2020-02-29 New Zealand Listener

FEBRUARY 29 2020 LISTENER 23

Jackson says the

number of people

being treated in the

highest risk group

should be a lot higher

and he is surprised it

is so low. “We need to

be doing a lot better

for them.” He says

although 90% of eli-

gible people have

had a cardiovascular

risk assessment, the

Ministry of Health

doesn’t know the

results because the

data is much harder

to extract in a con-

sistent way nationally

from GP records. It

also doesn’t know if

similar proportions of

people regionally are

receiving the treat-

ment they should be.

“Comparing regions

is a very powerful

tool for improvement

because if some areas

are out of step with

others it’s a good

opportunity to find

out why.”

The work provides

health policymakers

with quite detailed

data on regional dif-

ferences in risk and

treatment practices

• and in effect, at the

click of a button, pro-

vides an individual

predicted heart disease risk assessment for

almost every adult New Zealander and links

it with their current treatment status. It

sounds like Big Brother, but Jackson empha-

sises the only goal is to improve equity in

heart health through accurate risk-assess-

ment tools and quality-improvement

programmes. “Privacy is at

the forefront of our minds

and has been since we started

collecting data in 2002.”

This will become increas-

ingly important as the

researchers hope to expand

the databases they mine

for information, including

mammograms and retinal

photographs (for informa-

tion about vascular health),

CT scans,

body-mass-

index data

from general

practice and

hospital discharge summa-

ries. Should we worry about

a data breach? Jackson says

no – all the data is encrypted

at source, already stripped

of names and addresses.

He says data sovereignty is

paramount, encryption is

military strength and audits are stringent.

He expects that if the additional informa-

tion is sought, it’s likely an independent

watchdog would oversee it.

New research is investigating the best

treatments post-heart attack, too, when

patients are routinely prescribed three drugs

• aspirin to thin the blood, statins to lower
  cholesterol and a drug to lower blood pres-
  sure. Christchurch Heart Institute senior
  clinical lecturer Dr Philip Adamson, an
  interventional cardiologist, is investigat-
  ing whether blood tests can predict those
  patients who have an increased risk of
  internal bleeding from the blood-thinning
  treatment and those who may be at higher
  risk of a further heart attack.

PREDICTING THE FUTURE

About one in five of the 10,000 people

a year admitted to hospital with a heart

attack will die within 12 months, about

half of those from heart-related causes. But

others will die or become ill with bleeding

complications. In a Heart Foundation-

funded study, Adamson will measure levels

in the blood of recently discovered proteins

that may provide information about the

risks of both another attack and serious

bleeding.

His group have already shown

the benefits of measuring levels

of troponin – which increase

when heart muscle is damaged

• when patients are convalescing
  after hospital discharge. “When
  it is measured, even about four
  months after a heart attack, it’s a
  very useful marker of future heart
  problems. Based on that, we think
  there might be an opportunity
  when patients are being followed
  up by their GP or cardiologist six
  to eight weeks after an attack to
  make some more personalised
  treatment decisions.”
  For the first year after their heart
  attack, patients are routinely prescribed a
  second blood thinner because the combina-
  tion with aspirin reduces repeat attacks by
  about a quarter to a third. In a second study,

funded by the Health Research Council,

Adamson will investigate whether some

patients would be better off receiving the

two thinners for only three months.

He says doctors tend to adopt a “one size

fits all” approach to heart-attack treatment,

presuming every patient is at increased risk

of a further event. “That’s true, but the risk

varies a lot. Some people are at very high

risk and potentially stand to benefit a lot

from our treatments, but many never go

on to have another attack and don’t stand

to benefit much but still face all the risks

[of the drugs] and we are not very good at

separating them out.” l

ST

EP

HE

N

RO

BI

NS

O

N

About one in five of the

10,000 people a year

admitted to hospital

with a heart attack will

die within 12 months.

Recently discovered

proteins may provide

information about

the risks of another

heart attack and

serious bleeding.

From top,

epidemiologist

Rod Jackson, Heart

Foundation medical

director Gerry Devlin

and interventional

cardiologist Philip

Adamson.