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Preventing cardiovascular disease

• 90% of the 17m heart related deaths each year are preventable

• Not preventing heart disease will cost US$47 trillion over the next 20 years

• Contrasting Indian and English preventative strategies are described

• Devi Shetty, world renowned heart surgeon describes heart disease

• Technology shifts the management of heart disease to communities and homes

Each year cardiovascular disease (CVD) accounts for more than 17 million deaths worldwide. Despite the fact that 90% are preventable, deaths from CVD are projected to grow to some 24 million by 2030. In addition to the human costs, the economic costs for not preventing CVD are estimated to be US$47 trillion over the next 20 years.

CVD is often asymptomatic, caused by atherosclerosis, and represents a family of conditions linked by common risk factors, and includes coronary heart disease, stroke, hypertension, hypercholesterolemia, diabetes, chronic kidney disease, peripheral arterial disease and vascular dementia. Many people who have one CVD condition commonly suffer from other related conditions. Devi Shetty, world-renowned heart surgeon, founder and chairman of Narayana Health, India, describes heart disease:

         
 

Two prevention strategies

As CVD prevention strategies evolve, we describe two; both developed by cardiologists:
 

Billion Hearts Beating

Billion Hearts Beating is an open, and easy-to-use website launched in 2010 by Dr Prathap Reddy, and Indian entrepreneur and cardiologist who founded the Apollo Group; the first corporate chain of hospitals in India: http://billionheartsbeating.com/. Reddy is mindful that there are some 65 million people in India with CVD, but each year only about 100,000 of these receive specialist treatment. Unsurprisingly, 2.4 million people die each year in India from CVD. The Billion Hearts Beating website identifies five simple solutions for lowering the risk of CVD: (i) a healthy diet, (ii) cessation of smoking, (iii) increased physical activity, (iv) reduced stress, and (v) regular heart checks. The website invites visitors to regularly check their heart disease risk with its easy-to-use embedded risk calculators, and sign a pledge to follow recommended solutions to reduce their overall CVD risk.
 

JBS3 Risk Calculator

The Joint British Societies Risk Calculator, the JBS3, was launched in 2014 after a long iteration between experts from 11 British cardiovascular societies chaired by Professor John Deanfield, the British Heart Foundation Vandervell Professor of Cardiology at the University of London. The Calculator embodies the UK’s national guidelines for CVD prevention. Although available as an app, it’s recommended for doctors rather than patients because it requires data that are not readily available. The JBS3 is managed by the British Cardiovascular Society, supported by the British Heart Foundation, and allows doctors to assess and communicate a person’s true heart age, and lifetime risks of CVD. These communications are expected to motivate individuals to adopt healthier diets and lifestyles, which would lower their risk of CVD: http://www.jbs3risk.com/

According to Shetty such risk calculators are symptomatic of rapidly growing technologies that are shifting the management of CVD away from hospitals, and into communities and peoples’ homes:

    
 

Cycle of care

The cycle of care for CVD includes, (i) prevention and control of risk factors, which need sustained and effective communications, (ii) surgical and medical interventions, which require screening and early interventions, and (iii) the maintenance of a healthy state, which requires effective communications for disease management, and the modification of diets and lifestyles. The communications of all three care-strategies are underserved because overwhelmingly doctors operate “hands-on” care to diagnose and treat symptoms, and are reluctant to embrace modern technologies to improve doctor-patient communications. Shetty explains:

   
 

Takeaways

Preventing CVD involves changing peoples’ behavior, which requires effective communications between health providers and the general public. Developing risk calculators is no guarantee of preventing CVD, but it’s a significant contribution to preventative strategies. It’s too early to assess the effectiveness of the JBS3 Risk Calculator, but it appears to have underestimated the challenge associated with getting overstretched and demoralised UK primary healthcare professionals to adopt it. The Billion Hearts Beating campaign fares better, not least because it engages individuals directly. To-date, over 355,000 visitors to the website have used its embedded risk calculators, and pledged to improve their diets and lifestyles in order to reduce their risk of CVD.