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 MortalityTRANSCRIPT
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CHD Prevention and Risk Asssessment:
Old concepts new context?
Dr Paul D MacIntyre
Director of Cardiology, RHH
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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
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Prevention of CHD:3 Silos
1. Low risk primary prevention2. High risk primary prevention3. Secondary prevention
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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
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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
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Population Risk
Mean Cholesterol Physical
activity
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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
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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
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Individual Approach
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Smoking
Stop starting and start stopping Young Programmes for low income Hospital Smoking cessation services
including NRT Primary care services
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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
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Barriers to Exercise
Master Tom MacIntyre
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Diet
Noddy’s guide– Cut the crap
Accessibility Cost Convenience
– Reduce portion size– Eat fruit and vegetables
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Hospital Fruit Shop ?
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High risk primary prevention Anticipatory care Case finding High risk registers
– Structured – Opportunistic– Outreach
Social deprivation Risk assessment Risk factor modification
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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
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Flower of Scotland
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Magnificent All Blacks
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Predict
Prof Rod Jackson Predict Absolute risk Unique identifier 90 % penetration in primary care
– >400,000 IT issues resolved Outcome data
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Hope for Australia ?
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Australian absolute cardiovascular disease risk calculator
http://www.cvdcheck.org.au/
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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
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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