‘Heart Smart’ Mayo
A Report on a Cardiovascular Disease
Prevention Programme in Co. Mayo
Main Findings and Outcomes
Croí, the West of Ireland Cardiac Foundation is a registered Irish charity
dedicated 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 on
families by promoting and supporting initiatives in prevention, lifestyle change
and enhanced cardiac care. Croí plays a role in virtually all areas of cardiac
care, 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 need
for 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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A Report on a Cardiovascular Disease
Prevention Programme in Co. Mayo
Background
Cardiovascular Disease (CVD) is the single largest cause of death for both men
and women in Ireland, accounting for 35% of all deaths (Central Statistics Office,
2010). Fortunately, in Ireland as in other European countries, there have been
substantial declines in mortality rates from cardiovascular disease (Department
of 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 Continuing
Care launched a community based Cardiovascular Disease Prevention
Programme 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 circulatory
system. There are three main manifestations of heart disease: angina, heart
attack (myocardial infarction) and sudden cardiac death. Circulatory diseases
include peripheral vascular disease and stroke.
The principal risk factors for cardiovascular disease include raised blood
pressure, raised cholesterol and smoking in addition to physical inactivity and
obesity. The evidence for cardiovascular disease prevention is compelling with
recommendations for lifestyle management – to stop smoking, make healthy
food 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 health
employing the skills of motivational interviewing
Refer those who are at high-risk to their GP and invite them for review
of their risk factors at the 6-month ‘Heart Smart’ follow-up.
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What is ‘Heart Smart?’
The ‘Heart Smart’ Programme is a nurse-led community based screening
programme which is offered free of charge and provides a 25-minute
assessment 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 during
2009. These individuals were from various communities across Co. Mayo
including 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
GMS
Male
44% (n=678)
Female
56% (n=863)
Yes
47% (n=720)
No
53% (n= 821)
Risk Factor Profile
The prevalence of risk factors was high among this population.
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Total Cholesterol >5mmol/l
47%
LDL Cholesterol >3mmol/l
40%
Systolic Blood Pressure >140mmHg
38%
Diastolic Blood Pressure >90mmHg
16%
Physical Inactivity
BMI>25Kg/ m2
33%
Smoking
18%
79%
A Report on a Cardiovascular Disease
Prevention Programme in Co. Mayo
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 to
estimate an individual’s risk of having a fatal cardiovascular event such as a
heart 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 their
risk factors, with 748 attending, resulting in a response rate of 79%.
Many individuals reached European target levels for Cholesterol and Blood
Pressure at the 6-month follow-up visit (see Figure 1). Furthermore, 65% of
individuals made changes to their diet and 33% reported improvements to
both the duration and intensity of the exercise they were taking following
their 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
28%
30%
23%
25%
20%
%
15%
15%
12%
10%
5%
0%
Total
LDL
Cholesterol
Systolic
Diastolic
Blood Pressure
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Medication Treatment
Cholesterol medication prescribed
Blood Pressure medication prescribed
Diabetic medication prescribed
5%
12%
9%
One individual had their cholesterol medication dose increased and ten
individuals 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 made
available in a place of work. Its informal approach of being delivered in local
venues such as libraries and community centres encouraged individuals to
attend, and for many it was the first time they had a cholesterol check.
‘would never have bothered to have cholesterol checked only for this
service coming along - great service’
‘Heart Smart’ Mayo highlighted the importance of having risk factors such as
cholesterol and blood pressure checked. In many cases individuals were
shocked to find out they had raised cholesterol or blood pressure in the
absence 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 was
the key element of the programme.
‘made me aware that changes in diet could help
with blood pressure and cholesterol’
‘the explanation of the HDL and LDL was beneficial'
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‘beneficial having card with all results’
A Report on a Cardiovascular Disease
Prevention Programme in Co. Mayo
For many who attended ‘Heart Smart’ Mayo, the overall success of the
Programme was attributed to the 6-month follow up. The follow-up visit was
viewed as a reminder and a motivator to make lifestyle changes;
encouragement when changes had made a difference e.g. weight or
cholesterol reduction, and a fresh start for those whose risk factors may have
increased 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 their
attendance at this appointment.
Conclusion
The prevention of cardiovascular disease remains a challenge for health care
professionals. The ‘Heart Smart’ Mayo Programme successfully identified those
most at risk in the community, encouraged high-risk individuals to attend their
GP and made significant reductions to their risk factor profile.
The findings from the ‘Heart Smart’ Mayo Programme have illustrated the
benefits of implementing a community-based Cardiovascular Prevention
Programme.
However, many challenges remain if we are to reduce the incidence of heart
disease and stroke in the community. In order to reduce the mortality and
morbidity in high-risk individuals in Co. Mayo, it is necessary to implement a
more comprehensive lifestyle programme. This programme would provide an
opportunity to address lifestyle behavours e.g. healthy eating and risk factor
management, e.g. blood pressure reduction, over a longer period of time, in
order to achieve the lifestyle, risk factor and therapeutic targets for
cardiovascular disease prevention.
References
Central Statistics Office (2010) Report on Vital Statistics 2007. Dublin:
The Stationary Office.
Department of Health and Children (2010) Changing Cardiovascular Health
National Cardiovascular Health Policy 2010 – 2019. Dublin: Government
Publications.
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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