Launch of Evohealth report on ASCVD
The ECCT arranged a Premium Event to officially launch a report by Evohealth on tackling Atherosclerotic Cardiovascular Disease (ASCVD) in Taiwan (台灣心臟疾病報告書發表會). The report "Atherosclerotic cardiovascular disease in Taiwan: A public health priority" was commissioned by Novartis International AG to develop a range of population health solutions to address the CVD burden in Taiwan.
At the event, guest speaker Dr Renae Beardmore, Founder of Evohealth, presented a pre-recorded overview of the report, which explains the modifiable ASCVD risk factors and sets out population health recommendations to address ASCVD. This was followed by a panel discussion moderated by Dr Li Yi-Heng, Senior Attending Physician of the Division of Cardiology at National Cheng Kung University Hospital (國立成功大學醫學院內科部及內科學科 李貽恒教授) featuring the following panellists: Wu Chao-Chun, Director General, Health Promotion Administration (HPA 衛生福利部國民健康署吳昭軍署長); Shih Chung-Liang, Director General, National Health Insurance Administration (NHIA 衛生福利部中央健康保險署石崇良署長) and Fran Milnes, Novartis Taiwan President (台灣諾華總裁麥芳蘭女士).
The report was produced based on research conducted in 2022, which included interviews with clinicians and policy makers. According to the report, despite a decline in recent years, cardiovascular disease (CVD) remains a leading cause of death and disability, accounting for almost one third of all deaths worldwide. ASCVD is a major contributor to the burden of CVD, accounting for an estimated 85% of cases globally.
Yet, as many of the main risk factors for ASCVD are preventable, this means that, when identified early, up to 90% of CVD deaths are preventable. ASCVD is an important public health priority in Taiwan, with 40% people at risk of developing this life-threatening disease. In Taiwan, despite the availability of statins and other treatments, the ASCVD burden is growing at a rate of 3.5% per annum, particularly amongst the over 65s, which is higher than Japan and Australia.
The European Society of Cardiology identifies four modifiable risk factors for ASCVD – all of which are highly prevalent in Taiwan: hyperlipidaemia (high cholesterol, which affects 44-58% of Taiwanese people), hypertension (high blood pressure, which affects 25% of Taiwanese people), diabetes (which affects 10.3% of Taiwanese people) and smoking (13.1% of Taiwanese people are regular smokers).
According to the report, reducing the burden of ASCVD will require a shift in paradigm from physician-centred care to an evidence-based population health approach in order to address the volume of the problem. Of the five risk factors, hyperlipidaemia is the easiest one to modify. The key barriers to addressing ASCVD are that hyperlipidaemia is a "silent symptom", so many patients do not seek treatment, there is limited patient access to advanced treatment due to strict reimbursement criteria for newer medicines, hyperlipidaemia is not prioritised as a risk factor in government policies (only 30% of people consider it a serious condition), there are low prescribing rates for lipid-lowering therapies while many patients (one out of three) do not adhere to treatments.
This report sets out six population health recommendations to reduce the burden of ASCVD in Taiwan:
1. Develop a targeted public health awareness campaign that emphasises the importance of early detection and ongoing treatment of ASCVD risk factors. This is urgent given the fast ageing population and high growth rate of the ASCVD burden.
2. Increase screening of ASCVD risk factors in young people to enable activation of primary prevention strategies, in line with clinical guidelines. Doing so can prevent future events.
3. Develop a strategy for continuous upskilling of primary care physicians on ASCVD to improve compliance with clinical guidelines. This should include reducing misunderstandings as to how to measure and monitor patient progress.
4. Develop a framework for follow-up care that empowers primary care physicians in the ongoing monitoring and management of patients with ASCVD.
5. Partner with cardiac specialists and medical societies to develop patient education resources on ASCVD prevention and treatment.
6. Expand patient access to therapies in line with clinical guidelines and global best practice.
It is estimated that following these recommendations would save 19,115 lives and avoid 229,385 non-fatal CVD events in the first five years in Taiwan. There would also be a five-fold increase in people achieving LDL-C targets within five years, a 26% improvement adherence to recommended therapies and, given the improvement in overall health of these patients, there would be an increase in productivity.
In the panel discussion, HPA Director General Wu said that prevention and screening for non-communicable diseases and slowing down the rate of CVD is part of his agency’s goals. He added that recommendations made in the paper would be considered for inclusion in the HPA’s future plans.
NHIA Director General Shih said that policy makers are fully aware of the health issues associated with an ageing society. He noted that fighting cancer accounts for one sixth of the NHIA’s budget while tackling diabetes also accounts for a significant portion. He acknowledged the importance of screening and regular check-ups and educating the public. He touted the usefulness of the NHIA’s My Health Bank app, which allows users to check their healthcare records and could be used in future to remind patients to get regular check-ups.
Fran Milnes said that the report aimed to highlight the best practices from many countries. While Taiwan has a good healthcare system, there are opportunities for public private partnership aimed at further improving health outcomes, such as through public awareness campaigns on CVD risk factors.