Improving prevention

Improve prevention: connect patients to lifestyle community networks, clinical pathways and new technology.

Victor AWM Umans MD PhD FACC

Medical Center Alkmaarthe Netherlands

History of improving infarct outcomes

Vulnerable pts need:

healing environmentknowledgeH2H program

e-adviceeasy access

healthy lifestyle

Critically ill pts need:

Innovation

Structure of Health care in the Netherlands

Country In Western Europe and 4 islands in the Caribean 17 million inhabitants, 0.2% the size of Russia 90 hospitals, 1200 cardiologists

Healthcare Mandatory to purchase a baselevel of insurance Free to choose own insurer and to chance once a year Covers family doctor, hospitalisation, treatment costs 10% of the gross domestic product (€5000/inhabitant)

Cardiovascular health status in the Netherlands

CVD mortality and morbidity: 147 per 100.000 among the lowest in Europe appr: 730.000 CHD, 260.000 AF and 120.000 HF patients

Population changes over time

Who are vulnerable and at risk

Population Determinants are:

Jobless

Low income

Low education

Handicapped

7 years shorter life expectancy compared to the high-educated persons

Why and how to prevent

Why 28% of all Dutch deaths are cardiovascular driven Mainly Coronary Artery Disease, CVA and Heartfailure Lost years-to-live: 11 yrs for men, 9 years for women

How

Population Groups at risk High-risk individuals Patients

Universal and selective prevention

Dutch government and municipalities

Actions to create public communities

National Prevention Compass Promote health and prevent disease in the environment

Healthy school and Young people with Healthy Weight Campaign on healthy food and environment

Alliance Netherlands Smoke-free Create communities for people who stop smoking Restaurants and public buildings 100% smoke-free October is smoke alert month: www.STOPTOBER.nl

Population Groups at risk High-risk individuals Patients

Indicated prevention

Dutch Heart Association and Health Care Insurers

Actions to create clinical pathways

CardioVascular Risk Management Guidelines and Standard Operation Forms for Risk Managment

Chronic Care Model Model to introduce yearly controls in high risk groups Use of internet-accessible personal records

Population Groups at risk High-risk individuals Patients

Care related prevention

Personal digital record

Care related prevention

Cardiologists and nurses

Actions to create patient networks

Hartvolgers.nl

StopAFib.org

Social media groups for education Forum, blogs, you-tube, live chat

Population Groups at risk High-risk individuals Patients

Care related prevention

Cardiologists and nurses

Hartvolgers.nl

Care related prevention

Cardiologists and nurses

Actions to create new technology networks

Wearables Horizons 2020 project Heart Rehabilitation by phone TEXTme trial on lifestyle text messages JAMA 2015;314:1255

Smart Networks Philips Motiva HeartFailure support @ home

Smart Cooking Rehabilitation programs with Weight Watchers Cooking with Jamie Oliver and Philips HomeCooker

Population Groups at risk High-risk individuals Patients

Care related prevention

Cardiologists and nurses

WearablesHorizons 2020 project Heart Rehabilitation

@home

TEXTme trial JAMA 2015:Text messages improved lifestyle adherence

Care related prevention

Cardiologists and nurses

Smart Networks

Philips Motiva HeartFailure support @ home

Use of IoT communication for Atrial Fibrillation

Care related prevention

Cardiologists and nurses

Smart Cooking

Cooking with Jamie Oliver and his HomeCooker

‘the device has been developed byJamie Oliver as part of his mission to get more of us to eat fresh home cooking on a regular basis’

Take home messages

to create healthy populations

It starts with early education

Connect secondary prevention with primary prevention through the healthy living concept