Preventive

Cardiology
Preventive Cardiology
 Estimated Compliance with
Secondary Prevention Measures
(Pearson et al. 1996)

Referral to cardiac rehabilitation <5%

Smoking cessation counseling 20%
Lipid-lowering drug therapy 25%
Beta-blocker therapy 40%
ACE inhibitor therapy 60%
Aspirin 70%
 EUROASPIRE 111:
The Nurses Role in Secondary Prevention
 EUROASPIRE 111
European Action on Secondary and
Primary Prevention through
Intervention to Reduce Events
EUROASPIRE 1: 1995-1996- 9 countries

EUROASPIRE 11: 1999-2000- 15 countries

EUROASPIRE 111: 2006-2007- 22 countries

Results
No change in prevalence of smoking and
continuing adverse trends in prevalence of
obesity and central obesity

No change in blood pressure control despite

increased use of anti-hypertensive
medications (61% above therapeutic target)

Continuing improvement in lipid control

with increased use of statins
Results
Increasing prevalence of diabetes, both self
reported and undetected, and deteriorating
therapeutic control
Increased use of anti-platelets, beta-
blockers, ACE/ARBs, statins and diuretics
with a lower use of CCBs.
Only 31% of coronary patients accessed
cardiovascular prevention and rehabilitation
programmes in the EUROASPIRE III survey
 BARRIERS TO SECONDAY
PREVENTION ROLE
Behavioural modification are not part of nursing
curricula
43% nurses reported not knowing how to counsel
patients, 27% not rewarding, 8% too time consuming,
14% no formal training in counselling (Goldstein 1987;
Lindsay 1995; Wollard et al 2003
Nurses believe that if they do advice a patient to stop
smoking the likelihood of them stopping is not very
high (Kviz et al 1987, Prev Med)
Journal Impact Factor
2007
In the short-term future, until approximately 2020, the balance
of these two influences will favor intervention and the number of
procedures will continue to expand.

Beyond 2020, interventions are certain to continue to become

more useful, and they will continue to become simpler, more
effective, and less expensive.

However, the application of genetics and genomics to

cardiovascular disease will tip the balance and the need for
intervention will decline, at first gradually, then rapidly.
The evidence for heritability of myocardial infarction (MI) is striking,
with a positive family history being one of the most important risk
factors for this complex trait.

If most individuals who carry MI susceptible genes can be

recognized at an early age, prevention, lifestyle factors, and
personalized drug approaches could be implemented to markedly
reduce the toll of MI in the future.
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