Primary and secondary prevention of cardiac disease: bridging the two solitudes.
Clinical cardiovascular medicine uses two models for atherosclerosis: primary and secondary prevention. The essential goal of both strategies is risk factor modification, but intervention strategies and funding mechanisms to achieve these goals have traditionally differed, leading to professional and clinical segregation. The current system defies biological reality, patients and families are not well served, and important opportunities for improved care are lost. Developing a more inclusive paradigm of primary and secondary prevention remains a significant challenge. Such a paradigm could transform a longstanding trend of two solitudes where efforts in one area rarely benefit from new developments in the other. New models need to be developed that balance and integrate diagnostic, curative and preventive care, and that coordinate public health and personal health services. Working on 'bridging strategies' will help create synergies that will lead the way to further integration and will help improve the heart health of the population.
Dafoe
W A
WA
Prevention and Rehabilitation Program, University of Ottawa Heart Institute, Ontario, Canada. WDafoe@ottawaheart.ca
Huston
P
P
Wong
C
C
Stokes
H
H
D003324:Coronary Artery Disease / Q000175:diagnosis; D003327:Coronary Disease / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D008955:Models, Cardiovascular