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Preventing cardiovascular disease

Dr Ray Vella describes how a family-based approach is working for patients at his Kent practice.

I have always been interested in primary prevention of cardiovascular disease (CVD) but, until recently, found myself following the tried and tested route of prescribing statins, issuing diet sheets and telling patients to stop smoking.

This changed when I became involved in the pilot of MyAction which combines education, physical activity, dietary advice and smoking cessation at a local leisure centre, supervised by a nurse specialist.

One highly effective aspect of the scheme is that patients' partners are also asked to enrol and so receive good diet advice. This is significant, since not all patients with a high risk of CVD cook for themselves.

Referrals by email
Referring patients is straight forward. It is possible to email referrals to the initiative using NHSnet. MyAction then contacts the patient and their partner directly.

The GP receives regular updates on their progress, and a summary at the end of the programme. All the patients I referred were very positive about being able to access such a comprehensive programme in a local community setting.

The programme's success has not been measured in terms of a reduction in the number of heart attacks, strokes and death, but according to its impact on individuals. Results were encouraging with an average 2cm reduction in waist measurement and significant reductions in patients' BMI. More than two thirds achieve the BP target.

From a GP's perspective, MyAction is effective and I found I was able to offer it to all interested patients who were at risk of CVD.

Its funding (from NHS Bromley) has ended, but we hope our PBC cluster will pick it up in due course.

Now that the government has committed to vascular checks for all 40-74 year olds, GPs will increasingly be involved in prevention. A programme like MyAction offers a good way of dealing with patients at high risk of cardiovascular disease.

  • Dr Vella is GP in Beckenham, Kent
MyACTION

Funding By PCTs, usually those that recognise they have high risk areas for heart disease.

Cost per patient About £500 to £600.

Results so far We recorded a 2cm reduction in patients' waist measurement and significant reduction in their BMI. More than two thirds achieved their BP target and two thirds met the targets for physical activity. More than 90 per cent were satisfied with the programme.

Set up by Imperial College, London and charitable leisure trust Mytime - MyAction team lead is a professor of cardiovascular medicine.

Empirical basis Based on largest-ever European preventive cardiology project, EUROACTION, which spanned eight countries and 24 hospital and general practice centres, in a cluster randomised controlled trials.

Uptake As well as NHS Bromley, NHS Westminster and NHS East Berkshire use MyAction and a programme has been launched in Galway, Ireland.

Drug company input None although patients do receive pharmocotherapies for smoking, hypertension and hyperlipidemia.

 

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