Croí MyAction, a Community Based Cardiovascular Disease Prevention Programme – Ireland
Croí MyAction is a 12-16 week intensive cardiovascular disease prevention programme. It is aimed at individuals and their partners/ family members at very high cardiovascular risk. It was developed in response to the need of an effective model of prevention for individuals at high multifactorial risk. The programme is a gold standard intensive risk factor management and lifestyle modification programme driven by specific protocols designed to achieve the latest ESC Guidelines. High-risk individuals defined as those with SCORE (Systematic Coronary Risk Evaluation) of >5% or type-2 diabetes were referred to the programme through a series of pathways which include general practice and hospital departments such as cardiology, stroke, and endocrinology. Subsequently, the programme was expanded to include patients with stroke/TIA (Transient Ischemic Attack) and coronary heart disease. Established in 2009, this flagship community-based prevention model has reached over 1100 individuals.
The key components are: lifestyle modification (smoking cessation, healthy food choices, and physical activity); medical risk factor management (blood pressure, lipids, and glucose); and the prescription of cardio protective medication where appropriate. The programme is co-ordinated by a multidisciplinary team which includes a nurse specialist, a dietitian and a physiotherapist/exercise specialist supported by a physician. An important principle of the programme is involvement of the partner, as risk factors cluster in families due to shared lifestyles. The 16-week programme includes individualised follow-up, a weekly educational workshop and supervised exercise session. There is also a weekly meeting to review lifestyle, risk factor and therapeutic goals including medication prescription as appropriate. The programme is flexible, offering individuals the choice of attending during the day or in the evening. The Croi MyAction model was first developed by Imperial College London and has its strong evidence base in the EUROACTION study which demonstrated that an intensive nurse-led programme can achieve effective and substantial lowering of CVD risk factors in high risk groups of patients compared with usual care. The programme adopts the settings-based approach to health promotion and is underpinned by values such as empowerment, public participation, equity and partnership. It is actively empowering to people and communities through its individualised behavioural change approach to lifestyle modification. It is family-centred, actively involving family members. By locating the programme in the heart of the community it is more accessible to those who most need it, removing the barrier of having to attend the doctor’s clinic or hospital. This programme has been shown to be clinically effective, cost effective and cost saving. A recent economic analysis demonstrates that is cost-effective compared to usual care and represents an efficient use of resources.
Additional information: http://www.nipc.ie/5yearReport2015.pdf
(last accessed in March 2017)