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Prevention: The Ferrara Example

Roberto Ferrari


Introduction • In the last 30 years, life span has increased by 8 years

• Cardiology has contributed to at least 6 of these years

• CV death continues to be the number 1 killer worldwide


Introduction • We have only delayed CV

death and transformed an acute disease into a chronic one

• We should not drop our guard - and we will not


Treatment vs Prevention

• We are trained to treat • We have proven that we are able to do so

• Only recently we pay

attention to prevention


Treatment vs Prevention • Role of therapy (Asprin, ACE-

inhibitors, statins, β-blockers) is enormous.

• The more costly interventions

(although highly advocated by cardiologists) contribute little.


Treatment vs Prevention • Revascularisation explains 5% of the fall in CV death.

• It is applied too late or to too few and is too expensive

• Even doubling revascularisation would make little difference


Prevention vs Treatment

• Treatment accounts for

between 25-55% of the CV mortality decline

• Prevention could account for between 45-75%


Prevention vs Treatment

• Treatment rests in the

hands of cardiologists

• Prevention does not and should not


Which prevention strategy? 1 - A population strategy

• Paramount importance • Dealt with by doctors,

institutions, cities, nations, policy makers, politicians


Which prevention strategy? 2 – High risk strategy

• Important but limited for survivors

• Dealt with by cardiologists


What is prevention? • Awareness, behavior, laws, education, lifestyle, etc.

• Alteration of majority (if not all) aspects of the Western civilisation.

• Too important to be left to medical doctors alone.


Prevention and lifestyle

• Changing the lifestyle of a

population for the better is not an easy task

• Ironically it is easier to deteriorate it


Changing lifestyle • A battle against the negative subliminal messages from consumer society (movies, TV, internet).

• A challenge to important economic interests.

• Needs time


Walking the dog


Ferrara a city of prevention


Why Ferrara? • A city of 131.000 inhabitants • With more than 600 years of university culture

• With close links between different institutions


Why Ferrara? • 9 Km of medieval wall


Why Ferrara? • 9 Km of medieval wall • A city of bicycles


Why Ferrara? • 9 Km of medieval wall • A city of bicycles • Number 1 producer of fruit and vegetables in Italy


Why Ferrara? • 9 Km of medieval wall • A city of bicycles • Number 1 producer of fruit and vegetables in Italy

• Heavy fishing industry


Why Ferrara? • 9 Km of medieval wall • A city of bicycles • Number 1 producer of fruit and vegetables in Italy

• Heavy fishing industry • Only 1 cardiological department!


Ferrara: City of Prevention An integrated project with the:

• Italian Ministry of Health • Italian National Institute of Health • University and Hospital of Ferrara • Regional Health Government • Ferrara Municipality and District Councils


Ferrara: City of Prevention An integrated project with the:

• GVM Hospitals of Care and Research • Anna Maria Sechi Foundation • Various patient associations • Hospitality and catering industry • Fruit and vegetable industry • Fishing industry


Ferrara: City of Prevention An integrated project of:

• Surveillance of disease burden • Preventative action at population and individual levels

• Assessment of the efficacy


Ferrara: City of Prevention National TV

Several institutions

University & Industry School for prevention professionals

Food Industry


Ferrara: City of Prevention Dedicated health channel

Several institutions

University & Industry School for prevention professionals

Food Industry


Ferrara: City of Prevention Dedicated health channel

Several institutions

University & Industry School for prevention professionals

Production Of adequate food


Ferrara: City of Prevention Dedicated health channel

Several institutions

University & Industry To create a prevention professional

Production Of adequate food


Ferrara: City of Prevention Dedicated health channel

Awareness websites Books etc.

University & Industry To create a prevention professional

Production Of adequate food


Ferrara: City of Prevention • Creation of “home of prevention” strategically located – Palazzo Turchi di Bagni in front of the Palazzo dei Diamanti in the heart of the city


Ferrara: Home of prevention what is it? A place where:

•Citizens can assess their CV risk whenever they want

•CV patients can receive information on reducing their risk


Ferrara: Home of prevention what is it?

• ad hoc trained personnel (from the school) dedicate time to citizens to help them remain healthy and to provide suggestions to high risk patients.


Ferrara: Home of prevention what is it?

• A place to learn how to:  stop smoking  shop for appropriate ingredients  prepare appropriate menus  exercise


Ferrara: Home of prevention what is it?

• A place with an operative kitchen for proper cookery courses.

• A place where educational material can be found.


Ferrara: City of Prevention Global preventative action

• Website: “Cuore al Centro” • TV: 1 hour of weekly education at a national level.

• Constitution of a university

certified digital health channel


Ferrara: City of Prevention Global preventative action

• Preparation of frozen portions of adequate food

• Production of heart healthy bread and cakes

• Preparation of adequate frozen menus for hospitals


White, no salt, high omega3, fibres and‌ tasty!


Ferrara: City of Prevention Project assessment

• The concept will be exported to other countries.

• Data will be horizontally

collected yearly for at least 10 years and compared with the general population.


Conclusion • This is not the end. It is not even the

beginning of the end. But it is, perhaps, the end of the beginning…

• We hope in 10 years to:  understand how and why people make the wrong decision regarding diet and lifestyle  convince a city to have the courage to advocate policy changes for the better  produce a model for CV prevention


End

Roberto Ferrari

SHA24/035004  

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