Transcript Slide 1

Cardiovascular Disease
Prevention in Clinical Practice –
The National Coordinator
Dr Siobhan Jennings,
Consultant in Public Health Medicine
National Coordinator
Irish Cardiac Society
Age Standardised Mortality Rates per 100,000
population, 0-64 years
Age Standardised Mortality Rate
160
140
Ireland - Diseases of the
circulatory system
120
EU15 - Diseases of the circulatory
system
100
Ireland - Ischaemic heart disease
80
EU15 - Ischaemic heart disease
60
Ireland - Cerebrovascular
diseases
40
EU15 - Cerebrovascular diseases
20
19
80
19
82
19
84
19
86
19
88
19
90
19
92
19
94
19
96
19
98
20
00
20
02
20
04
20
06
0
Year
Source: WHO-HFA-DB
CHD mortality fall in Ireland 1985 - 2000 explained by
a) treatments in CHD patients & b) population risk factors
Bennett K et al J Epi Community Health 2006 Risk
Factors worse +14%
Obesity (increase)
+ 4%
Diabetes (increase)
+ 6%
Physical activity (less) + 4%
0
Risk Factors better –61%
-1000
Smoking
-25%
Cholesterol
-30%
Population BP fall - 6%
-2000
-3000
-4000
3763
fewer deaths
1985
Treatments -43.6%
2000
AMI treatments
Secondary prevention
Heart failure
Angina:CABG & PTCA
Angina: Aspirin etc
Hypertension drugs
Statins 1’ prevention
Unstable angina
-4.4%
-18%
-9.1%
-5%
-3.4%
–1.6%
-1.2%
-1%
CHD TRENDS: US ( x age groups)
Trends in Age-Specific Mortality Rates From Coronary Heart Disease
Ford, E. S. et al. J Am Coll Cardiol 2007;50:2128-2132
SLÁN 2007 Hypertension Profile,
n=1,207 age 45+
CVD Medication Use - GMS Scheme
(1998-2006)
1000 prescriptions
Prescribing frequency of CVD drugs in Ireland under the
GMS scheme 1998-2006
2500
2000
1500
1000
500
0
1998
1999
2000
Aspirin (Anti-thromb)
2001
2002
Diuretics
BB
2003
2004
ACE i
2005
CCB
2006
LLD
CVD Prevention
• Population approach
• Secondary prevention
• High risk approach
– 4JTF from ESC adopted by CVD Policy, 2010
– Record risk factors, Assess risk, consider
intervention
ESC brief for National Co-ordinator
• Facilitate ……….. endorsement, adaptation,
and publication of guidelines
• Co-ordinate ……….adaptation and
dissemination of CVD Preventions tools
• Build national alliances (multidisciplinary,
professional)
• Make contact with Health (and Local)
Authorities promoting EHHC
• Act as direct contact person with ESC Coordinator
National Coordinator – my approach
• Asked by Irish Cardiac Society
• Discussions with IHF (and within HSE)
– Review of Councils
- Council on
Prevention
– Resource
- Project manager (B. Caffrey –
Armstrong)
– Multidisciplinary Consensus Conference
(today)
– Meeting with Dr Joe Clarke, HSE Primary
Care Clinical programme
IHF Council on Prevention of CVD
Membership
• Prof Ian Graham (Chair)
• Dr Siobhan Jennings (National Coordinator, ROI)
• Dr Mahan Varma (National Coordinator, NI)
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•
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•
•
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Prof H Mc Gee
Dr Joseph Harbison
Dr Angie Brown
Dr John Cox
Dr Pat Doorley
Prof Eoin O Brien
Dr John Devlin
Mr Michael O Shea
Ms Bridget Caffrey- Armstrong (Project Manager)
National Coordinator – my approach
• Asked by Irish Cardiac Society
• Discussions with IHF (and within HSE)
– Review of Councils
- Council on
Prevention
– Resource
- Project manager (B. Caffrey –
Armstrong)
– Multidisciplinary Consensus Conference
(today)
– Meeting with Dr Joe Clarke, HSE Primary
Care Clinical programme
National Coordinator – my approach
• Baseline survey in GP with ICGP planned
• Relationship with
• Clinical programmes in HSE (HF, ACS,
Stroke and Primary Care)
• Health Promotion in HSE
• DOH&C
–National Clinical Effectiveness
Committee to mandate national
guidelines
• Organisations who have taken action
-
CROI MyAction programme
Croi MyAction
A nurse led, multidisciplinary CVD prevention
programme
An initiative by Croi in collaboration with HSE West PCCC
and Imperial College London
• Based on the ESC 4JTF and SCORE
• Modelled on EuroAction study (Lancet 2008)
• 12-16 week intensive lifestyle programme with baseline,
end of programme and 1 year follow-up
• Co-ordinated by 2 Nurses, Dietitian, Physiotherapist and
Medical sessional support
• Family based – enrol patient and partner
Outcomes
Based on first 120 patients
Initial
End of
Assessment Programme
Smoking
13.7%
6%
% Cholesterol to target
45%
71.6%
% B/P to target
55.1%
75.2%
Weight (Kg)
92.3
88.6
Waist Circumference
109.4
104.5
% Achieving Physical Activity
Targets
8%
61.4%
Mediterranean Score
4
7.7
Summary
• Ireland -
a significant decline in mortality from CVD
but
– We’re not there yet
– We have challenges
ahead
• Systematic approach
needed to preventing
CVD in those at high risk
– ESC 4JTF guidelines
– SCORE as validated tool appropriate to European
population
Philosophy - REDUCING THE INCIDENCE OF CVD:
The European Heart Health Charter
“Every child born in the new millenium has the right
to live until the age of at least 65 without suffering from
avoidable cardiovascular disease” (June 2007)