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Up to seven in ten of the 76 000 people screened during the Shane Warne Legacy Health Check at the 2023 Boxing Day Test cricket match and 311 participating community pharmacies were identified to have an undiagnosed cardiovascular risk factor.
Cardiovascular disease (CVD) remains the leading cause of death in Australia, accounting for over 40 000 deaths annually — that’s about one in every four deaths. Despite advances in preventive approaches and therapies, the burden of CVD persists due to a lack of participation in general health checks among the general population. Traditional models of care for cardiovascular screening rely on individuals proactively engaging with their general practitioners (GP) or local health services. Numerous barriers exist in this model, ranging from lack of time and high cost, to distance from services, to the simple fact that many Australians do not prioritise preventive health until they’re unwell.
Population-level screening would help increase the identification of cardiovascular risk factors and allow for early treatment to prevent CVD. This begs the question: what if instead of asking people to come to us, we went to them?
A pop-up approach to screening in the community
In late 2023 and early 2024, an opportunistic pop-up model of community cardiovascular screening was undertaken as part of the Shane Warne Legacy Health Check. The initiative was a collaboration between SiSU Health, La Trobe Health Services, the Shane Warne Legacy and the Victorian Heart Institute at Monash University.
Over a seven-week period, health stations were placed in 311 community pharmacies nationwide, and at the Melbourne Cricket Ground during the 2023 Boxing Day Test match. The health stations were self-operated by participants and captured participant demographics, blood pressure, body mass index (BMI), smoking status, medical history, and prior engagement with health care. The average time for each health check was about four minutes and trained pharmacists were on hand for assistance if needed. All participants were advised to visit their local GP for a formal health check regardless of results from the screening.
Staggering results
Over 76 000 Australians took part in the initiative. Of these, around 68 000 (~90%) were screened at pharmacies and 7 700 (~10%) at the cricket match.
Approximately seven in ten participants (68.9%) had either elevated blood pressure readings, elevated BMI, or were active smokers. When analysed individually, 37% recorded blood pressure readings in the hypertensive range, 61% were overweight or obese, and 12% were active smokers. Among those with elevated blood pressure readings, approximately half had not had a blood pressure measurement taken within the preceding year.
Interestingly, the prevalence of uncontrolled risk factors varied depending on screening location and times. Those screened at the cricket match were more likely to be male, middle-aged, and had higher rates of uncontrolled cardiovascular risk factors than those at pharmacies. Among pharmacy participants, higher rates of uncontrolled cardiovascular risk factors were found in rural pharmacy locations. Those who attended screening on a weekday and during the daytime were also more likely to have an uncontrolled cardiovascular risk factor.
Although striking, there were some limitations to the results that need to be considered. Firstly, elevated blood pressure readings in this program do not necessarily reflect hypertension, as measurements could be falsely elevated by stress, excitement, recent physical movement, or alcohol consumption at the cricket match. Data was also self-entered into the health stations and were not formally adjudicated.
Looking ahead
Our results highlight the potential for an opportunistic pop-up approach to cardiovascular screening. The temporary nature of a pop-up screening program can be more engaging and interesting for participants rather than traditional screening models. Additionally, the opportunistic nature of screening people in the community where they are allows convenient access to health care for community members who may not otherwise visit their local GP. The results also highlight the importance of choosing appropriate community locations and opening hours to be able to identify community members who are at risk of CVD.
The challenge with the results of this study is what we do next. Detecting raised blood pressure or BMI is only useful if it leads to follow-up and treatment. While all participants were encouraged to see their GP, the study did not track whether they actually did. Future efforts need to develop a stronger link between pop-up screening and ongoing existing care pathways — perhaps direct referral systems and collaboration with local GPs and health services.
Conclusion
CVD remains a prevalent health problem in Australia. If we are serious about prevention, we must think creatively about meeting people where they are — whether that’s at the pharmacy counter, the shopping centre, or even in the stands of the Melbourne Cricket Ground.
Drs Sean Tan, Rahul G. Muthalaly, and Nitesh Nerlekar are cardiologists at the Victorian Heart Institute, Monash University and Victorian Heart Hospital.
Dr Adam Nelson is a cardiologist and researcher supported by a Heart Foundation Postdoctoral Fellowship.
Dr Noel Duncan was employed by SiSU Health at the time of study.
Ms. Helen P. Nolan is the CEO of the Shane Warne Legacy.
Professor Stephen J. Nicholls is Director of the Victorian Heart Institute, Monash University and Program Director of the Victorian Heart Hospital.
This research was supported by SiSU Health.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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Great initiative to capture the broader population at their leisure location – we know that men are less likely than women to attend their GP.
I disagree Steve – but only on the size of the suggested risks! That’s alarming and, as you say, indicates a severe limitation to the preventive role so well characterised by a well supported Primary Care system, which has been so seriously eroded by successive governments, and now faces even worse fragmentation, not reconstruction! Will such reconstruction cuts more initially? Of course it MUST, but the longer term savings are obvious, because it moves the risks from “the bottom of the cliff”, back to the top, where GP-led Primary Care teams can do the excellent work of which they are highly capable.
No surprises here. We have a great “sick: care system in this country not a “health” care system. A nice hospital at the base of that cliff (if you are in a capital city) to deliver a stent within four hours of a STEMI but little focus on systematic outreach prevention. Take a look at https://www.health.gov.au/resources/publications/draft-recommendations-from-the-primary-health-reform-steering-group?language=en for some ideas. Let’s not build another parallel system – let’s use what we have in a better way.