1. Improving prevention Improve prevention: connect patients to lifestyle community networks, clinical pathways and new technology. Victor AWM Umans MD PhD FACC Medical Center Alkmaar the Netherlands

2. History of improving infarct outcomes Vulnerable pts need: healing environment knowledge H2H program e-advice easy access healthy lifestyle Critically ill pts need: Innovation

3. Structure of Health care in the Netherlands Country In Western Europe and 4 islands in the Caribean 17 million inhabitants, 0.2% the size of Russia 90 hospitals, 1200 cardiologists Healthcare Mandatory to purchase a baselevel of insurance Free to choose own insurer and to chance once a year Covers family doctor, hospitalisation, treatment costs 10% of the gross domestic product (€5000/inhabitant)

4. Cardiovascular health status in the Netherlands CVD mortality and morbidity:  147 per 100.000 among the lowest in Europe  appr: 730.000 CHD, 260.000 AF and 120.000 HF patients

5. Population changes over time

6. Who are vulnerable and at risk Population Determinants are: Jobless Low income Low education Handicapped 7 years shorter life expectancy compared to the high-educated persons

7. Why and how to prevent Why 28% of all Dutch deaths are cardiovascular driven Mainly Coronary Artery Disease, CVA and Heartfailure Lost years-to-live: 11 yrs for men, 9 years for women How PopulationGroups at riskHigh-risk individualsPatients

8. Universal and selective prevention Dutch government and municipalities Actions to create public communities National Prevention Compass  Promote health and prevent disease in the environment Healthy school and Young people with Healthy Weight  Campaign on healthy food and environment Alliance Netherlands Smoke-free  Create communities for people who stop smoking  Restaurants and public buildings 100% smoke-free  October is smoke alert month: www.STOPTOBER.nl PopulationGroups at riskHigh-risk individualsPatients

9. Indicated prevention Dutch Heart Association and Health Care Insurers Actions to create clinical pathways CardioVascular Risk Management  Guidelines and Standard Operation Forms for Risk Managment Chronic Care Model  Model to introduce yearly controls in high risk groups  Use of internet-accessible personal records PopulationGroups at riskHigh-risk individualsPatients

10. Care related prevention Personal digital record

11. Care related prevention Cardiologists and nurses Actions to create patient networks Hartvolgers.nl StopAFib.org Social media groups for education  Forum, blogs, you-tube, live chat PopulationGroups at riskHigh-risk individualsPatients

12. Care related prevention Cardiologists and nurses Hartvolgers.nl

13. Care related prevention Cardiologists and nurses Actions to create new technology networks Wearables  Horizons 2020 project Heart Rehabilitation by phone  TEXTme trial on lifestyle text messages JAMA 2015;314:1255 Smart Networks  Philips Motiva HeartFailure support @ home Smart Cooking  Rehabilitation programs with Weight Watchers  Cooking with Jamie Oliver and Philips HomeCooker PopulationGroups at riskHigh-risk individualsPatients

14. Care related prevention Cardiologists and nurses Wearables Horizons 2020 project Heart Rehabilitation @home TEXTme trial JAMA 2015: Text messages improved lifestyle adherence

15. Care related prevention Cardiologists and nurses Smart Networks Philips Motiva HeartFailure support @ home Use of IoT communication for Atrial Fibrillation

16. Care related prevention Cardiologists and nurses Smart Cooking Cooking with Jamie Oliver and his HomeCooker ‘the device has been developed by Jamie Oliver as part of his mission to get more of us to eat fresh home cooking on a regular basis’

17. Take home messages to create healthy populations It starts with early education Connect secondary prevention with primary prevention through the healthy living concept