A hospital pharmacist has pioneered a new system to help heart attack patients avoid heart failure and future heart attacks.
During 2020/21, Victorian Central Highlands pharmacist Adam Livori conducted research into whether cardiac telehealth services made a difference to clinical outcomes for patients following a heart attack.
"Globally, we know that patients are pretty good at taking their medicines for the first month after their heart attack, but about half will drop off the medicines they should be on at the 12-month mark - and we know that is linked to increased risk of heart attack and death," Mr Livori said.
"The intention is that if we can get them to maintain that therapy for the first 12 months, then we can significantly reduce the likelihood of them having further heart attack, stroke, heart failure, and death."
As part of the research, every person who suffered a heart attack and was treated at Ballarat Health Services was referred to Mr Livori who is team leader pharmacist of the Medical Specialties Pharmacy Team and Outpatient Pharmacist clinics in Ballarat.
He conducted a telehealth conference with each patient one month, three months and 12 months after the heart attack in which they talked about the medications prescribed, what each one is for, how they work, whether there were any side effects, and if patients were attending the follow-up appointments recommended with their GP or cardiologist.
Comparing the Ballarat data to matched Victorian data he found patients who took part in the study fared much better 12 months later than those who did not.
"What we found was that there was a significantly higher likelihood that patients who see a cardiology pharmacist through the cardiac telehealth clinic are on the correct therapy and taking them appropriately in comparison to those patients prior to the clinic commencing," he said.
"We saw an absolute increase of a quarter of patients who showed improvement in adherence and we know that improvement is linked with lower risk of heart attack at three years.
"So a quarter of patients are now in a risk group associated with lower risk of heart attack rather than a high risk group, and we saw a pretty significant reduction in hospitalisation too."
Mr Livori said not adhering to medications and failing to attend follow-up appointments was a "big concern when we have so many heart attacks in our region".
"Ballarat is particularly bad in terms of looking at cardiac outcomes, and among the worst in Australia for cardiovascular risk."
According to the Heart Foundation, the Ballarat local government area has a heart disease death rate of 66 per 100,000 people which is significantly higher than the Victorian average and higher than the national average.
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And for the wider Ballarat region, in the five years from 2012 to 2017 the rate of heart disease admissions to hospital was 118 per 10,000 people
Mr Livori said there was an average of one stemi heart attack, the most serious form of heart attack, every three days in Ballarat's catchment area.
BHS is the only hospital in Victoria to run this type of program, which Mr Livori said was significant.
"This isn't something a big hospital is doing, it is starting from a regional centre, with research in the regions, and that's a pretty powerful message," he said.
Mr Livori said even before the study they knew the cardiac pharmacy clinic was working from a service perspective, but now they knew its clinical value too.
"Heart disease is still the number one killer in Australia - if you have chest pain, please come to hospital and we will look after you. Don't put off chest pain because you're worried about COVID."
His warning comes after several high profile deaths from heart attack in recent weeks including cricket legend Rod Marsh, spin king Shane Warne and Victorian federal Labor senator MP Kimberley Kitching, who were both 52 when they died, and a severe heart attack that left former Essendon star Dean Wallis in hospital on the weekend.
Heart disease is still the number one killer in Australia - if you have chest pain, please come to hospital and we will look after you. Don't put off chest pain because you're worried about COVID- Adam Livori
Mr Livori's research, completed as part of a Masters of Clinical Pharmacy, saw him win first prize in the PharmAlliance Graduate Research E-Symposium. He has been invited to present next month at The University of North Carolina, Monash University and the University College London and will also be flown to London for a two-week placement later this year.
Mr Livori said the telehealth clinics also improved understanding of some of the barriers that patients face in taking their medications and attending follow-up appointments.
"We know there can be side effects that patients experience that they don't feel comfortable discussing with their pharmacist, GP or cardiologist," he said.
"Real-time monitoring of prescription data is not easily available to GPs and pharmacists, and many patients might not have had a regular GP before so they have gone from not taking any medications to now needing to take multiple medicines at different times for different reasons and some just stop taking them.
"There's also socio-economic barriers and often it's those patients who need the most who have less access whether it's to health professionals, family support or the medicines themselves."
Mr Livori is now running online training workshops for other hospital pharmacists and clinicians around his project.
Since winning the award Mr Livori has received a Scholarship to start a PhD at Monash University investigating patterns and predictors of heart outcomes based on medicines used.
"I'm really passionate about cardiovascular health in the Ballarat region - I really love working at the Base Hospital, and it's important to know that you don't need to be in a metro site to be doing meaningful and novel work," he said.
"I intend to continue working at BHS during my PhD and give back where I can to mentoring pharmacists, nurses and doctors within the cardiology space."
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