Rehabilitation services designed to keep patients well and prevent their hospital readmission is key to reducing the incidence and cost of recurring (secondary) heart attacks or strokes (2). However, these services across the region remain underdeveloped (1).
This is according to a white paper “The cost of inaction: Secondary prevention of cardiovascular disease in Asia-Pacific”, released today by leading public policy commentator The Economist Intelligence Unit (EIU), and sponsored by Amgen. (https://bit.ly/costofinactionamgen).
The report included a Scorecard which assessed the policy response to cardiovascular disease (CVD) across eight Asia-Pacific markets, including Australia, mainland China, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand. It follows the 2018 EIU report, “The cost of silence: Cardiovascular disease in Asia”, which examined the prevalence and costs of the top four modifiable risk factors that contribute to CVD across the same eight markets.
An estimated 80% of CVD, including heart disease and stroke, is preventable (3]. For example, lowering
LDL-C (‘bad’ cholesterol) reduces cardiovascular events (4), yet patients in Asia-Pacific are routinely not meeting guideline-defined LDL-C goals (5-8), due to lack of medication adherence (5).
Due to the high risk of recurrence of heart attacks and stroke (9), the two deadliest forms of CVD (10), secondary prevention through quality follow up care once patients leave hospital, is important to help to minimize the CVD economic burden (11).
“Patients who have experienced a heart attack or stroke carry a 30% higher risk of another event over the ensuing four year (9). Furthermore, two in three stroke survivors experience disabilities, such as paralysis or loss of vision (12). As a result, survivors may be unable to work or study, and may require the support of family members. This can pull family caregivers away from employment, training or education. As such, CVD-related disability can disrupt households and threaten family stability (13),” said Mr. Vernon Kang, Chief Executive Officer, Singapore Heart Foundation. “CVD already accounts for approximately 18 million deaths each year worldwide (10). The findings from ‘The cost of inaction: Secondary prevention of cardiovascular disease in Asia-Pacific’ confirms more can be done to ensure patients are supported to comply with their treatment and rehabilitation needs, and to reduce their risk of secondary disease, for which they are at high risk (4,5,14).”
Key findings from the report include (1):
– Heart attacks are rising among younger people across the Asia-Pacific markets examined.
– Heart disease is costing the Asia-Pacific markets USD 46.3 billion (estimated across Australia, mainland China, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand).
– CVD policies do exist in some form in all economies studied, however there is substantial room for improvement.
– Policies on modifiable risk factors exist, but the success of translating these into legislation and action, along with measuring impact, remains to be defined.
– Only one market (Australia) has implemented a comprehensive secondary prevention of CVD public health awareness campaign.
– Clinical practice guidelines for CVD secondary prevention, heart attack and stroke, vary substantially across economies.
– Government audits are lacking. Only two study economies have any form of audit in place.
– Integrated primary care systems are still emerging in many Asian economies, and in many cases, patient uptake of services remains low.
“Empowering patients through education and awareness may help to overcome the various barriers to attendance at, and participation in, cardiac rehabilitation across the region. Cardiac rehabilitation involves multidisciplinary CVD management plans combining exercise, education and behaviour modification. Although they have been shown to significantly improve patient outcomes (15,16), the white paper revealed participation rates across Asia-Pacific were as low as 6% in some economies,” Mr Kang said.
Commenting on the findings, Amgen Vice President and regional General Manager, Penny Wan, said now more than ever, avoiding re-hospitalization from Cardiovascular disease, was imperative. “In many countries, good emergency care stops people dying from a heart attack or stroke. However, these patients are at higher risk of having another attack, which is compounded by lack of follow-up care, making future events more difficult to manage.”
“Amgen is committed to working as part of a coordinated, multi-stakeholder approach to shift healthcare models from ‘Break It Fix It’, to one that seeks to ‘Predict and Prevent’ to support patients and health care systems to become more resilient to health care shocks such as a pandemic,” Ms. Wan said.
The Economist Intelligence Unit managing editor, Thought Leadership, Asia, Mr. Jesse Quigley Jones said “The cost of inaction: Secondary prevention of cardiovascular disease in Asia-Pacific” white paper found that despite the availability of effective interventions and proven care models for CVD, these were inconsistently implemented across the eight economies studied. “For instance, although each had policies for controlling CVD risk factors, such as obesity and tobacco use, few make explicit provision for preventing recurrent cardiovascular events. Furthermore, lack of government audits against quality care standards and poor compatibility of electronic health and medical records, makes it difficult to track the application of guidelines, referral to rehabilitation services, treatment adherence and outcomes.”
“Healthcare systems that integrate patient-centric intervention, education and empowerment, such as electronic reminders and health records, may help to increase adherence, and subsequently improve overall patient outcomes,” Mr Quigley Jones said.
Available for interview
– Ms Penny Wan, Amgen Regional Vice-President and General Manager, JAPAC, HONG KONG
– Jesse Quigley Jones, The Economist Intelligence Unit, Managing Editor, Thought Leadership, Asia, HONG KONG
– Dr. Chan Ngai-Yin, President, Hong Kong College of Cardiology, HONG KONG
– Dr Saikiran Leekha, Amgen Regional Medical Director, JAPAC, HONG KONG
– Prof. Carolyn Lam, Senior Consultant, National Heart Centre Singapore (NHCS), Professor of Duke-NUS Cardiovascular Academic Clinical Programme, SINGAPORE
– Mr Vernon Kang, Chief Executive Officer, Singapore Heart Foundation, SINGAPORE
– Edwin, 29, financial adviser & former hip-hop dancer who survived a heart attack last year, SINGAPORE
Kirsten Bruce and Julia Slater, VIVA! Communications, AUSTRALIA
+61 401 717 566 / +61 422 074 354
email@example.com / firstname.lastname@example.org
Eleanor Ng, Amgen, JAPAC, HONG KONG
+852 9469 3000 / email@example.com
About cardiovascular disease (CVD)
As the world’s leading cause of premature death (10,17) CVD claims the lives of 26,000 people a day in Asia alone (18). In fact, Asia currently bears half the global CVD burden (19) as the world’s fastest ageing region (20,21). The elderly are on track to cost the region* an estimated USD 20 trillion in healthcare expenses between 2015 and 2030 (20). Based on findings of the GBD Study 2016, ischemic heart disease and stroke are forecast to be the top two causes of early death in 2040, not only on a global basis, but also for the regions of East Asia and Southeast Asia. The rising incidence and CVD-related cost-of-illness will challenge the sustainability of health and financial systems worldwide. Therefore, health systems will need to apply primary and secondary prevention strategies to reduce healthcare costs, increase economic productivity, and improve quality of life.
* Includes the 14 economies of Australia, China, Hong Kong, India, Indonesia, Japan, Malaysia, New Zealand, the Philippines, Singapore, South Korea, Taiwan, Thailand and Vietnam.
About the research
The Amgen-sponsored “The Cost of Inaction: Secondary prevention of cardiovascular disease in Asia-Pacific” is an Economist Intelligence Unit and EIU Healthcare report. The report describes the EIU Healthcare-created Secondary Prevention of Cardiovascular Disease in Asia-Pacific Scorecard findings, together with 11 in-depth interviews featuring global CVD experts. The scorecard was developed to assess the burden and health system response to secondary cardiovascular events in eight Asia-Pacific economies: Australia, China, Hong Kong, Japan, Singapore, South Korea, Taiwan and Thailand. The report follows the 2018 EIU report, “The Cost of Silence: Cardiovascular disease in Asia”, which examined the prevalence and costs arising from the top four modifiable risk factors that contribute to CVDs across the same eight economies.
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This news release contains forward-looking statements based on the current expectations and beliefs of Amgen. Unless otherwise noted, Amgen is providing this information as of the date of this news release and does not undertake any obligation to update any forward-looking statements contained in this document as a result of new information, future events or otherwise.
1. Economist Intelligence Unit, “The cost of inaction: Secondary prevention of cardiovascular disease in Asia-Pacific” 2020. https://bit.ly/costofinactionamgen.
2. Secondary prevention and rehabilitation after coronary events or stroke: a review of monitoring issues. Australian Institute of Health and Welfare, Editor. 2003, AIHW Cat. No. CVD 25: Canberra.
3. American Heart Association. CDC Prevention Programs. 2018 February 2020; Available from: https://www.heart.org/en/get-involved/advocate/federal-priorities/ cdc-prevention-programs.
4. Chan, M.Y., et al., Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol, 2016. 202: p. 861-9.
5. Poh, K.K., et al., Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Asia-Pacific region: results from the Dyslipidemia International Study II. Eur J Prev Cardiol, 2018. 25(18): p. 1950-1963.
6. Mach, F., et al., 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J, 2020. 41(1): p. 111-188.
7. Kim, H.S., et al., Current status of cholesterol goal attainment after statin therapy among patients with hypercholesterolemia in Asian countries and region: the Return on Expenditure Achieved for Lipid Therapy in Asia (REALITY-Asia) study. Curr Med Res Opin, 2008. 24(7): p. 1951-63.
8. Park, J.E., et al., Lipid-lowering treatment in hypercholesterolaemic patients: the CEPHEUS Pan-Asian survey. Eur J Prev Cardiol, 2012. 19(4): p. 781-94.
9. Bhatt, D.L., et al., Comparative Determinants of 4-Year Cardiovascular Event Rates in Stable Outpatients at Risk of or With Atherothrombosis. JAMA, 2010. 304(12): p. 1350-1357.
10. G. B. D. Causes of Death Collaborators, Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2018. 392(10159): p. 1736-1788.
11. Notara, V., D.B. Panagiotakos, and C.E. Pitsavos, Secondary prevention of acute coronary syndrome. Socio-economic and lifestyle determinants: a literature review. Cent Eur J Public Health, 2014. 22(3): p. 175-82.
12. Deloitte Access Economics, The economic impact of stroke in Australia. 2013, National Stroke Foundation.
13. Harikrishnan, S., et al., A race against time: The Challenge of Cardiovascular Diseases in Developing Economies. Centre for Chronic Disease Control, 2014.
14. Yusuf, S., et al., Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med, 2014. 371(9): p. 818-27.
15. Piepoli, M.F., et al., Challenges in secondary prevention after acute myocardial infarction: A call for action. Eur J Prev Cardiol, 2016. 23(18): p. 1994-2006.
16. Briffa, T.G., et al., An integrated and coordinated approach to preventing recurrent coronary heart disease events in Australia. 2009. 190(12): p. 683-686.
17. Institute for Health Metrics and Evaluation (IHME), Findings from the Global Burden of Disease Study 2017. 2018: Seattle.
18. Roth, G.A., et al., Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J Am Coll Cardiol, 2017. 70(1): p. 1-25.
19. Ohira, T. and H. Iso, Cardiovascular disease epidemiology in Asia: an overview. Circ J, 2013. 77(7): p. 1646-52.
20. Asia Pacific Risk Centre, Advancing into the Golden Years: Cost of Healthcare for Asia Pacific’s Elderly. 2016.
21. Deloitte, Voice of Asia. 2017: p. 25.