Prof. Mark Balnaves

The Clinical Updates focus squarely on cardiovascular matters in the April Edition of Medical Forum. The technology and education and training advances have been extraordinary in this field and stand in stark contrast to ancient ways of identifying and dealing with coronary heart disease. But was coronary heart disease common among pre-modern humans? Did people describe it?

What did the ancients know?

Rachel Haja provided a recent historical overview of whether or not the ancients identified coronary artery disease and whether coronary artery disease was, indeed, a problem among the ancients. The paper Coronary Heart Disease: From Mummies to 21st Century appeared in Heart Views in 2017.

A physical test of Egyptian mummies found probable or definite atherosclerosis in 34% of 137 mummies studied. The researchers conclude that heart disease was common among the ancients. Haja also looked at whether or not the signs and symptoms of coronary heart disease were reported in literature.

Arab cardiologist, Dr. H.A. Hajar Albinali, is given credit for possibly identifying the first and best historical description of angina. The Arabic book Majnoon Lila: Between Medicine and Literature, translated an ancient poem into English. Dr. Albinali concluded that the poet had CAD and died with myocardial infarction.

“My heart is firmly seized
By a bird’s claws;
My heart is tightly squeezed,
When Lila’s name flows.
My body is tightly bound,
My body is tightly bound,
Is like a finger ring around.”

The Australian context

Ancient Egyptian and Arabic cultures did not collect data on population health. The first self-administered questionnaire was conducted by Karl Marx, seeking information on worker health. He got no replies. Serious survey tools were a 20th Century innovation with researchers like Paul Lazarsfeld deploying statistical methods. Today, of course, detailed data on population health are common and with wearable devices the capacity to capture more complex data.

The Australian Institute of Health and Welfare’s Australia’s Health 2018 estimated that in 2014-2015 645,000 Australians aged 18 and over, 3.3% of the adult population, had heart disease. One in six adults aged 75 and over are affected.

An estimated 61,600 people aged 25 and over had a heart attack or unstable angina, about 170 events every day.

Coronary Artery Disease was the leading single cause of death in 2016 with 19,100 deaths, representing 12% of all deaths, and 43% of cardiovascular deaths. More than 40% of the deaths resulted from a heart attack.

The impact of CAD increases with remoteness and socioeconomic disadvantage with rates 2.0 to 3.1 times as high among Aboriginal and Torres Strait Islander people as among non-Indigenous Australians and 1.4 to 2.4 times as high in remote and very remote regions as in major cities. The lowest socioeconomic areas compared with the highest socioeconomic areas are 1.3 to 2.2 times as high.

Trends in Cardiovascular Medicine

The skills of cardiologists are already having a major impact on outcomes for patients and the future of coronary care. The American College of Cardiology Cardiology Magazine asked experts what they saw as key trends in 2019.

The answers included greater emphasis on cost and value; greater use of direct oral anticoagulants (DOACs) in atrial fibrillation (AF); new models in the management of mitral valve regurgitation (MR) in heart failure patients; increased use of transcatheter aortic valve replacement (TAVR); increased impact of wearable and implantable devices and the data they collect; and not least the rise of artificial intelligence (AI) in cardiovascular medicine.

Cardiac Care in WA

Competition amongst cardiologists is strong, in an ageing population, and particularly amongst interventional cardiologists. Imaging is going ahead in leaps and bounds so technological advances in equipment, often expensive, becomes important. While the cardiologists test out the minutia of cardiac care, testing one intervention against the other, the general practitioner takes a global view. Forgetting to take the white tablets for a variety of acceptable reasons may be the barrier faced by all.

This is a problem of modern times.

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