‘Heart Smart’ Mayo

A Report on a Cardiovascular DiseasePrevention Programme in Co. Mayo

Main Findings and Outcomes

Croí, the West of Ireland Cardiac Foundation is a registered Irish charitydedicated to the fight against heart disease and stroke in the West of Ireland.

The aim of the Foundation is to reduce the impact of cardiovascular disease onfamilies by promoting and supporting initiatives in prevention, lifestyle change

and enhanced cardiac care. Croí plays a role in virtually all areas of cardiaccare, both in hospital and in the community, with the prevention of heart

disease and stroke being foremost among its objectives.

The Croí 'Heart Smart' Programme was developed in response to the clear needfor a community based high-risk, early intervention programme. 'Heart Smart'

Mayo is a collaboration between Croí and Mayo Primary Community &Continuing Care (PCCC) and to date the project has been supported by HSE

Innovation Funding.

This report has been compiled by:Ms. Ailish Houlihan BNS, MA (Health Promotion)

Croí 'Heart Smart' Co-ordinator

A Croí Publication.

© Croí 2011.

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Background

Cardiovascular Disease (CVD) is the single largest cause of death for both menand women in Ireland, accounting for 35% of all deaths (Central Statistics Office,2010). Fortunately, in Ireland as in other European countries, there have beensubstantial declines in mortality rates from cardiovascular disease (Departmentof Health and Children, 2010). However, despite the decline in recent years,death rates from cardiovascular disease remain high.

In 2009, Croí in collaboration with Mayo Primary Community and ContinuingCare launched a community based Cardiovascular Disease PreventionProgramme for Co. Mayo called ‘Heart Smart’ Mayo.

What is Cardiovascular Disease and what are the main risk factors?

Cardiovascular disease refers to diseases of the heart and the circulatorysystem. There are three main manifestations of heart disease: angina, heartattack (myocardial infarction) and sudden cardiac death. Circulatory diseasesinclude peripheral vascular disease and stroke.

The principal risk factors for cardiovascular disease include raised bloodpressure, raised cholesterol and smoking in addition to physical inactivity andobesity. The evidence for cardiovascular disease prevention is compelling withrecommendations for lifestyle management – to stop smoking, make healthyfood choices and become physically active – at the forefront.

Objectives of ‘Heart Smart’ Mayo

• Identify and target those most at risk of developing heart disease

• Offer lifestyle (e.g. healthy eating) and risk factor management(e.g. cholesterol lowering) advice

• Support and empower individuals to take control over their healthemploying the skills of motivational interviewing

• Refer those who are at high-risk to their GP and invite them for reviewof their risk factors at the 6-month ‘Heart Smart’ follow-up.

A Report on a Cardiovascular DiseasePrevention Programme in Co. Mayo

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What is ‘Heart Smart?’

The ‘Heart Smart’ Programme is a nurse-led community based screeningprogramme which is offered free of charge and provides a 25-minuteassessment of the following:

✓ Cholesterol and Glucose

✓ Blood Pressure

✓ BMI (Body Mass Index) and Waist Circumference

✓ Physical Activity levels

✓ Diet

Results

1541 individuals were assessed by the ‘Heart Smart’ Mayo Programme during2009. These individuals were from various communities across Co. Mayoincluding farming, health care, Traveller community, and the general public.Table 1 outlines the gender and GMS status of the population.

Table 1: Gender and GMS (General Medical Scheme) Status

Gender Male 44% (n=678)

Female 56% (n=863)

GMS Yes 47% (n=720)

No 53% (n= 821)

Risk Factor Profile

The prevalence of risk factors was high among this population.

Total Cholesterol >5mmol/l 47%

LDL Cholesterol >3mmol/l 40%

Systolic Blood Pressure >140mmHg 38%

Diastolic Blood Pressure >90mmHg 16%

Physical Inactivity 33%

BMI>25Kg/ m2 79%

Smoking 18%

Referral to GP

In total, 64% of the population were referred to General Practice.7% of individuals were advised to attend within 24-48hrs.

Cardiovascular Risk of the Population

The SCORE (Systematic Coronary Risk Evaluation) system was used as a tool toestimate an individual’s risk of having a fatal cardiovascular event such as aheart attack or stroke within a 10-year period.

• 21% of the population were at high-risk (>5%)

• 49% of the population had a CVD risk SCORE of between 1-4%

Results at 6 month Follow-Up

A total of 948 individuals were invited to attend for a re-assessment of theirrisk factors, with 748 attending, resulting in a response rate of 79%.

Many individuals reached European target levels for Cholesterol and BloodPressure at the 6-month follow-up visit (see Figure 1). Furthermore, 65% ofindividuals made changes to their diet and 33% reported improvements toboth the duration and intensity of the exercise they were taking followingtheir attendance at the ‘Heart Smart’ Mayo Programme. Ten individuals (8%)quit smoking during the 6-month period.

Figure 1: Achieving European targets for Cholesterol and Blood Pressure

15%

12%

28%

23%

0%

5%

10%

15%

20%

25%

30%

Total LDL Systolic Diastolic

Cholesterol Blood Pressure

%

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A Report on a Cardiovascular DiseasePrevention Programme in Co. Mayo

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Medication Treatment

Cholesterol medication prescribed 5%

Blood Pressure medication prescribed 12%

Diabetic medication prescribed 9%

One individual had their cholesterol medication dose increased and tenindividuals had their blood pressure medication dose increased. In addition,one individual had their diabetic medication dose increased.

Impact of the Programme

The ‘Heart Smart’ Mayo Programme was very well received by the public.The programme was deemed convenient and accessible especially when madeavailable in a place of work. Its informal approach of being delivered in localvenues such as libraries and community centres encouraged individuals toattend, and for many it was the first time they had a cholesterol check.

‘would never have bothered to have cholesterol checked only for thisservice coming along - great service’

‘Heart Smart’ Mayo highlighted the importance of having risk factors such ascholesterol and blood pressure checked. In many cases individuals wereshocked to find out they had raised cholesterol or blood pressure in theabsence of symptoms.

‘great service - gave me the shock I needed'

'being given a prescription at GP visit was a scare'

‘used to going to GP when sick - not so much for prevention'

‘wake up call - keeps it in the mind'

‘having this check encouraged me to go to GP to get my cholesterol down'

‘really grateful to Heart Smart for discovering diabetes’

‘had been unaware of raised blood pressure’

The link between risk factor management and making lifestyle changes wasthe key element of the programme.

‘made me aware that changes in diet could helpwith blood pressure and cholesterol’

‘the explanation of the HDL and LDL was beneficial'

‘beneficial having card with all results’

For many who attended ‘Heart Smart’ Mayo, the overall success of theProgramme was attributed to the 6-month follow up. The follow-up visit wasviewed as a reminder and a motivator to make lifestyle changes;encouragement when changes had made a difference e.g. weight orcholesterol reduction, and a fresh start for those whose risk factors may haveincreased since the first visit.

'the revisit is important for motivation'

‘revisit part of programme was the big benefit'

‘impressed with call back’

Each person received a reminder call or text prior to their revisit appointment.This was emphasised by many individuals as being responsible for theirattendance at this appointment.

Conclusion

The prevention of cardiovascular disease remains a challenge for health careprofessionals. The ‘Heart Smart’ Mayo Programme successfully identified thosemost at risk in the community, encouraged high-risk individuals to attend theirGP and made significant reductions to their risk factor profile.

The findings from the ‘Heart Smart’ Mayo Programme have illustrated thebenefits of implementing a community-based Cardiovascular PreventionProgramme.

However, many challenges remain if we are to reduce the incidence of heartdisease and stroke in the community. In order to reduce the mortality andmorbidity in high-risk individuals in Co. Mayo, it is necessary to implement amore comprehensive lifestyle programme. This programme would provide anopportunity to address lifestyle behavours e.g. healthy eating and risk factormanagement, e.g. blood pressure reduction, over a longer period of time, inorder to achieve the lifestyle, risk factor and therapeutic targets forcardiovascular disease prevention.

References

Central Statistics Office (2010) Report on Vital Statistics 2007. Dublin:The Stationary Office.

Department of Health and Children (2010) Changing Cardiovascular HealthNational Cardiovascular Health Policy 2010 – 2019. Dublin: GovernmentPublications.

Cover photograph courtesy of Liam Lyons Photography.

For more landscape images of the West and South West of Ireland visit: www.liamlyons.com

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A Report on a Cardiovascular DiseasePrevention Programme in Co. Mayo