Effectiveness of public health and education programs for creating awareness of and managing cardiovascular disease

摘要

Abstract: This paper reviews the effectiveness of public health and education programs for creating awareness of, preventing and managing cardiovascular disease (CVD), with a particular focus on their impact on people’s behavior. Evidence-based guidance recommends that such programs, eg, cardiac rehabilitation, should include risk assessment, modification of lifestyle risk factors and, where appropriate, medication. However, despite substantial evidence of cardiac rehabilitation being beneficial, a significant proportion of eligible patients fail to receive cardiac rehabilitation and numerous barriers to attendance remain, particularly because cardiac rehabilitation service provision continues to be patchy and of variable quality. Evidence suggests that educational programs to prevent CVD may achieve favorable reductions in mortality and overall CVD risk. However, whilst people tend to have significant knowledge of the modifiable risk factors for CVD, this does not necessarily lead to action to reduce risk, because lay epidemiology appears to play a significant role in sophisticated determinations of CVD causation, amongst other factors. Some people, but not all, make and maintain some lifestyle changes, but not necessarily all of the changes recommended, because they may only change aspects of lifestyle that are perceived to have been likely causes of their CVD. In addition, many people experience difficulty in making and maintaining lifestyle changes. There appears to be considerable disquiet among patients about taking medicines prescribed for CVD, particularly concerning side effects, which in some instances may affect medicine-taking. New developments and patient approaches recognize the wider societal issues that influence the lifestyle choices people make. Initiatives to increase attendance and widen access to cardiac rehabilitation have included home-based and technological innovations as alternatives to hospital-based cardiac rehabilitation programs. Effective future approaches are likely to build on these developments, and offer even greater choice in accessing preventative services.