Year: 2025
Type: article
Abstract: All correspondence relating to this paper should be sent to: [email protected] John Deanfield is a leading British cardiologist specialising in both congenital and acquired disease, with a special interest in prevention and early treatment. He has been instrumental in shaping policy and practice in these areas and has pioneered public health initiatives focused on cardiovascular disease prevention. He is a Professor of Cardiology at University College London, UK, and Director of the National Institute for Cardiovascular Outcomes Research (NICOR) (Figure 1). Professor John Deanfield Director of NICOR and pioneer of public health initiatives focused on cardiovascular disease prevention A University of Cambridge graduate, Prof. Deanfield trained in London and was drawn to cardiology by its prominence as a major disease area. He also acknowledges the influence of one of his cardiology lecturers, Douglas Wigle, whose teaching, and doctor-patient rapport left a lasting impact. Unusually, as part of his training he had the opportunity to step into paediatric cardiology at London’s famous children’s hospital Great Ormond Street—an experience that informed much of his subsequent work. He says: ‘I was inspired by the Hospital motto ‘the child first and always’ and how they dealt with children and their families who were disadvantaged and struggling through no fault of their own.’ This period in the 1980s saw major changes in the treatment of congenital heart disease and advances in surgery. ‘Before this, most children with congenital heart disease were either severely disabled or died, but as a result of advances in medicine and surgery over the next 10 to 20 years, most would survive and reach adulthood. It was incredibly exciting to be part of such rapid change and witness new methods for diagnosis and treatment.’ Working across adult and paediatric cardiology was eye-opening for a doctor who was deeply immersed, academically and clinically, in adult coronary and arterial diseases. He says: ‘I realized that children who had a separate set of diseases were now surviving into adulthood and would need care both for the long-term effects of childhood diseases and for the heart conditions that they could develop later in life. This created a unique interaction that hadn’t existed before, and no-one was investing in this population.’ Recognising that conditions like atherosclerosis begin early, Prof. Deanfield focused on prevention rather than waiting to start treatment of clinical complications in adulthood. He set-up the largest unit for adults with congenital heart disease in the UK and an academic unit to study the earliest changes in the arteries of children and young adults. He developed non-invasive tests of endothelial function which are now used worldwide in large cohorts. The importance of these new fields has since become widely recognized and his pioneering research into lifestyle factors like obesity and cholesterol has influenced clinical practice and public health. This shift in approach to CVD moves the focus from addressing the disease once it emerges clinically, typically after the age of 50, to proactive prevention. According to Prof. Deanfield, this transformation in healthcare is driven by three key factors. Firstly, healthcare systems are under increasing pressure to manage growing numbers of patients who are living longer and developing chronic diseases associated with aging. Secondly, research shows that heart attacks and strokes in later life develop as a result of risk factors and behaviours that start in childhood. Thirdly, the revolution in digital technology has enabled delivery of prevention at scale. Whilst past efforts centred on treating a limited number of patients and providing broad lifestyle recommendations, today’s digital society enables large-scale communication and personalized guidance on disease risk, making early intervention more effective. Using a financial analogy Prof. Deanfield refers to this as ‘investing in your arteries’ suggesting that an effective model for ‘retirement’ requires starting early to prevent conditions before they take hold. The prevention work grew from Prof. Deanfield’s academic and clinical research and observations, leading him to become an expert advisor to the UK government and healthcare providers. In May 2024, he outlined his latest public health initiative in the report: Making Prevention Everyone’s Business: A Transformational Approach to Personalized Prevention in England, that advocates a digital-first National Prevention Service, accessible through a new digital health and wellness portal and recommends relocating preventive services, such as blood pressure monitoring into community spaces, integrating prevention into daily life. Obstacles to effective preventive healthcare include not only lack of public awareness of risk factors for disease but also accessing opportunities that exist to reduce these factors. A further obstacle is that healthcare systems are designed to treat disease, not fund prevention. Prof. Deanfield says: ‘You’re always at the back of the queue if you frame prevention as a healthcare issue in a system focused on treating sick patients, so I developed a strategy called ‘health and wealth are a one-letter difference, shifting the focus from prevention as a burden to it being a wealth-generating opportunity for society.’ This approach has been more successful with policy makers and funders. ‘We need to inform, empower, and reward people by collecting and analysing their data and giving them insights to understand opportunities of what can happen in daily life.’ The purpose of prevention is he says, not only to keep people living longer but living better. This will require the next generation of cardiologists to be trained in precision medicine, risk prediction, and data analysis. Communication will also be key: ‘We need to rethink how we communicate, not just with patients, but with people at large in ways that engage and sustain their involvement.’ Prof. Deanfield believes future cardiologists will no longer wait for patients to come to them but will actively advocate for population health. His advice is: ‘Be bold and ambitious in your career. Think about where and how you can truly make a difference.’ At ESC Congress 2024, Prof. Deanfield delivered a lecture named after the eminent epidemiologist Geoffrey Rose, who identified the ‘Prevention Paradox’ that a large number of people at modestly elevated risk can generate more cases of disease than the smaller number at high risk. This means that while a preventive measure—such as lowering blood pressure—can significantly reduce cases at a population level, its benefits may seem minimal to individuals, leading them to undervalue it. He explains: ‘You can solve this paradox by delivering personalized prevention at scale, communicating risk and benefit to the public, by harnessing the advances in technology, and particular artificial intelligence, to inform, empower and reward individuals for taking care of their health.’ All authors declare no disclosure of interest for this contribution.
Source: European Heart Journal
Author: Judith Ozkan
Language: English
Subfield: History and Philosophy of Science
Field: Arts and Humanities
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W4414003229