Cardiovascular Disease Prevention in Clinical Practice –

The National Coordinator

Dr Siobhan Jennings, Dr Siobhan Jennings, Consultant in Public Health MedicineConsultant in Public Health Medicine

National Coordinator National Coordinator Irish Cardiac SocietyIrish Cardiac Society

Age Standardised Mortality Rates per 100,000 population, 0-64 years

0

20

40

60

80

100

120

140

160

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

Year

Ag

e S

tan

dar

dis

ed M

ort

alit

y R

ate Ireland - Diseases of the

circulatory system

EU15 - Diseases of the circulatorysystem

Ireland - Ischaemic heart disease

EU15 - Ischaemic heart disease

Ireland - Cerebrovasculardiseases

EU15 - Cerebrovascular diseases

Source: WHO-HFA-DB

-4000

-3000

-2000

-1000

0

37633763fewer deathsfewer deaths

Risk Factors worse +14%Risk Factors worse +14%

Risk Factors better Risk Factors better ––61%61%

Treatments Treatments -- 43.6%43.6%

2000200019851985

CHD mortality fall in Ireland 1985 CHD mortality fall in Ireland 1985 -- 2000 explained by 2000 explained by a) treatments in CHD patients & b) population risk factora) treatments in CHD patients & b) population risk factorss

Obesity (increase) + 4%Obesity (increase) + 4%Diabetes (increase) + 6%Diabetes (increase) + 6%Physical activity (less) + 4%Physical activity (less) + 4%

SmokingSmoking -- 25%25%Cholesterol Cholesterol -- 30%30%Population BP fall Population BP fall -- 6%6%

AMI treatments AMI treatments -- 4.4%4.4%Secondary prevention Secondary prevention -- 18%18%Heart failureHeart failure -- 9.1%9.1%Angina:CABG & PTCA Angina:CABG & PTCA -- 5%5%Angina: Aspirin Angina: Aspirin etcetc -- 3.4%3.4%Hypertension drugs Hypertension drugs ––1.61.6%%StatinsStatins 11’’ prevention prevention -- 1.2%1.2%Unstable angina - 1%

Bennett K et al J Epi Community Health 2006

Ford, E. S. et al. J Am Coll Cardiol 2007;50:2128-2132

CHD TRENDS: US ( x age groups)Trends in Age-Specific Mortality Rates From Coronary Heart Disease

SLÁN 2007 Hypertension Profile,SLÁN 2007 Hypertension Profile, n=1,207 age 45+ n=1,207 age 45+

CVD Medication Use - GMS Scheme CVD Medication Use - GMS Scheme (1998-2006)(1998-2006)

Prescribing frequency of CVD drugs in Ireland under the

GMS scheme 1998-2006

0

500

1000

1500

2000

2500

1998 1999 2000 2001 2002 2003 2004 2005 2006

1000

pre

scrip

tions

Aspirin (Anti-thromb) Diuretics BB ACE i CCB LLD

CVD PreventionCVD Prevention

• Population approachPopulation approach

• Secondary preventionSecondary prevention

• High risk approachHigh risk approach– 4JTF from ESC adopted by CVD Policy, 20104JTF from ESC adopted by CVD Policy, 2010– Record risk factors, Assess risk, consider Record risk factors, Assess risk, consider

intervention intervention

ESC brief for National Co-ordinator

• FacilitateFacilitate ……….. endorsement, adaptation, and publication of guidelines

• Co-ordinate Co-ordinate ……….adaptation and dissemination of CVD Preventions tools

• Build national alliancesBuild national alliances (multidisciplinary, professional)

• Make contact withMake contact with Health Health (and Local) Authorities promoting EHHC

• Act asAct as direct contact persondirect contact person with ESC Co-ordinator

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 CVDMembership

• Prof Ian Graham (Chair)• Dr Siobhan Jennings (National Coordinator, ROI)

• Dr Mahan Varma (National Coordinator, NI) • 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 MyActionA nurse led, multidisciplinary CVD

prevention programmeAn 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 Assessment

End of 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 -Ireland - a significant decline in mortality from CVD but– We’re not there yet We’re not there yet – We have challenges We have challenges

aheadahead

• Systematic approachSystematic approach needed to preventing

CVD in those at high risk – ESC 4JTF guidelinesESC 4JTF guidelines – SCORE as validated toolSCORE 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 rightto live until the age of at least 65 without suffering from

avoidable cardiovascular disease” (June 2007)