Background
Cardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-...incidence ratio (MIR) across the world over 28 years.
Methods
The age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990–2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017.
Results
The obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990–2017 (p < 0.05). Nevertheless, the developing nations had a more rather shallow decrease in MIR compared to developed ones.
Conclusions
Generally, the findings of this study revealed that there was an overall downward trend in CVD incidence and mortality rates, while the survival rate of CVD patients was rather stable. These results send a satisfactory message that global effort for controlling the CVD burden was quite successful. Nonetheless, there is an urgent need for more efforts to improve the survival rate of patients and lower the burden of this disease in some areas with an increasing trend of either incidence or mortality.
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Heart failure (HF) is a global public health concern with disproportionate socioeconomic, morbidity and mortality burden on low- and middle-income countries (LMICs). This review summarises contemporary data on the demographic and clinical characteristics, aetiologies, treatment, economic burden and ...outcomes of HF in LMICs. Patients with HF in LMICs are younger than those from high-income countries (HICs) and present at advanced stages of the disease. Hypertension, ischaemic heart disease (IHD), cardiomyopathy (CMO), and rheumatic heart disease (RHD) are the leading causes of HF in LMICs. The contribution of infectious diseases to HF remains prominent in many LMICs. Most health facilities in LMICs lack adequate diagnostic tools for HF, and the use of evidence-based medical and device therapies is suboptimal. Further, HF in LMICs is associated with prolonged hospital stay and high in-hospital and one-year mortality. Finally, HF has profound economic impact on individual patients who, mostly, have no health insurance, and on societies where patients are young, comprising those who have the greatest potential to contribute to economic productivity.
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Many low-resource settings have a shortage of physicians and health workers. (1) In order to provide patient-centred continuous care more effectively, primary care systems can include team-based care strategies in their clinic workflows and protocols. Team-based care uses multidisciplinary teams (wh...ich may involve new staff, or the shifting of tasks among existing staff). Teams can include patients themselves, primary care physicians, and other allied health professionals, such as nurses, pharmacists, counsellors, social workers, nutritionists, community health workers, or others. Teams reduce the burden on physicians by utilizing the skills of trained health workers. Strong evidence shows that team-based care is effective in improving hypertension control among patients in a cost-effective way. (2) Some amount of task shifting/team-based care is already taking place in many settings; this module provides further guidance on how to maximize this approach for greater impact.
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On 14 August 2024, the Director-General of the World Health Organization determined that the upsurge of mpox in a growing number of countries in Africa constitutes a new public health emergency of international concern (PHEIC) under the International Health Regulations (IHR) (2005)
The 2023 update of the Global Strategy for Asthma Management and Prevention incorporates new scientific information about asthma based on a review of recent scientific literature by an international panel of experts on the GINA Science Committee. This comprehensive and practical resource about one o...f the most common chronic lung diseases worldwide contains extensive citations from the scientific literature and forms the basis for other GINA documents and programs.
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Aerosol pollutants are known to raise the risk of development of non-communicable respiratory diseases (NCRDs) such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, and allergic rhinitis. Sub-Saharan Africa’s rapid pace of urbanization, economic expansion, and population growt...h raise concerns of increasing incidence of NCRDs. This research characterizes the state of research on pollution and NCRDs in the 46 countries of Sub-Saharan Africa (SSA). This research systematically reviewed the literature on studies of asthma; chronic bronchitis; allergic rhinitis; and air pollutants such as particulate matter, ozone, NOx, and sulfuric oxide.
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The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death... and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world’s population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them.
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Introduction Community health workers (CHWs) are increasingly being tasked to prevent and manage cardiovascular disease (CVD) and its risk factors in underserved populations in low-income and middle-income countries (LMICs); however, little is known about the required training necessary for them to ...accomplish their role. This review aimed to evaluate the training of CHWs for the prevention and management of CVD and its risk factors in LMICs.
Methods A search strategy was developed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and five electronic databases (Medline, Global Health, ERIC, EMBASE and CINAHL) were searched to identify peer-reviewed studies published until December 2016 on the training of CHWs for prevention or control of CVD and its risk factors in LMICs. Study characteristics were extracted using a Microsoft Excel spreadsheet and quality assessed using Effective Public Health Practice Project’s Quality Assessment Tool. The search, data extraction and quality assessment were performed independently by two researchers.
Results The search generated 928 articles of which 8 were included in the review. One study was a randomised controlled trial, while the remaining were before–after intervention studies. The training methods included classroom lectures, interactive lessons, e-learning and online support and group discussions or a mix of two or more. All the studies showed improved knowledge level post-training, and two studies demonstrated knowledge retention 6 months after the intervention.
Conclusion The results of the eight included studies suggest that CHWs can be trained effectively for CVD prevention and management. However, the effectiveness of CHW trainings would likely vary depending on context given the differences between studies (eg, CHW demographics, settings and training programmes) and the weak quality of six of the eight studies. Well-conducted mixed-methods studies are needed to provide reliable evidence about the effectiveness and cost-effectiveness of training programmes for CHWs.
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Toolkit regarding Zika Virus
The active participation and engagement of health and care workers (HCWs) in health emergency preparedness, readiness and response is crucial to support risk communication, community engagement and infodemic management (RCCE-IM) interventions during emergencies. HCWs hold unique position...s in society – repeatedly being identified among the main influencers of people’s behaviours: they are one of the most trusted sources of health information and advice in communities and role models for the acceptance and uptake of protective measures during health emergencies. On the frontline, HCWs have valuable insights and knowledge that can be harnessed to support health emergencies across the entire emergency cycle. Between October and December 2023, the WHO Regional Office for Europe interviewed key informants on strategies and experiences to meaningfully engage HCWs during emergencies
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Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status—wealth and education—differ among... high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management.
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Many low- and middle-income countries (LMICs) are undergoing an epidemiological transition. With an improvement in socioeconomic conditions and an aging population, cardiovascular diseases (CVDs), like cardiac arrhythmias, are expected to increase in these countries. However, there are limited studi...es on the epidemiology and management of cardiac arrhythmias in LMICs. This review will highlight the unique challenges and opportunities that these countries face when managing cardiac arrhythmias.
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This publication aims to provide updated guidance on the specific use of yellow fever laboratory assays in the context of surveillance to be used across the Global Yellow Fever Laboratory Network for disease surveillance. In the recent years, new commercial assays became available and are now recomm...ended for use by WHO and this publication will support national program on the use of compound laboratory assays as per the most recent recommended testing algorithms. This piece is aligned with the elimination effort set in the comprehensive global strategy to eliminate yellow fever epidemics (EYE) strategy 2017-2026 and where its advisory laboratory technical working group actively contributed to its development. The target audiences are policy-makers and health workers.
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Global cardiovascular disease (CVD) burden is high and rising, especially in low-income and middle-income countries (LMICs). Focussing on 45 LMICs, we aimed to determine (1) the adult population’s median 10-year predicted CVD risk, including its variation within countries by socio-demographic char...acteristics, and (2) the prevalence of self-reported blood pressure (BP) medication use among those with and without an indication for such medication as per World Health Organization (WHO) guidelines.
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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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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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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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Background
Chronic congestive heart failure is a common condition that, if untreated, markedly impairs the quality of life and is associated with a high risk of recurrent hospitalization and death.
Methods
This review is based on articles retrieved by a selective search in PubMed, as well as on r...elevant guidelines.
Results
Evidence-based treatment options are available only for congestive heart failure with a low ejection fraction. Pharmacotherapy is based on neurohumoral inhibition of the renin-angiotensin-aldosterone system and the adrenergic system. The prognosis of patients with this condition has been further improved recently through the introduction of combined angiotensin receptor antagonists and neprilysin inhibitors. Modern implantable devices are a further component of treatment. Implantable defibrillators and special pacemakers for cardiac resynchronization are well established; the utility of alternative devices (baroreflex modulation or cardiac contractility modulation) needs to be investigated in further studies. It was recently shown that the catheter-based treatment of secondary mitral regurgitation with a MitraClip improves the outcome of selected patients.
Conclusion
The treatment of chronic systolic heart failure as recommended in the relevant guidelines, with drugs and implanted devices if indicated, can significantly improve the clinical outcome.
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HEARTS provides a set of locally adaptable tools for strengthening the
management of CVD in primary health care.
HEARTS is designed to enhance implementation of WHO PEN by providing:
• operational guidance on further integrating CVD management
• technical guidance on evaluating the impact of... CVD care on patient outcomes.
For countries not using WHO PEN, CVD management can still be integrated into
primary health care. The process of implementing HEARTS will vary, depending
on country context, and may require a significant reorienting and strengthening
of the health system. At some sites, existing CVD management services may be
reoriented toward a risk-based approach, while other sites may adopt a public
health approach, strengthening management of particular risk factors such as
hypertension. Whether or not introducing CVD management into primary care is a
new intervention, successful implementation will require engagement with national and local health planners, managers, service providers, and other stakeholders.
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Health facilities in the Region of the Americas frequently suffer the effects of health emergencies and disasters, which jeopardize their ability to provide services to the population. The STAR-H methodology helps staff responsible for health emergency and disaster risk management to identify and as...sess risks as part of strategic planning to improve facility preparedness. It is intended to help them develop, with a multi-hazard approach, a response framework with operating procedures to deal with hazards of any type, scale, or frequency; determine roles and responsibilities; facilitate the effective use of resources; undertake strategic planning exercises, and improve the preparedness of facilities to effectively respond to and recover from impacts. This methodology is designed for use in health facilities of any size and capacity, and makes it possible to generate historical reports and national or subnational risk profiles. This information can be used to develop an effective health emergency and disaster risk management program.
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