Concepts and Theories of Prevention: Reasons for Soliciting Behavioral Medicine Knowledge
Kristina Orth-Gomér Karolinska Institute
Cardiovascular disease (CVD) is the number-one killer of men and women in industrialized countries. In men above age forty and in women above age sixty CVD is the most important cause of death ( 1). In older age groups, CVD is also the most important cause for hospitalization. Furthermore, in many countries, heart disease is an important cause of early retirement from work. Thus, CVD is associated with enormous costs for care and loss of productivity, as well as for disabilities, pensions, and so on. Furthermore, it is the cause of acute and prolonged suffering in many people. All this has motivated clinicians and scientists to develop and implement new methodologies and technologies to better care for patients who are hospitalized for heart disease.
Efforts to improve care in the acute phases of coronary heart disease (CHD), the most common CVD, have been very successful. In the 1960s and 1970s, the initiation of intensive coronary care units (ICCUs) with continuous monitoring of cardiac activity and prompt therapy of life-threatening complications substantially reduced mortality rates. In an early Swedish trial, patients were randomized to intensive coronary care or traditional inpatient care without continuous surveillance. Mortality fell by 50% in the former group ( 2).
During the last decade, the immediate mortality risk of a patient admitted to coronary care for a suspected myocardial infarction (MI) or other acute coronary syndrome has further decreased to less than 10%. This can be ascribed to various attempts to limit infarct size before the full development of the myocardial damage has occurred. Thrombolysis, beta blockade, angiotensin converting enzyme inhibitors for patients with early signs of heart failure, and acute surgery have all contributed to these remarkable gains in human lives and well-being ( 3).