Why do we need a prevention approach in cardiovascular disease (CVD), and how is it different from ordinary care? Ask any of the 85 million people in Europe who are living with CVD, who often struggle to get the care and support they need to avoid further acute events and admissions.
Last year, we were invited to work with leading Irish stakeholders to help them develop a new vision for a national cardiovascular plan. Inspired by this project, I have been reflecting on the value of prevention in cardiovascular health and how this mindset must be brought across the whole patient journey, not only in Ireland but across Europe.
The urgent need for a new approach to cardiovascular care
Governments have traditionally allocated most healthcare spend to the short-term management of acute events, such as heart attacks and strokes, with hospitals providing much of the care. Yet as noted by the Irish Health Service Executive, this approach is ‘neither patient-centred nor sustainable’, a verdict that is relevant to most other high-income countries as well. In fact, across OECD countries, less than 3% of healthcare spending is allocated to preventive services and programmes. Considering that many more people than before are surviving a heart attack or stroke, and that 25–30% of strokes occur in people who have had a previous stroke, such level of underinvestment has a tangible impact on our budgets and societies.
To an extent, Western governments understand the need to prevent non-communicable diseases. Many have launched national public health programmes with a range of measures to support healthy living, such as reducing intake of fat, salt and sugar, further reducing smoking and helping people exercise and lose weight. Yet as fundamental as these behavioural and environmental drivers are, we must be honest about the likelihood of public health measures alone being successful in dealing with these giants and their consequences.