TY - JOUR

T1 - Stratified prevention: opportunities and limitations

T2 - Report on the 1st interdisciplinary cardiovascular workshop in Augsburg

AU - Kirchhof, Gregor

AU - Lindner, Franz Josef

AU - Achenbach, Stephan

AU - Berger, Klaus

AU - Blankenberg, Stefan

AU - Fangerau, Heiner

AU - Gimpel, Henner

AU - Gassner, Ulrich M.

AU - Magnus, Dorothea

AU - Kersten, Jens

AU - Rebscher, Herbert

AU - Schunkert, Heribert

AU - Rixen, Stephan

AU - Kirchhof, Paulus

N1 - Funding Information: This paper is the main outcome of an interdisciplinary work shop in Augsburg on 24 and 25 October 2016. Cardiologists, epidemiologists, experts in law, ethics, the German health insurance system and in the economics of emerging technologies met for 2 days, applying the methodology of their disciplines to a common topic, stratified prevention of cardiovascular diseases. The present paper described the main outcomes of this 2-day process in a language that respects the rules and requirements of the different professions. We thank the Institut für Bio- gesundheits- und Medizinrecht at University of Augsburg for supporting and hosting the work shop, and Franziska Huber for excellent assistance during the conference, and Neil Mussett for editorial assistance with legal aspects of the English language. We also thank the German Centre for Cardiovascular Research (DZHK) and the German Society of Cardiology (DGK) for endorsing the workshop. Publisher Copyright: © 2017, The Author(s).

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Sufficient exercise and sleep, a balanced diet, moderate alcohol consumption and a good approach to handle stress have been known as lifestyles that protect health and longevity since the Middle Age. This traditional prevention quintet, turned into a sextet by smoking cessation, has been the basis of the “preventive personality” that formed in the twentieth century. Recent analyses of big data sets including genomic and physiological measurements have unleashed novel opportunities to estimate individual health risks with unprecedented accuracy, allowing to target preventive interventions to persons at high risk and at the same time to spare those in whom preventive measures may not be needed or even be harmful. To fully grasp these opportunities for modern preventive medicine, the established healthy life styles require supplementation by stratified prevention. The opportunities of these developments for life and health contrast with justified concerns: A “surveillance society”, able to predict individual behaviour based on big data, threatens individual freedom and jeopardises equality. Social insurance law and the new German Disease Prevention Act (Präventionsgesetz) rightly stress the need for research to underpin stratified prevention which is accessible to all, ethical, effective, and evidence based. An ethical and acceptable development of stratified prevention needs to start with autonomous individuals who control and understand all information pertaining to their health. This creates a mandate for lifelong health education, enabled in an individualised form by digital technology. Stratified prevention furthermore requires the evidence-based development of a new taxonomy of cardiovascular diseases that reflects disease mechanisms. Such interdisciplinary research needs broad support from society and a better use of biosamples and data sets within an updated research governance framework.

AB - Sufficient exercise and sleep, a balanced diet, moderate alcohol consumption and a good approach to handle stress have been known as lifestyles that protect health and longevity since the Middle Age. This traditional prevention quintet, turned into a sextet by smoking cessation, has been the basis of the “preventive personality” that formed in the twentieth century. Recent analyses of big data sets including genomic and physiological measurements have unleashed novel opportunities to estimate individual health risks with unprecedented accuracy, allowing to target preventive interventions to persons at high risk and at the same time to spare those in whom preventive measures may not be needed or even be harmful. To fully grasp these opportunities for modern preventive medicine, the established healthy life styles require supplementation by stratified prevention. The opportunities of these developments for life and health contrast with justified concerns: A “surveillance society”, able to predict individual behaviour based on big data, threatens individual freedom and jeopardises equality. Social insurance law and the new German Disease Prevention Act (Präventionsgesetz) rightly stress the need for research to underpin stratified prevention which is accessible to all, ethical, effective, and evidence based. An ethical and acceptable development of stratified prevention needs to start with autonomous individuals who control and understand all information pertaining to their health. This creates a mandate for lifelong health education, enabled in an individualised form by digital technology. Stratified prevention furthermore requires the evidence-based development of a new taxonomy of cardiovascular diseases that reflects disease mechanisms. Such interdisciplinary research needs broad support from society and a better use of biosamples and data sets within an updated research governance framework.

KW - Law

KW - Genomics

KW - Prevention

KW - Heart failure

KW - Atrial fibrillation

KW - Stratified medicine

KW - Personalised medicine

KW - Payor

KW - Health Economics

UR - http://www.scopus.com/inward/record.url?scp=85038109928&partnerID=8YFLogxK

U2 - 10.1007/s00392-017-1186-y

DO - 10.1007/s00392-017-1186-y

M3 - Journal articles

C2 - 29248989

VL - 107

SP - 193

EP - 200

JO - Clinical Research in Cardiology

JF - Clinical Research in Cardiology

SN - 1861-0684

IS - 3

ER -