Cardiovascular Disease Prevention in Clinical Practice – The National Coordinator Dr Siobhan Jennings, Consultant in Public Health Medicine National Coordinator Irish Cardiac Society

Source: WHO-HFA-DB

Bennett K et al J Epi Community Health 2006

Ford, E. S. et al. J Am Coll Cardiol 2007;50: CHD TRENDS: US ( x age groups) Trends in Age-Specific Mortality Rates From Coronary Heart Disease

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

CVD Medication Use - GMS Scheme ( )

CVD Prevention Population approachPopulation approach Secondary preventionSecondary prevention High risk approachHigh risk approach –4JTF from ESC adopted by CVD Policy, 2010 –Record risk factors, Assess risk, consider intervention

ESC brief for National Co-ordinator FacilitateFacilitate ……….. endorsement, adaptation, and publication of guidelines Co-ordinateCo-ordinate ………. adaptation and dissemination of CVD Preventions tools Build national alliancesBuild national alliances (multidisciplinary, professional) Make contact with HealthMake contact with Health (and Local) Authorities promoting EHHC Act as direct contact personAct as direct 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 CVD Membership 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 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) 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 Smoking13.7%6% % Cholesterol to target45%71.6% % B/P to target55.1%75.2% Weight (Kg) Waist Circumference % Achieving Physical Activity Targets 8%61.4% Mediterranean Score47.7

Summary Ireland -Ireland - a significant decline in mortality from CVD but –We’re not there yet –We have challenges ahead Systematic approachSystematic approach needed to preventing CVD in those at high risk –ESC 4JTF guidelines –SCORE as validated tool –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)