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In the UK there are some 2.6 million people living with heart disease, two million more have early signs of it. Each year, roughly 200,000 people die of cardiovascular complications and the disease costs the UK about $10 billion annually. A similar story can be told for most countries.
 
According to the World Health Organisation, "Coronary heart disease is now the leading cause of death worldwide; it is on the rise and has become a true pandemic that respects no borders".
 
A polypill prevents heart attacks and strokes
According to a 2012 study undertaken by scientists from the University of London, a polypill that combines three generic blood pressure medicines and a cholesterol fighting drug, reduces blood pressure by 12%, lowers bad cholesterol by 39% and could cut heart disease events by 72% and strokes by 64% and, on average, patients receiving the therapy could gain an extra 11 years of life.
 
According to Dr David Wald from Queen Mary College, London, who led the study, "If half of the over-50s in the UK took the pill daily, it would prevent many thousands of heart attacks and strokes each year".
 
Path breaking gene therapy for heart patients
The polypill does not work for chronic heart failure sufferers of which there are more than 0.75 million in the UK alone. Such patients have renewed hope from a new human clinical study, led by Dr Alexander Lyon, Imperial College London, which employs gene therapy to repair damaged hearts.
 
The study is based on 20 years of laboratory research spearheaded by Professor Sian Harding of Imperial College London who discovered that patients suffering from heart failure exhibit low levels of the protein SECRA2a. He also developed a genetically modified virus designed to produce high levels of SECRA2a. Professor Harding then engineered a way for the virus to be introduced into a failing heart to target and reverse some of the critical molecular changes arising in the heart when it fails and thereby restore the diseased organ to its former status.
 
Over a decade ago, gene therapy was widely viewed as a panacea, but it failed to deliver on its early promise. However, recent clinical successes have bolstered renewed optimism in gene therapy and scientists hope that Dr Lyon's study will be a turning point for the technique as well as benefitting people with heart failure.
Underfunding of pensions a threat to heart treatment
A challenge to the costly management of heart disease is the UK government's chronic underfunding of state and public sector pensions, which, to a large extent, is currently paid out of general taxation. Recent government reforms and public sector cuts do not compensate for the lack of growth in the economy and the escalating healthcare costs of heart disease.
 
The enormity of the gap between the monies the UK government receives and monies it pays out in state and public sector pensions is ballooning out of control and will result in a significant cash flow crunch. If nothing transformative is achieved in healthcare, significant and deep cuts to the NHS are inevitable and heart patients will suffer. 
 
More transformative health strategies called for
The challenge for the NHS is not simply to protect the diagnosis and treatment of heart disease for a few difficult years and then expect everything to return to normal. Rather, it is to deliver a step change in the management of heart disease. Both the UK National Audit Office and the Parliamentary Select Committee on Health have raised concerns about the NHS being unable to make genuine efficiency gains. Both bodies suggest that the Department of Health is not sufficiently focused on transformative change. 
 
Significant infrastructural support for transformative healthcare change already exists. While modern society fosters unhealthy diets and lifestyles, which contribute to heart disease, it also facilitates the availability of health information and interactive mobile devices that together can help to reduce and manage the burden of coronary heart disease. 
Transformative change for heart disease is at our fingertips
The management of heart disease is at our fingertips and can benefit from the explosion and the transformative effects of eHealth. At the close of 2012, the UK had 82.5 million mobile subscribers and 36 million of these were Smartphone accounts. By the end of 2013 the number of Smartphone's in the UK is projected to be 44 million rising to 63 million by the end of 2016. 
 
Currently, Smartphone's and tablets have access to some 60,000 mobile health-based apps, a significant number of which can assist with the reduction and management of heart disease. eHealth devices can detect and track vital signs, monitor the progression of risk factors and connect heart patients directly with health professionals without leaving their homes.
 
Such devices can be used to reduce the burden of heart disease while transferring a large part of its management to the home.
 
eHealth apps under FDA scrutiny
If you have not been prescribed a mobile app, you soon may be. In March 2013 the US Food and Drug Administration (FDA) announced that eHealth apps, which transform mobile phones into medical devices, will be regulated.
 
However, tablets and Smartphone's will not be considered by the FDA as medical devices, app stores and developers will not be  considered medical device manufacturers and apps will not be forced to seek re-approval for small updates. Also, apps that either contribute to electronic health records or act as personal health monitors will not be regulated. 
 
This suggests that the explosion in eHealth apps for the management of heart disease will continue. Heart patients will become increasingly knowledgeable about eHealth and this will help drive the management of the disease away from hospitals and primary care centres into peoples' homes and encourage individuals to take greater care and more control of their own hearts.
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