The first three things that developed from the 1950s epidemic of Heart Attacks were:
1. Identifying that it started in young people
2. Research into why it happened in some people and not in others; the causes and risk factors.
3. The understanding that 60% of the deaths from Coronary Thrombosis occurred within the first hour of the symptoms, and therefore before the patient had even reached hospital
As a result of the third, we saw the invention of the “Cardiac Ambulance” in Belfast, Northern Ireland. Professor Frank Pantridge originated the first so-called ‘Paramedics’ by putting DC Defibrillators in an Ambulance and staffing it with trained Ambulance Personnel, Nurses and Staff Physicians. When a call was made to Central Dispatch for a victim of chest pain or cardiac arrest the ambulance was immediately dispatched to the home or site of the incident. Cardiopulmonary resuscitation and, if necessary, defibrillation and drug therapy was instigated on the spot. Survivors could then be admitted to Coronary Care Units where blocked arteries could be identified and replaced with Bypass Graph Surgery or later on with stents in Percutaneous Coronary Intervention. Professor Pantridge also pioneered the use of Automated External Defibrillators which could be placed in areas where ‘Heart Attacks’ might occur such as gyms, pools and sports arenas.
These techniques, CPR and AEDS, for Secondary Prevention have now been adopted world-wide and have been responsible for 50 % of the reduction in the incidence of the disease worldwide.
As a result of individuals surviving, we began to see the need and structuring of Cardiac Rehabilitation for those individuals who survived acute coronary, and stroke, syndromes. These were largely exercise-based Community programs which provided advice on activity, diet, medication and lifestyle changes designed to nullify the factors that had led to the event in order to prevent a re-occurrence. These programs have shown that individuals do initiate major behavioral changes when they know they have the disease.
The end result of the above initiatives in Secondary and Tertiary Prevention has been to reduce the Morbidity from CVD by almost 50% and the incidence by 30% (although that decrease has reversed in the last few years). But still 160,000 Canadians have a First Time Heart Attack as do 735,000 Americans. So the reduction is higher in those who know they have the disease than in those who are not aware of their risk and go on to have a Heart Attack.
Which confirms the need to assess children for increased risk before the disease progresses. The other argument against intervention in childhood is that individuals do not make significant lifestyle changes even when they are aware of an increased risk. This is a snow job. Yes! Not everyone makes those changes. But some do! We have not even tried to inform young people and their families of their future CAD risk so we have no idea of what the response would be if this was a national coordinated strategy with the opportunity to create a tipping effect in Public Health compliance.
The National Heart, Lung and Blood Institute’s guidelines on Cardiovascular Health and Risk Reduction in Children and Adolescents published 5 years ago provided strong recommendations that we involve Adolescents and their families in Risk Reduction especially if a Positive Family History exists or Obesity or a clustering of Risk Factors. Yet, all we do every year is tell the whole population to be active, eat more healthily and stop smoking. We make no effort to target the families who need referral to clinics and programs who offer those services individually and who specialize in motivational counselling, smoking cessation, nutrition, activity and medication. Every February we repeat the same snow job. And every year about 50% of our young people will leave school to start their lives totally unaware that their arterial blood vessels are no longer lined with ‘teflon’ but now resemble ‘velco’ as “sandbars” of atherosclerosis have already begun to stick to the banks and block the stream. They leave school unaware that they, and other members of their family, are carrying a time bomb inside them set to detonate in middle age. A condition that is totally preventable.
We can stop hardening our hearts! The research provides us the answers. The data tells us our hearts are not getting better and we must do something before it is too late. To stop hardening our hearts, we need to be aware of our own risk factor scores from childhood. We must take care of our arteries by making Teflon and not Velcro.We must start before the damage is too severe and irreversible. This means addressing CAD in adolescences. In order to reach the whole population, we need to go where we can provide all adolescents the same benefits and opportunities. Schools are the only place where we can see the whole adolescent population. Ontario needs to provide Cardioprevent centres where primary care providers can refer at risk families.
Heart Niagara’s Healthy Heart Schools’ Program is a model works. Tomorrow, I’ll share the model solution for eradicating ASHD, the Healthy Heart Schools Program.