Preventing heart break

The doctor of the future will give no medicine, but will interest his patients in the care of the human body, in diet, and in the cause and prevention of disease. – Thomas Edison, 1905

This is one of Jenni Jones’s favourite quotes. As the newly appointed director of prevention programmes, training and education with Croí, the West of Ireland Cardiology Foundation and honorary senior lecturer at NUI Galway, it is hardly surprising that she identifies with Edison’s words.

One of her aims in moving from Imperial College London, one of the leading cardiac prevention centres in Europe, to Galway is to help Croí set up a national Cardiovascular Health and Disease Prevention Institute. “I would like to see evidence-based models [for cardiac prevention] being rolled out across other areas of the country,” she says.

Jones started her professional life as a physiotherapist and early on in her career moved into the area of cardiac rehabilitation. She subsequently developed the Master’s programme in preventive cardiology at Imperial, something she hopes to replicate at NUIG with a diploma and master’s programme there.

So what are the biggest changes she has seen in cardiovascular disease prevention?

“In recent years there has been a stronger emphasis on the ‘science’ of prevention, for example scientifically investigating the mechanisms that underpin prevention strategies such as physical activity and nutrition.

“There is a growing recognition that prevention is a continuum and one’s absolute risk of disease is multifactorial.”

Rather than provide care in isolated “silos”, she says: “I have seen and learnt first-hand that integrated service models providing a comprehensive vascular health programme to all these individuals in one common programme works.”

Croí MyAction is an evidence-based measurable programme in cardiovascular health and disease prevention for those identified as being at high risk of cardiovascular disease. It aims to reduce each individual’s future risk of diabetes, heart attack and stroke.

Jones says that it has proved to be highly successful, with people entering the programme seeing dramatic improvements in their cardiovascular health.

“Measurable successes include a 50 per cent reduction in smoking and almost twice as many participants at blood pressure and cholesterol targets by the end of the 16-week programme as well as one year later. Waist circumference reduces significantly, on average by 5cms, which translates to health outcomes in the range of a 20 per cent reduction in cardiovascular risk.”

She is keen to bring out the message that small changes in lifestyle are powerful and are backed by scientific evidence. And she recognises the need to tailor the advice given by health professionals to a person’s individual circumstances.

What about those who might say the country is broke and that we will be lucky if we can keep acute services going, let alone invest in prevention?

“There has been a longstanding under-investment in prevention,” Jones says. “Failure to invest in prevention is only digging a deeper hole for the acute services. Interventions are rapidly developing and people are living longer.

“The effectiveness of costly interventions longer term is being confounded by people’s underlying state of risk factors or disease state.

“When hypertension, diabetes and coronary status are well controlled then the outcomes of these cardiological wizardries seem so much more effective.

“Ireland’s economic future demands we find ways to reduce healthcare costs. Preventing people from getting sick is one of the most important ways we can drive costs down,” is her emphatic response.