title: Secondary prevention: the Heart Foundation's experience in driving change through advocacy.
abstract: BACKGROUND
  Heart disease is the leading single cause of death for men and women in Australia. There are 685,000 people living with heart disease, approximately 50% will be experiencing signs and symptoms of heart failure. This article aims to articulate the key advocacy activities required to improve the provision of evidence-based secondary prevention including cardiac rehabilitation and multidisciplinary chronic heart failure management services.
  
  
  METHODS
  The Heart Foundation undertook an extensive consultation process with many experts, policy makers, health and public health professionals through forums, evidence reviews and working groups. A range of actions are required to improve access to secondary prevention, but only those that the Heart Foundation could drive and support have been included.
  
  
  RESULTS
  The results identified three synergistic advocacy areas between heart failure and cardiac rehabilitation to drive secondary prevention advocacy. These were data, policy and people.
  
  
  CONCLUSIONS
  The priority actions are discrete and tangible to progress rather than revisit established evidence-based recommendations, and to support uptake and implementation at a national and state/territory level. We must consider the current landscape within which secondary prevention sits and identify the intersecting barriers and enablers that can be influenced. There is no single solution or lever for change.
  
  
  CONCLUSIONS
  Best-practice management of heart disease can be achieved through a co-ordinated effort to implement system change. Focus should be paid to a multi-faceted approach in the key advocacy areas identified here - data, policy and people - as these will provide benefit across the disease continuum, from secondary prevention and cardiac rehabilitation through to heart failure management.
authors.affiliation: National Heart Foundation of Australia, Acute Coronary Syndromes.
authors.forename: Michelle
authors.initials: M
authors.lastname: Stewart
authors.affiliation: National Heart Foundation of Australia, Health Equity and Secondary Prevention, Deakin University. Electronic address: karen.page@heartfoundation.org.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Page
authors.affiliation: National Heart Foundation of Australia, Cardiovascular Health.
authors.forename: Rachael
authors.initials: R
authors.lastname: de Jong
authors.affiliation: National Heart Foundation of Australia, Health Equity and Secondary Prevention.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lee
authors.affiliation: National Heart Foundation of Australia, Cardiovascular Health.
authors.forename: Robert
authors.initials: R
authors.lastname: Grenfell
mesh_terms: D001315:Australia / Q000453:epidemiology; D005260:Female; D005582:Foundations; D006333:Heart Failure / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D010344:Patient Advocacy
keywords: Cardiac rehabilitation; Health care reform; Health policy; Heart failure; Patient advocacy; Secondary prevention