Jenni Jones, Croí’s director of prevention(click to enlarge)

Jenni Jones has recently been appointed director of prevention, training and education with Croí, the West of Ireland Cardiac Foundation. She formerly worked at Imperial College, London, where she was involved in collaborating with Croí to support the Croí MyAction programme, which launched in Galway in 2008.

“As a coordinator of the original EUROACTION preventive cardiology study, my connection initially with Croí was in setting up, auditing and providing quality assurance for the Croí MyAction programme through a collaborative initiative with Imperial College.

“The MyAction model of care evolved from the EUROACTION study, which demonstrated that a nurse-managed multidisciplinary, family-based vascular health programme could achieve and sustain healthy lifestyle changes and better risk factor control than usual care.

“Croí MyAction is an evidence-based measurable programme in cardiovascular health and disease prevention for those identified at high risk of developing cardiovascular disease, aimed at reducing each individual’s future risk of diabetes, heart attack and stroke. It has proved to be highly successful, with people entering the programme seeing dramatic improvements in their cardiovascular health.

“Measurable successes include a 50% reduction in smoking and almost twice as many participants at BP and cholesterol targets by the end of the 16-week programme as well as one year later. Waist circumference reduces significantly, on average by five centimetres, which translates to health outcomes in the range of a 20% reduction in cardiovascular risk.

“Also, we are seeing objective improvements in fitness associated with a 12-20% reduction in all-cause mortality and significant improvements in diet and psychological well-being.

“In reaching further with prevention, Croí is now providing a wide range of innovative health programmes in addition to the MyAction programme that can be accessed by the general public and aim to reduce the impact of heart disease and stroke on families living in the West of Ireland.”

 Jenni’s background is in physiotherapy, with a particular interest in preventive cardiology. She said: “In 2008, Imperial commenced a Masters degree programme in Preventive Cardiology – the only one of its kind in Europe. As the leader for this postgraduate qualification, the programme has grown to reach across the world using innovation and multimedia, creating talented ambassadors for prevention equipped to raise the standards of preventive care. 

“NUI Galway will commence a diploma and masters programme in preventive cardiology, in partnership with Croí, and I’m absolutely delighted to contribute in continuing to develop clinicians and equipped to deliver high quality care in cardiovascular health and disease prevention.

“My role with Croí is to direct the delivery of innovative programmes in cardiovascular health and wellbeing and intrinsically link these to research, education and training. In operating as an institute for teaching and training, education and research, a centre for healthy living and a centre for patient and family support, Croí is positioned to become a national centre of excellence in cardiovascular health and disease prevention, and to support a national roll-out of evidence-based prevention and rehabilitation programmes.”

Jenni says a milestone for Croí has been the recent opening of the first purpose-built centre dedicated to the prevention of heart disease and stroke (see pages 8-9). In many ways, she says, this centre is the physical embodiment of the type of preventive initiatives Croí has been undertaking since its foundation in 1985.

“The Croí Heart and Stroke Centre is set in the heart of the community, raising awareness within the local community, offering accessible support for prevention and rehabilitation.”   

Jenni admits that there are challenges ahead in getting the prevention message across. “Research has shown that a high proportion of people already known to be at high risk of developing cardiovascular disease and with established atherosclerotic disease, despite increased use of medications, are not achieving national BP and cholesterol targets. There are growing levels of obesity, central obesity. So despite greater use of medications, the risk factor profile for our population remains alarming and of major concern. 

“Part of my role at Croí is to provide professional support, training and education to help change that. We’ve shown through the EUROACTION programme that it is possible to implement the CVD prevention guidelines in everyday clinical practice and raise the standards of care.”   

Jenni admits that health professionals often find it difficult to effectively get people to change their lifestyles as part of CVD prevention. “Human behaviour is complex and health professionals need to be equipped with a scientific understanding of evidence-based approaches to behaviour change and education, together with skills in brief and comprehensive interventions, including motivational interviewing and cognitive behavioural approaches. As an institute for teaching and training, education and research, Croí provides a wide range of workshops, courses and conferences that support health professions to deliver effective care in cardiovascular disease prevention and rehabilitation.

“Under a joint funding arrangement between Croí, HSE West, NUIG and Kerry Group, a Diploma and Masters in Preventive Cardiology will be launched at NUI Galway in September 2013. I was the programme leader for the Masters in Preventive Cardiology at Imperial College, London, the only Masters in Prevention in Europe, which brings an opportunity to impart these experiences in shaping what will be a highly valuable postgraduate qualification.” 

Croí is also currently collaborating on a number of research projects in the areas of heart disease and stroke prevention; gestational diabetes; obesity; behaviour and lifestyle change; and exercise prescription. This research activity informs prevention services with the ultimate aim of facilitating wide implementation of effective community-based preventive programmes, supported by its training and education centre.    

But how far can health professionals go in changing behaviour and is it all really up to the patient in the end?

Ms Jones said: “To support a change in behaviour requires a client-centred approach. Ultimately, change has to come from the individual and the health professional’s role is to develop their ability to change and equip individuals with the skillset required to manage their health. People often present to us with misconceptions and confused by mixed messages they’ve heard in the media, through friends and family and other health professionals.  

“Factors such as anxiety and depression also make lifestyle changes challenging. Health professionals can be an enormous support to successful change by dealing with misconceptions and provide targeted evidence-based strategies that are sensitive to the individual’s physical, psychosocial (cognitive and behavioural) capabilities and needs.”

 The Croí programmes involve both secondary and primary prevention. “We see people who are found to be at high multifactorial risk – essentially a calculation of the risk of developing cardiovascular disease in the next ten years, using age, sex, smoking status together with BP and cholesterol measures. We also support people who have atherosclerotic disease, particularly people post-stroke and TIA or people with angina. 

“These individuals all share the same risk factors and correspondingly we deliver programmes that are fully inclusive of all of these individuals. Croí employs a multidisciplinary team of 14 highly qualified full-time staff, eight part-time staff and is supported by a team of community volunteers, leading initiatives and delivering fully integrated multidisciplinary evidence-based programmes in cardiovascular disease prevention and rehabilitation right in the heart of the community.

With the new centre, Croí is expanding its area of activity from heart disease to both heart disease and stroke, Jenni says. “Eighty per cent of heart attacks and strokes are preventable. We could see significant returns from evidence-based programmes that improve physical activity and nutrition and lower smoking rates in communities. Not only could we save money, but many more people in Ireland would have the opportunity to live healthier lives.”

Jenni says it was encouraging to hear the Taoiseach talk about promoting the concept of wellbeing and fitness and not just treating disease.

“There has been considerable investment in cath labs, advances in surgical techniques and treatments. But there are also strong arguments for investing in prevention, and dealing with the causes of cardiovascular disease holds enormous promise to save money for the health service.

“The types of targeted, evidence-based and measurable community-based prevention programmes available at Croí should be accessible wherever you live in Ireland. Croí welcome the opportunity to partner with others in the concept of building a national model for prevention.”

 Jenni says prevention can also be helped by government policy at a population level. “For example, implementing measures to tackle childhood obesity through regulations, policy and curricula. Plain packaging or health warning regulations for fizzy sugar drinks is just one of many examples. This type of policy, unlike taxation, is not potentially discriminating against lower income groups.  

“Another example, published in the BMJ in 2011, highlighted if average salt consumption reduced from 8.6 to 5.6 grams per day we could expect 20,000 fewer CVD deaths per year and considerable cost savings.”