Scaling cardiac care

Natalie Raffoul leverages her pharmacy skills in public health, leading national initiatives that improve cardiovascular care.

What sparked your interest in cardiac care?

I spent a lot of time in cardiology wards when I was young due to my dad’s extensive cardiovascular disease (CVD). After beginning my pharmacy degree,
my intrigue quickly turned into passion as I became more fascinated by prevention and management of CVD, especially pharmacologically. Balancing different treatment approaches, combining strategies for multiple cardiovascular conditions and helping people live healthier, longer lives is really exciting. Then there’s the wave of new therapies across the cardiovascular-renal-metabolic space. We’re pushing the envelope with pharmacological interventions – more risk reduction, better mortality outcomes and improved quality of life.

How did you get into clinical strategy?

I started my career in hospital pharmacy, later specialising in cardiology and gaining a graduate certificate in pharmaceutical medicine. While helping individual patients was incredibly satisfying, it made me think about the broader impact I could have –
at a hospital, state or even country level. This was my segue into public health.
I undertook a Master of Public Health Management at UNSW, building skills to tackle system-level changes and improve outcomes for more Australians. I moved on to work for NPS MedicineWise, where I led the clinical design and implementation of behaviour change and education programs in general practice. This role exposed me to the best evidence and strategy for health program design and implementation.

I started at the Heart Foundation in 2019 as the Risk Reduction Manager – working on preventative activities including GP education, mass health marketing campaigns and clinical guideline development. Now, I’m Senior Manager for Healthcare Programs and Clinical Strategy. My team oversees the design, build and implementation of healthcare programs to improve the prevention and management of CVD in Australia.

How do you design clinical programs?

It starts with understanding the problem. For example, rather than thinking, ‘high cholesterol is a risk factor for CVD’, it’s about unpacking what’s standing in the way of Australians controlling their cholesterol. This entails examining barriers and enablers spanning attitudes, beliefs, and gaps in knowledge, systems and evidence. From there, a human-centred design process ensures programs can be prototyped and validated quickly before scaling. Understanding problems and gaps between evidence and clinical practice helps with the design of targeted solutions. For instance, no amount of ‘health professional education’ will address patients’ negative beliefs about statins.

What’s the most rewarding cardiac initiative you’ve worked on?

Leading mass marketing campaigns to increase Medicare Heart Health Checks – with over 1 million delivered in Australia since we started our implementation efforts in 2019! We also designed and scaled a structured CVD screening program across 200 general practices, identifying and recalling eligible Australians at risk of CVD via a simple text message. They were invited to book a 20 minute Heart Health Check with their GP and understand their risk of developing CVD. Over 100,000 patients were recalled as part of two initiatives which resulted in a 13-fold increase in Heart Health Check delivery versus control practices.

What excites you about the evolving role of pharmacists in cardiovascular care?

Pharmacists possess skills highly relevant to a health workforce moving towards multidisciplinary collaboration. With the growing burden of disease and an ageing population placing our health system under strain, pharmacists are perfectly placed to provide clinical care to the community. We can support the rollout of national health initiatives and programs, and we also have the ability to reach people who are not currently engaging with the primary or tertiary health system. This makes pharmacists invaluable to any future public health initiative, especially for common conditions like CVD. 

Day in the life of Natalie Raffoul, Heart Foundation, Sydney,
New South Wales