Monitoring is a crucial element in any successful programme. It is important to
know if health care facilities – and ultimately countries – are meeting the agreed
goals and objectives for preventing and managing cardiovascular diseases (CVD).
Monitoring is the on-going collection, management ...and use of information to
assess whether an activity or programme is proceeding according to plan and/
or achieving defined targets. Not all outcomes of interest can be monitored. Clear
outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met.
To allow progress to be monitored, this module provides a set of indicators on
CVD management. Agreeing on a set of indicators allows countries to compare
progress in CVD management and treatment across different districts or
subnational jurisdictions, as well as at a facility level, identify where performance
can be improved, and track trends in implementation over time. Monitoring
these indicators also helps identify problems that may be encountered so that
implementation efforts can be redirected.
This module starts from the collection of data at facility level, which is then
“transferred up” the system: facility-level data are aggregated at subnational level
to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys.
Implementing a monitoring system requires action at many levels. At national and
subnational levels, staff can determine how best to integrate data elements into
existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS).
In the facility setting, personnel must be aware of what data are needed. Sample
data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools
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The recommendations cover the level of blood pressure to start medication, what type of medicine or combination of medicines to use, the target blood pressure level, and how often to have follow-up checks on blood pressure. In addition, the guideline provides the basis for how physicians and other h...ealth workers can contribute to improving hypertension detection and management.
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Peripheral artery disease (PAD) is the most underdiagnosed, underestimated and undertreated of the atherosclerotic vascular diseases despite its poor prognosis. There may be racial or contextual differences in the Asia-Pacific region as to epidemiology, availability of diagnostic and therapeutic mod...alities, and even patient treatment response. The Asian Pacific Society of Atherosclerosis and Vascular Diseases (APSAVD) thus coordinated the development of an Asia-Pacific Consensus Statement (APCS) on the Management of PAD.
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Heart failure with a reduced ejection fraction (HFrEF) is a condition frequently encountered by healthcare professionals and, in order to achieve the best outcomes for patients, needs to be managed optimally. This guideline document is based on the European Society of Cardiology Guidelines for the t...reatment of acute and chronic heart failure published in 2016, and summarises what is considered the best current management of patients with the condition. It provides information on the definition, diagnosis and epidemiology of HFrEF in the African context. The best evidence-based treatments for HFrEF are discussed, including established therapies (beta-blockers, ACE-i/ARBs, mineralocorticoid receptor antagonists (MRAs), diuretics) that form the cornerstone of heart failure management as well as therapies that have only recently entered clinical use (angiotensin receptor-neprilysin inhibitor (ARNI), sodium/glucose cotransporter-2 (SGLT2) inhibitors). Guidance is offered in terms of more invasive therapies (revascularisation, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) by implantation of a biventricular pacemaker with (CRT-D) or without (CRT-P) an ICD, left ventricular assist device (LVAD) use and heart transplantation) in order to ensure efficient use of these expensive treatment modalities in a resourcelimited environment. Furthermore, additional therapies (digoxin, hydralazine and nitrates, ivabradine, iron supplementation) are discussed and advice is provided on general preventive strategies (vaccinations). Sections to discuss conditions that are particularly prevalent in sub-Saharan Africa (HIV-associated cardiomyopathy (CMO), peripartum CMO, rheumatic heart disease, atrial fibrillation) have been added to further improve clinical care for these commonly encountered disease processes.
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ABSTRACT
More than 500 million people worldwide live with cardiovascular disease (CVD). Health systems today face fundamental challenges in delivering optimal care due to ageing populations, healthcare workforce constraints, financing, availability and affordability of CVD medicine, and service del...ivery.
Digital health technologies can help address these challenges. They may be a tool
to reach Sustainable Development Goal 3.4 and reduce premature mortality from
non-communicable diseases (NCDs) by a third by 2030. Yet, a range of fundamental barriers prevents implementation and access to such technologies. Health system governance, health provider, patient and technological factors can prevent or distort their implementation.
World Heart Federation (WHF) roadmaps aim to identify essential roadblocks on the pathway to effective prevention, detection, and treatment of CVD. Further, they aim to provide actionable solutions and implementation frameworks for local adaptation. This WHF Roadmap for digital health in cardiology identifies barriers to implementing digital health technologies for CVD and provides recommendations for overcoming them.
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The Global Burden of Disease Study (GBD) began 30 years ago with the goal of providing timely, valid and relevant assessments of critical health outcomes. Over this period, the GBD has become progressively more granular. The latest iteration provides assessments of thousands of outcomes for diseases..., injuries and risk factors in more than 200 countries and territories and at the subnational level in more than 20 countries. The GBD is now produced by an active collaboration of over 8,000 scientists and analysts from more than 150 countries. With each GBD iteration, the data, data processing and methods used for data synthesis have evolved, with the goal of enhancing transparency and comparability of measurements and communicating various sources of uncertainty. The GBD has many limitations, but it remains a dynamic, iterative and rigorous attempt to provide meaningful health measurement to a wide range of stakeholders.
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This is an update (third edition) of the BACPR Standards & Core Components and represents current evidence-based best practice and a pragmatic overview of the structure and function of Cardiovascular Prevention and Rehabilitation Programmes (CPRPs) in the UK. The previously described seven standards... have now been reduced to six but without sacrificing any of the key elements and with a greater emphasis placed on measurable clinical outcomes, audit and certification. Similarly, the second edition provided an overview of seven core components felt to be essential for the delivery of quality prevention and rehabilitation, and this too has been reduced to six. The interplay between cardio-protective therapies and medical risk factors is almost impossible to disentangle for the vast majority of patients and even if specific drug therapies are deployed exclusively for risk factor modulation, the indirect effect will also be cardio-protective. Thus, these have been combined into a single core component – medical risk management.
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Diabetes is a significant public health issue that affects approximately one in 10 adults globally, with type 2 diabetes accounting for 90–95% of cases. This chronic condition causes considerable morbidity and mortality and is growing in impact, with cases projected to rise from 537 million in 202...1 to 784 million by 2045.1 As cases rise, it is imperative to ensure the healthcare workforce is prepared to care for affected individuals. However, there is a growing global shortage of healthcare workers, which was estimated, pre pandemic, to reach 15 million by 2030.2 Therefore, all of the healthcare workforce will need to be utilised to their fullest potential in order to address the growing global burden of diabetes. Pharmacists will continue to be essential in this endeavour.
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Hypertension is the number one health related risk factor in India, with the largest contribution to burden of disease and mortality. It contributes to an estimated 1.6 million deaths, due to ischemic heart disease and stroke, out of a total of about 10 million deaths annually in India. Fifty seven ...percent of deaths related to stroke and 24% of deaths related to coronary heart disease are related to hypertension. Hypertension is one of the commonest non-communicable diseases in India, with an overall prevalence of 29.8% among the adult population, and a higher prevalence in urban areas (33.8% vs. 27.6%)
according to recent estimates.
Awareness of hypertension in India is low while appropriate treatment and control among those with hypertension is even lower: Hypertension is a chronic, persistent, largely asymptomatic disease. A majority of the patients with hypertension in India are unaware of their condition. This is because of low levels of awareness and the lack of screening for hypertension in adults-either as a systematic programme or as an opportunistic exercise during visits to healthcare providers.
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In recent decades, India has witnessed a rapidly exploding epidemic of diabetes.
Indeed, India today has the second largest number of people with diabetes in the
world. The International Diabetes Federation (IDF) estimates that there are 72.9 million people with diabetes in India in 2017, which is... projected to rise to 134.3 million by the year 2045. The prevalence of diabetes in urban India, especially in large metropolitan cities has increased from 2% in the 1970s to over 20% at present and the rural areas are also fast catching up.
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Alcohol use is deeply embedded in the social landscape of many societies, and some 2300 million people drink alcoholic beverages in most parts of the world. At the same time, more than half of the global population aged 15 years and older reported having abstained from drinking alcohol during the pr...evious 12 months. Several major factors have an impact on levels and patterns of alcohol consumption in populations – such as historical trends in alcohol consumption, the availability of alcohol, culture, economic status and implemented alcohol control measures. At the individual level the patterns and levels of alcohol consumption are determined by multiple factors that include gender, age and individual biological and socioeconomic vulnerability factors as well as the policy environment. Prevailing social norms that support drinking behaviour and mixed messages about the harms and benefits of drinking may encourage alcohol consumption, delay appropriate health-seeking behaviour and weaken community action.
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Alcohol consumption is deeply embedded in the social landscape of many societies. Several major factors have an impact on levels and patterns of alcohol consumption in populations – such as historical trends in alcohol consumption, the availability of alcohol, culture, economic status and trends i...n the marketing of alcoholic beverages, as well as implemented alcohol control measures. At the individual level, the patterns and levels of alcohol consumption are determined by many different factors, including gender, age and individual biological and socioeconomic vulnerability factors, as well as the policy environment. Prevailing social norms that support drinking behaviour and mixed messages about the harms and benefits of drinking encourage alcohol consumption delay appropriate health-seeking behaviour and weaken community action
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El documento, "Progreso en la prevención y el control de las enfermedades no transmisibles" (ENT), informa sobre los esfuerzos globales para reducir el impacto de las ENT, como las enfermedades cardíacas, el cáncer, la diabetes y las enfermedades respiratorias crónicas, siguiendo los compromisos... asumidos en reuniones de alto nivel de las Naciones Unidas. Destaca el progreso insuficiente para alcanzar las metas establecidas en el Objetivo de Desarrollo Sostenible 3.4, que busca reducir en un tercio la mortalidad prematura por ENT para 2030. Los desafíos clave incluyen la falta de financiamiento, la implementación limitada de intervenciones efectivas y barreras políticas y económicas, especialmente en países de bajos ingresos. El informe hace un llamado para fortalecer la cooperación internacional, reformar políticas y adoptar enfoques innovadores para cumplir con las metas de salud global.
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Le document, intitulé « Progrès dans la prévention et le contrôle des maladies non transmissibles », rend compte des efforts mondiaux pour réduire l’impact des MNT (maladies non transmissibles), telles que les maladies cardiaques, le cancer, le diabète et les maladies respiratoires chroniq...ues, conformément aux engagements pris lors de réunions de haut niveau des Nations Unies. Il souligne les progrès insuffisants pour atteindre l’objectif de développement durable 3.4, qui vise à réduire d’un tiers la mortalité prématurée liée aux MNT d'ici 2030. Les principaux défis incluent le manque de financement, la mise en œuvre limitée d’interventions efficaces et des obstacles politiques et économiques, en particulier dans les pays à faible revenu. Le rapport appelle à renforcer la coopération internationale, à réformer les politiques et à adopter des approches innovantes pour atteindre les objectifs mondiaux en matière de santé.
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The "Primary Healthcare Standard Treatment Guidelines and Essential Medicines List" by the South African National Department of Health provides evidence-based guidelines for diagnosing and managing common medical conditions at the primary healthcare level. This document includes treatment protocols ...for various health issues, such as infections, chronic diseases, maternal and child health, mental health, and emergency care. It aims to standardize care, promote rational medicine use, and ensure equitable access to essential medications across South Africa. The guidelines emphasize prevention, accurate diagnosis, and efficient treatment strategies to improve patient outcomes.
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The coronavirus disease (COVID-19) pandemic exacerbated pre-existing inequalities in the treatment and care of noncommunicable diseases (NCDs). This report examines the effect of the COVID-19 pandemic on access to NCD medicines, and the policies and strategies implemented by countries and health sys...tems to anticipate and mitigate stresses across NCD medicine supply chains. The full range of upstream and downstream impacts are investigated, including: manufacturing; procurement, importation and last mile delivery; patient-level effects through affordability and availability; and the effects on NCD medicine availability by category of disease. The report culminates in recommended actions and interventions for key stakeholders in the NCD pharmaceutical supply chain, including governments, regulatory authorities, manufacturers and the private sector; as well as directions for future research for improving access and supply chain access resilience.
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The key to a lasting world free of all forms of poliovirus lies in rapidly interrupting all remaining endemic transmission of WPV in the endemic areas of Pakistan and Afghanistan. This is the only way to ensure that such strains do not re-emerge globally through international spread. It lays the cor...nerstone for the eventual cessation of all oral polio vaccine use, in order to eliminate the long-term risks associated with variant poliovirus strains, which is the GPEI’s top operational priority. The target for certifying the
world free of all WPV remains end-2026.
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PEPFAR Malawi’s Country Operational Plan 2022 (COP22) embodies joint priorities from national and subnational dialogues building on the 2020-2025 National Strategic Plan for HIV/AIDS. The interagency team has developed a person-centered, district-tailored and Malawi Population-Based HIV Impact Ass...essment (MPHIA)-informed strategy through extensive engagement with Government of Malawi (GoM) and Civil Society Organizations (CSOs) to sustain HIV epidemic control. At the end of COP21, PEPFAR Malawi was commended for contributing to reaching epidemic control in strong collaboration with GoM and stakeholders including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This includes enrollment of 88% of recipients of care on three or more months of antiretroviral treatment (ART), better outcomes for Malawian children through remarkable efforts in Orphans and Vulnerable Children (OVC) programming and progress made towards reaching men with more intentional and focused programming.
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The HIV/AIDS Sustainability Index Dashboard is a tool completed every two years by President’s Emergency Plan for AIDS Relief (PEPFAR) teams, host government and partner stakeholders to sharpen the understanding of each country’s sustainability landscape and to assist PEPFAR and other donors in ...making informed HIV/AIDS investment decisions. Based on responses to more than 100 questions, the SID assesses the current state of sustainability of national HIV/AIDS responses across 17 critical elements. Scores for these elements are displayed on a color-coded dashboard, together with contextual charts and information. As the SID is completed over time,
it will allow stakeholders to track progress and gaps across these key components of financial and programmatic sustainability.
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The Guidance on global monitoring for diabetes prevention and control by WHO provides a comprehensive framework to support countries in tracking and managing diabetes prevention, care, and outcomes. This document outlines indicators across 4 domains: health system determinants, service delivery, ris...k factors, and outcomes/impacts. The guidance helps countries align their monitoring efforts with WHO’s global diabetes targets, Global Diabetes Compact, and relevant global NCD targets.
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