Chd prevention and risk asssessment old concepts new context
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CHD Prevention and Risk Asssessment : Old concepts new context?. Dr Paul D MacIntyre Director of Cardiology, RHH. Why Prevent CHD ?. P remature Mortality <65yrs of age Avoid chronic disease Quality of life Economic costs Delay or prevent We all die ! CVD v Cancer.

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CHD Prevention and Risk Asssessment : Old concepts new context?

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Chd prevention and risk asssessment old concepts new context

CHD Prevention and Risk Asssessment:Old concepts new context?

Dr Paul D MacIntyre

Director of Cardiology, RHH


Why prevent chd

Why Prevent CHD ?

  • Premature Mortality <65yrs of age

    • Avoid chronic disease

      • Quality of life

      • Economic costs

    • Delay or prevent

    • We all die !

      • CVD v Cancer


Prevention of chd 3 silos

Prevention of CHD:3 Silos

  • Low risk primary prevention

  • High risk primary prevention

  • Secondary prevention


Risk factors for cvd

Risk Factors for CVD

  • Modifiable

    • Smoking

    • Physical Activity

    • Obesity

  • Medical Conditions

    • Hypertension

    • Diabetes

    • Hyperlipidemia

    • Chronic Kidney Disease

  • Non Modifiable

    • Age

    • Sex

    • Family History

    • Socio economic status

      • Ethnicity

      • Relative poverty

      • Lack of hope


Low risk primary prevention

Low Risk Primary Prevention

  • General population at low risk of CHD

  • Public Health measures to improve lifestyle

    • Smoking

    • Diet

    • Exercise

  • Prioritise children

    • Childhood Obesity

  • Needs both population and individual approach


Population risk

Population Risk

Physical activity

Cholesterol

Mean


Population risk1

Population risk

  • Public Health policy

  • Partnership working

    • Health Services

    • Central government

    • Local authorities

    • Primary care

    • Voluntary sector

  • Create environmental change

    • Smoking ban in public places

    • Plain packaging of cigarettes

    • Healthy eating

    • Environmental change to facilitate physical activity

  • Social Determinants of Health


Public health measures healthy eating

Public Health measuresHealthy Eating

  • Food labelling

  • Restrictions

    • Ban Junk food from public sector

  • Engage with the food industry

    • Junk Tax

    • Fat Tax

  • Fruit shops in public sector buildings


Individual approach

Individual Approach


Smoking

Smoking

  • Stop starting and start stopping

  • Young

  • Programmes for low income

  • Hospital Smoking cessation services including NRT

  • Primary care services


Physical activity

Physical Activity

  • Inactivity doubles risk of CVD

  • Physical activity for Health

    • Adults accumulate 30 mins of moderate intensity exercise most days of week

    • Children 60 mins

  • Physical activity for fitness

    • 3 x 20 mins of vigorous intensity exercise per week

  • ? Intensity Level required for CVD protection


Barriers to exercise

Barriers to Exercise

Master Tom MacIntyre


Chd prevention and risk asssessment old concepts new context

Diet

  • Noddy’s guide

    • Cut the crap

      • Accessibility

      • Cost

      • Convenience

    • Reduce portion size

    • Eat fruit and vegetables


Hospital fruit shop

Hospital Fruit Shop ?


High risk primary prevention

High risk primary prevention

  • Anticipatory care

  • Case finding

  • High risk registers

    • Structured

    • Opportunistic

    • Outreach

  • Social deprivation

  • Risk assessment

  • Risk factor modification


High risk primary prevention1

High risk primary prevention

  • ?Already have the disease

  • JBS2 guidelines

    • ≥ 20% 10yr risk of CVD on Framingham score

    • Health inequalities

      • ASSIGN risk calculator for Scotland

      • Prof Tunstal-Pedoe

      • Social Deprivation and Family History

      • SIGN 97

      • Health behaviour change

      • Statin and aspirin prescription


Flower of scotland

Flower of Scotland


Magnificent all blacks

Magnificent All Blacks


Predict

Predict

  • Prof Rod Jackson

  • Predict

  • Absolute risk

  • Unique identifier

  • 90 % penetration in primary care

    • >400,000

  • IT issues resolved

  • Outcome data


Hope for australia

Hope for Australia ?


Australian absolute cardiovascular disease risk calculator

Australian absolute cardiovascular disease risk calculator

  • http://www.cvdcheck.org.au/


Secondary prevention

Secondary prevention

  • Step change

    • Menu based Cardiac Rehabilitation

    • Multidisciplinary team

    • Components

      • Education

      • Medical risk factor modification

      • Optimise pharmacological treatment

      • Health Behaviour Change interventions

        • Smoking

        • Diet

        • Exercise

        • Stress, anxiety and depression

    • Does it work?

    • Chronic disease management


Secondary prevention1

Secondary prevention

  • Chronic Stable CHD

    • Primary care setting

    • Medical risk factor modification

    • Optimise treatment

    • Chronic disease management programmes

    • Health behaviour change

      • Smoking cessation services

      • Diet

      • Exercise referral

      • Health coach model


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