Working with people to cut their risk


CORONARY PATIENTS and those at high risk of heart disease, and their families, are to be targeted in an innovative community programme developed by Croí, the west of Ireland cardiology foundation.

The campaign, which was endorsed in Galway yesterday by Minister for Community, Rural and Gaeltacht Affairs Éamon Ó Cuív, aims to nurture specific lifestyle changes in participants, with progress monitored by family doctors as part of a multidisciplinary approach.

Significantly, partners and families of coronary patients or those at high risk of it will be encouraged to sign up to the programme, known as “Croí MyAction”.

London-based Irish cardiologist Dr Susan Connolly, who has worked closely on the programme with Croí, says that risk tends to “cluster in families”, with smokers being attracted to smokers, and both partners sharing the same diet.

“Therefore, there’s no point in asking one adult to give up smoking if their partner continues,” she says.

Cardiovascular disease is the major cause of premature death in Europe and accounts for more than 36 per cent of all deaths in Ireland, she points out. Until now, only those who already had a cardiac event have been offered a structured community-based programme – Heartwatch – which is designed to offer secondary prevention to those with existing heart disease.

Croí MyAction intends to draw on the established European Society of Cardiology score system, working with general practitioners and other doctors in the west. This system identifies people with a risk greater than 5 per cent of dying from heart disease in the next 10 years.

The intensive risk reduction is “evidence-based”, Connolly says. She is joint author of a paper published in The Lancet medical journal in June 2008 on the success of “nurse-co-ordinated” multidisciplinary preventative cardiology programmes in a family setting.

The new programme is modelled on two existing initiatives – MyAction, which was developed at Imperial College London, and Euroaction, a preventative cardiology project run in eight European states. MyAction invites families to train with dedicated specialist teams, comprising a full-time nurse, dietitian, physiotherapist or physical activity specialist.

“People don’t tend to change unless they have specific support to make lifestyle adjustments,” Connolly says. The approach has been proven to empower individuals in their efforts to make sustainable behavioural and lifestyle changes which will save their lives.

Croí has worked with the Health Service Executive (HSE) West and with the British MyAction team based at Imperial College to develop the 16-week programme, which will be free of charge. Several hundred participants will have one-to-one appointments and will participate in group exercises and health promotion workshops.

At the end of the four months, participants will receive a summary of progress, which will also be sent to GPs.

Croí estimates that up to 450 people in the west will be involved in the first year. Participants will be invited through their GP practice, through the Croí Heart Smart programme and through hospital departments such as endocrinology, cardiology and vascular.

Referral will be based on risk factors such as family history, raised blood pressure, type 2 diabetes diagnosis, cholesterol levels, physical activity levels and smoking.

Connolly was sent to London to study preventative measures several years ago by the Department of Health, and developed Croí MyAction as a result of dialogue with Irene Gibson, a nurse with the cardiology foundation, at a conference in Athens, Greece. “I feel very privileged to be able to work with Croí to give something back,”she says.

Gibson, Croí MyAction programme co-ordinator, emphasises the cost effective approach of the programme to preventing disease.

Dr Jim Crowley, Croí MyAction clinical lead and consultant cardiologist at University Hospital Galway, says that lifestyle change and “other modifiable risk factors” make the “greatest impact on reducing cardiovascular risk”.