National Strategic Action Plan for Heart Disease and Stroke

Objectives

The National Strategic Action Plan for Heart Disease and Stroke provides a national framework to help all Australians live healthier lives through effective prevention, diagnosis, treatment, management and support for heart disease and stroke.[1]Its overarching purpose is to reduce disease burden, premature deaths, avoidable hospital admissions, suffering and associated costs through strategic, evidence-based, cost-effective and patient-focused action.[2][3]It uses a systems approach that addresses shared cardiovascular risk factors while retaining tailored responses where heart disease and stroke require distinct treatments or models of care.[4]

• Prioritise prevention and early detection through primary population-health measures, individual risk management and secondary prevention for people living with cardiovascular disease or following a heart attack or stroke.[5]
• Improve detection and management of cardiovascular risk by updating absolute cardiovascular risk guidance, expanding integrated health checks, improving hypertension care and supporting opportunistic atrial fibrillation checks.[5][6][7]
• Reduce modifiable risk factors through national tobacco-control, physical activity, nutrition and obesity strategies, supported by culturally adaptable measures and attention to affordable healthy food.[8][9]
• Provide efficient, effective, appropriate and equitable diagnosis, treatment and care, including timely access to cardiac and stroke services, emergency treatment, stroke units and transient ischaemic attack clinics.[10][11][12]
• Support ongoing recovery, wellbeing, community participation and return to education, work or retirement through person-centred rehabilitation, care transitions, tailored information, peer support and emotional support for patients and carers.[13][14][15]
• Strengthen cardiovascular research, evidence translation and data systems through research investment, living clinical guidelines, clinical quality registries, rehabilitation datasets and a national cardiovascular data platform.[15][16][17]

The four equally important priority areas are Prevention and Early Detection, Diagnosis and Treatment, Support and Care, and Research.[1][18]Action should address inequities experienced by Aboriginal and Torres Strait Islander peoples, rural, regional and remote communities, socioeconomically disadvantaged people, people living with mental illness, culturally and linguistically diverse populations, and other groups requiring tailored support.[19][13]

The research agenda includes progressing the Medical Research Future Fund Mission for Cardiovascular Health, stated as a 220 million dollar commitment, and directing funding towards identified gaps such as behavioural interventions, Aboriginal and Torres Strait Islander priorities, sex- and gender-specific research, stroke recovery, rehabilitation and childhood stroke.[16]The supplied material does not provide a complete quantified set of outcome targets or a whole-of-plan budget.[19][20]

Implementation

Implementation is intended to be nationally coordinated but locally adaptable, enabling states and territories to determine priorities, scope and timing according to local need, readiness and provider and funder capacity.[20]Delivery brings together Australian, state, territory and local governments, healthcare professionals, primary care, allied health and specialist bodies, researchers, non-government organisations, industry, the private sector, consumers, carers, families, communities and priority-population organisations.[3][20]

• Establish an Implementation Advisory Group of heart and stroke experts and key stakeholders, including the National Heart Foundation of Australia, Stroke Foundation, governments and primary healthcare representatives, to advise on delivery, coordinate implementation and identify drivers.[21]
• Develop an implementation timeline, assign lead responsibility for each action, identify delivery partners and prepare an implementation plan linked to the Action Plan's overall objectives.[21]
• Strengthen governance and leadership across sectors and jurisdictions, clarify implementation responsibilities and maintain partnerships with communities and priority populations.[22][19]
• Co-design culturally safe services with communities, using Aboriginal Health Workers, Aboriginal Community Controlled Health Services, interpreters, transport support, culturally appropriate care and appropriately distributed multidisciplinary workforces where needed.[19]
• Support the workforce through education, skills development, technology, infrastructure and health-literacy initiatives delivered with government, clinical leaders, practitioners, communities and relevant services.[19]
• Use primary care quality-improvement programmes, clinical education, software and decision-support tools, notification and recall systems, public campaigns and targeted communications to increase prevention and early-detection activity.[6][7]
• Expand delivery capacity through blended primary healthcare payments, specialist outreach, telehealth networks, standardised emergency responses, coordinated reperfusion services, specialised stroke units and multidisciplinary rehabilitation models.[10][11][12][13]

Operationally, the plan supports a National Telehealth Model linking state-based stroke telehealth networks and providing continuous access to neurologists and neuroradiologists.[11]It also proposes nationally consistent first-responder and emergency-department training, ambulance and air-retrieval protocols, pre-hospital notification and transport arrangements to appropriate cardiac and stroke centres.[12]Post-discharge delivery should include care planning, medication and lifestyle education, rehabilitation and primary-care referrals, telemonitoring, telephone support, community pharmacy, mental health services and peer-support channels.[14]

Monitoring and accountability are to be embedded in all actions through a comprehensive monitoring and evaluation plan overseen by the Implementation Advisory Group.[20][23]National clinical quality registries, a cardiac rehabilitation dataset, a National Cardiovascular Disease Data Platform and linked time-to-treatment data should support measurement of risk, incidence, prevention, quality of care, outcomes and inequities.[17][20][23]Measures should enable analysis by sex, Aboriginal and Torres Strait Islander status, socioeconomic status and culturally and linguistically diverse status.[20]

Implementation review includes twelve-month and three-year development checks and a five-year review, with reporting aligned to the National Strategic Framework for Chronic Conditions.[20][21]The plan anticipates marked improvement against its objectives within five years.[21]Sustainable, adequately distributed and efficiently used funding is identified as a foundation for implementation, but the supplied material does not specify whole-of-plan allocations, funding sources or detailed costings.[22][19][20]

Monitoring & Evaluation

The Action Plan proposes a national monitoring, evaluation and accountability system centred on linked cardiovascular data, clinical quality registries, consistent outcome measures and scheduled reviews. An Implementation Advisory Group is to advise on delivery and oversee a comprehensive monitoring and evaluation plan.[20]

• Establish nationally consistent data collection, management and outcome measures to inform decision-making, track implementation progress and support care.[19]
• Build a National Cardiovascular Disease Data Platform through partnerships involving state and territory jurisdictions, the Australian Institute of Health and Welfare, national agencies, clinical experts, researchers and consumers.[23]
• Use linked existing data, assess gaps in data systems, identify emerging data opportunities and improve national consistency and integration.[23]
• Use the data platform for population monitoring, incidence measurement, tracking recommended medicines for primary and secondary prevention, quality-of-care assessment and comprehensive reporting of cardiovascular risk factors.[23]
• Strengthen cardiac registry coordination and expand the Australian Stroke Clinical Registry into a national stroke clinical quality registry to monitor care quality, support clinical practice improvement and assess patient outcomes.[17]
• Develop agreed minimum cardiac rehabilitation data covering referral, participation, completion and readmission, and use these measures to identify service improvement opportunities and inform best-practice and alternative care models.[17]
• Develop a national framework for recording emergency heart and stroke treatment times, enabling ambulance, emergency and hospital services to capture and report the data.[20]
• Align treatment-time data with the Acute Coronary Syndromes Clinical Care Standard Indicators and Acute Stroke Clinical Care Standard Indicators.[20]
• Measure cardiovascular risk, incidence, prevention, care and outcomes, including variation by sex, Aboriginal and Torres Strait Islander status, socioeconomic status and culturally and linguistically diverse status.[20]
• Monitor variation in cardiac prevention, acute care and secondary care at national, jurisdictional and local levels, and use equity data to raise awareness and strengthen continuous quality improvement.[10]
• Monitor uptake of absolute cardiovascular risk assessments and integrated health checks in primary care, supported by expert advisory-panel recommendations and the Quality Improvement Incentive programme.[6]
• Use notification and recall systems to support completion of age-specific health checks.[6]
• Monitor e-cigarette safety, effects on smoking initiation and cessation, youth uptake and dual use with conventional tobacco products.[8]
• Maintain nutrition surveillance through a rolling Australian Health Survey incorporating biomedical risk factors, and assess the feasibility of 24-hour urinary sodium studies.[9]
• Map stroke units against stroke incidence and population need, with a plan to increase access from 67% to 90%, and develop accreditation linked to national standards and possible financial incentives.[12]
• Pilot and evaluate periodic community reviews for stroke survivors, assessing physical, verbal, cognitive and emotional needs and facilitating targeted rehabilitation.[13]
• Use continuous surveillance and rapid evidence updates in living clinical guidelines, and evaluate both the online living-evidence resource and guideline use in practice.[16]
• Conduct development checks at 12 months and three years, followed by a five-year review aligned with reporting under the National Strategic Framework for Chronic Conditions.[20][21]
• Formalise reporting by Australian and state and territory governments against the overarching goal and the objectives of the four priority areas.[21]

The plan does not specify numerical performance targets for most actions, detailed evaluation methodologies, or a complete public reporting schedule beyond the stated development checks, five-year review and reporting alignment.[20][21]

Costing & Financing

Financing is framed as a prerequisite for implementation, with sustainable, adequately allocated, appropriately distributed and efficiently used resources needed across prevention, treatment, support, data and research.[22][19]The plan identifies one explicit research mission allocation, while most proposed funding commitments are not quantified.[16]

• Implement and progress the Medical Research Future Fund Mission for Cardiovascular Health, valued at 220 million dollars, and allocate funding to identified research gaps.[16]
• Fund research addressing behavioural and lifestyle interventions, Aboriginal and Torres Strait Islander priorities, sex- and gender-specific research, stroke recovery and rehabilitation, and stroke among children and young people.[16]
• Provide funding for implementation and promotion of actions by jurisdictions, while allowing scope and timing to reflect local needs, readiness and funder and provider capacity.[20]
• Support continued funding for services in rural, regional and remote communities, including remote Aboriginal and Torres Strait Islander communities.[10]
• Provide significant long-term investment for the Rheumatic Heart Disease Roadmap, which aims to eliminate the disease by 2031.[11]
• Resource specialist outreach, telehealth infrastructure and specialist capacity, multidisciplinary reperfusion services, and possible incentives linked to stroke-unit accreditation.[11][12]
• Fund flexible, patient-centred cardiac and stroke rehabilitation, including inpatient, community-based, early, digital and telehealth models.[13]
• Fund health-check notification and recall work, tobacco-control campaigns and cessation services, a National Physical Activity Action Plan, and a National Nutrition Strategy.[7][8]
• Fund ongoing Australian Health Survey activity, national heart attack and stroke awareness campaigns, and primary healthcare payment arrangements.[9][10]
• Assess the clinical and cost effectiveness of integrated health checks to inform consideration of extended funding.[6]
• Recognise evidence cited by the plan that every dollar invested in prevention returns 14 dollars to the wider economy.[5]

Heart disease and stroke are associated with substantial social, economic and health-system costs, and the intended benefits of implementation include fewer premature deaths and avoidable hospital admissions and lower costs for individuals, families, communities and the health system.[3][4]The supplied material does not provide a consolidated budget, expenditure profile, financing sources, quantified funding gaps, cost estimates for individual actions, or wider economic assumptions.[18][22][20]