Hospital : (all are 0.5 FTE)