“Through my secondary prevention programme, I have discovered the power of self-care and prioritising my health.” Such valuable patient testimony reflects the crucial need for access to follow-up treatment after a cardiac event such as a heart attack or stroke. The “know-how” exists.
Every year, 20.5 million people die from cardiovascular disease (CVD), close to one-third of all deaths worldwide. Most of the CVD burden – more than 85% – is due to atherosclerotic cardiovascular diseases (ASCVD), as well as other important CVD manifestations such as heart failure and atrial fibrillation. ASCVD includes coronary artery disease, cerebrovascular disease, peripheral artery disease, and atherosclerotic aortic disease. It results from blocked and ruptured arteries due to plaque buildup of blood fats including cholesterol. The devastating impacts include premature death, disability, and soaring healthcare expenditure which could be better used for prevention.
Secondary Prevention involves drug therapy, support with lifestyle management, and counselling, all geared to help reduce the probability of a recurrent cardiovascular event in patients with known ASCVD. The availability of effective prevention strategies contrasts with their actual implementation due to factors that include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or of environments that support cardiovascular health behaviours.
Understanding the obstacles paves the way for opportunities to identify and implement recommendations: this Roadmap on Secondary Prevention of CVD – 2023 update does both. First launched in 2015 at the Policy Forum on the Secondary Prevention of Cardiovascular Disease, the Roadmap now integrates new literature and guidelines, including the 2021 European Society of Cardiology (ESC) Guidelines on Cardiovascular Disease Prevention in Clinical Practice, the inclusion of single-pill combinations for hypertension on the World Health Organization Essential Medicines’ list in 2019, and advances in digital health.
At least 15 core strategies are detailed in the Roadmap, ranging from individual and healthcare levels to healthcare systems and policies. Solutions include ensuring available and affordable secondary prevention medications and improving their access and use at hospital discharge and in cardiac rehabilitation programmes. Training healthcare providers is vital for supporting lifestyle management, behavioural change, and medication adherence. Strengthening the entire chain of health services delivery also entails training and supporting community health workers.
More than 250 responses to a WHF survey in 60 countries highlight the reality and sometimes, the variability, when it comes to secondary prevention tools. The lack of lifestyle intervention programmes was cited as a roadblock by 52 per cent of respondents with another 48 per cent in low-income countries pointing to the lack of affordable medications. The latest Roadmap on Secondary Prevention guides the uptake of practical tools and changes in policy, to ultimately improve the lives of the 300 million people living with ASCVD worldwide and promote cardiovascular health for all.
This Roadmap is part of the WHF’s Roadmap series, developed to help guide healthcare professionals, health authorities and policymakers towards reducing the burden of CVD and saving lives. WHF Roadmaps identify obstacles to implementation of health solutions, and propose tools, strategies, and recommendations that can be adapted to diverse contexts. They are developed with the expertise of peers and co-chairs of the process. WHF Roadmaps empower others to implement them, working with diverse stakeholders such as:
- Governments and policymakers
- NGOs, health activists and advocates
- Healthcare professionals
- Corporate entities
- Academic and research institutions
- Patients and patient groups
