Health check recommendations

• All people > 15 years of age opportunistically
• All Aboriginal and Torres Strait Islander people > 15 years of age annually
• Perform annual Australian cardiovascular disease risk calculator on all Aboriginal and Torres Strait Islander people from 30 years and all others from 45 years opportunistically

1. Procedure

• Ask the person the questions and perform the measurement as per Table 1.
• Be prepared to explore answers further
• Provide brief intervention and resources if required
• Determine if the person has measurements outside of normal limits. If so, make a referral and place on a follow-up and recall register

1. Heart rate and rhythm
   • Auscultate heart rhythm and sounds if experienced. See Resource 1.
2. Taking a blood pressure (BP) ^1,2
   • Patient to avoid caffeine, cigarettes and exercise for 30 mins prior to measuring
   • Sit in a quiet comfortable room. Remain seated and relaxed for 3–5 mins
   • Rest arm on table, mid-arm at heart level, legs uncrossed and feet flat on floor
   • Use a calibrated sphygmomanometer with appropriate sized cuff (smaller cuff overestimates and larger cuff underestimates BP)
   • Take 3 measurements with 1 min between each. Measure to the nearest 2 mmHg
   • If initial assessment, measure on both arms. If BP varies > 5 mmHg use the arm with the higher reading for all subsequent measurements
   • For symptoms of postural hypotension (feeling dizzy, light headed or queasy when standing, sitting or lying) and for elderly patients or those with Diabetes, measure BP both sitting and after standing for 1 minute and again after 3 minutes

2. Results

1. Breathing ³
   • A normal resting adult respiratory rate is 12–20 breaths per minute (bpm)
   • Breathing should be regular with no rasping, crackling, wheezing or gurgling noises
   • The person should not get breathless at rest, walking short distances or when waking at night
   • If a person answers ‘yes’ to snoring or sleep apnoea, assess for daytime sleepiness and OSA risk by using a validated tool. See Resource 2.
2. Heart rate and rhythm ³
   • A normal resting adult heart rate is 60–100 bpm
   • The heart rhythm should be regular and consistent
   • Perform a 12 lead ECG on a person with:
     • slow heart rate (bradycardia) is a heart rate < 60 bpm
     • rapid heart rate (tachycardia) is a heart rate > 100 bpm
     • any irregular heart rate (arrhythmias)
3. Blood pressure (BP) ^1,2
   • A normal resting adult BP is < 130/85
   • Consider a raised BP due to the assessment itself; ‘white coat’ hypertension
   • Record results of Australian cardiovascular disease risk calculator as high, moderate or low risk

3. Brief intervention

• Brief intervention focuses on Lifestyle modifications

1. Breathing ³
   • Undertaken to identify any underlying respiratory and cardiac issues attributed to exposure to environmental irritants (e.g. cigarette smoke), chest infections or
     congenital abnormalities
   • Snoring and OSA is associated with multiple chronic conditions including Chronic obstructive pulmonary disease, Asthma (adults and children > 12), Bronchiectasis, and Overweight and obesity (adult)
2. Heart rate and rhythm ³
   • Listening to (auscultating) the heart can provide information about the condition of the valves and presence of anatomical defects caused by Rheumatic heart disease, previous MI, untreated Hypertension or substance use
3. Blood pressure (BP) ^1,2
   • The measurement of pressure of blood against blood vessel walls
   • Hypertension develops gradually over many years and can cause and worsen underlying chronic conditions
   • Record results as high, moderate or low risk and provide interventions, goals and follow-up based on cardiovascular risk of Australian cardiovascular disease risk calculator

4. Referral

• Refer to the Primary Clinical Care Manual for BP ≥ 160/100, a variation of > 20 mmHg between arms or patient complains of chest pain
• Refer to a sleep specialist if a patient scores highly for OSA
• Refer to the MO/NP if:
  • abnormal breathing issues are identified
  • tachycardia, bradycardia or arrhythmias, along with a 12 lead ECG
  • BP varies between arms by > 15 mmHg
  • SBP reading ≤ 100
  • BP ≥ 140/90; Hypertension
  • patient Australian cardiovascular disease risk calculator is high or moderate
  • the patient or clinician have any concerns
• Review any patient comorbidities in relation to above

5. Follow-up

• Place the person on a recall register if required
• Ensure all referrals are actioned
• Provide the person with details of the next scheduled follow-up appointment

6. References

• All Chronic Conditions Manual references are available via the downloadable References PDF

7. Resources

1. Practical Cardiac Auscultation Reference Guide
2. The Epworth Sleepiness Scale and STOP-Bang questionnaire