Where on the healthcare continuum should we invest? The case for primary care?

Cardiovascular diseases and particularly coronary heart disease are associated with the major personal and economic health burden in Australia. They are also the major cause of health inequalities. The associated economic burden is projected to increase markedly with ageing of the population and decrease in case-fatality rates with acute events such as myocardial infarction. Prevention has recently been listed second among the priorities of the newly formed National Health and Hospitals Reform Commission. It is logical that strategies to prevent CVD events should impact across the healthcare continuum. These should include population-wide measures to counter the epidemic of overweight, targeted cost-effective approaches to high-risk asymptomatic individuals, more effective management of acute events and systems of care to support implementation of evidence-based secondary prevention therapies. Recent cost-utility analyses support the proposition that the general practice environment should be a particular focus for CHD primary and secondary prevention approaches.