Too few receive appropriate cardiac rehabilitation or treatment

• Around a quarter of heart attack or stroke patients will experience a follow-on event
• An increase in younger people experiencing cardiovascular diseases and ageing populations with multiple comorbidities are putting health systems under increasing pressure
• Heart attacks and strokes cost between an estimated 0.2% and 2.6% of GDP in Asia-Pacific economies
• Cardiac rehabilitation services are unavailable to many who need them; even where they are available as little as 6% of patients attend
• The proportion of high-risk patients receiving appropriate medication may be as low as 3%
• Improving integrated, coordinated care delivery between primary, secondary and tertiary systems should be a priority for health systems

The burden of cardiovascular disease (CVD) in Asia-Pacific is substantial and is collectively the leading or second-leading cause of death across the region. The prevalence is projected to rise along with the rapidly ageing population and increasing number of people with multiple chronic health conditions. In addition, a worrying increase in CVD among younger people is being seen. In addition, around one quarter of those who have a heart attack or stroke will go on to experience another cardiovascular event. Taken together, this is putting increasing pressure on health systems. In a time of unprecedented health-delivery challenges during the covid-19 pandemic, it is increasingly important to keep these high-risk people out of hospital settings.

The report, The cost of inaction: secondary prevention of cardiovascular disease in Asia-Pacific, sponsored by Amgen, explores the health and policy response to managing secondary cardiovascular events in eight Asia-Pacific economies: Australia, Mainland China, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand. It describes findings of the Secondary Prevention of Cardiovascular Disease in Asia-Pacific Scorecard, created by EIU Healthcare, along with in-depth interviews with 15 regional experts.

The overall estimated annual direct and indirect medical costs for ischaemic heart disease are US$22.8bn and US$23.5bn, respectively, while those for stroke are US$13.6bn and US$24.6bn, respectively, across the eight economies studied. This represents between 0.2% and 2.6% of GDP in the study economies. Beyond medical costs, the indirect financial and human cost can be substantial where younger working-age people are affected.

The provision of secondary prevention lacks coordination across Asia-Pacific. While non-communicable diseases plans are prevalent across the study economies, only two had CVD plans that make provision for secondary prevention: South Korea, and Australia (still in draft form). Where established cost-effective tools are available, they are inconsistently used. In particular, available cardiac rehabilitation services are insufficient to meet the needs; while around 50% of patients may be referred, as few as 6% attend services. The better use of technology and health data may offer opportunities to empower patients and increase access to preventive services.

Jesse Quigley Jones, editor of the report, said, “Despite recent progress made in addressing cardiovascular diseases across the region, there is insufficient priority placed on a large section of patients for whom intervention may have the most benefit—that is those who have already experienced a heart attack or stroke. Better provision of care for this group demands urgent attention but also offers a realisable opportunity for health systems. Now more than ever it is important to keep these high-risk patients healthy and out of hospital”.

The report is available for download here