Global Heart最新文献

Background: We examined cardiac implantable electronic device (CIED) implantation and outcomes related to geographical remoteness.

Methods: This was a retrospective cohort study of adult cardiovascular hospitalisations in New South Wales, Australia (2008-2018). The primary outcome was CIED implantation in arrhythmia, cardiomyopathy, and syncope groups (and subcategories) among rural and regional residents. Secondary outcomes included CIED subtypes: pacemaker (PPM), implantable defibrillator (ICD) and cardiac resynchronisation therapy (CRT), examination of 10-year implant trends, and 5-year mortality rates adjusted for age and comorbidities.

Results: Of the 1,291,258 cardiovascular admissions, 880,972 patients were from major cities (urban), 304,961 from inner regional (regional), and 105,325 from outer regional, rural, or remote areas (rural). Regional and rural patients received less PPMs (regional: aOR = 0.66; 95% CI 0.64-0.69; rural: aOR = 0.75; 95% CI 0.71-0.79), CRTs (regional: aOR = 0.71; 95% CI 0.65-0.78, rural: aOR = 0.72; 95% CI 0.83-0.94), and ICDs for regional patients (aOR = 0.72; 95% CI 0.67-0.77). Differences persisted in subcategories, including PPMs for complete heart block (regional: aOR = 0.58; 95% CI 0.56-0.60, rural: aOR = 0.66; 95% CI 0.62-0.70) and ICDs for ischaemic (regional: aOR = 0.44; 0.34-0.56, rural: aOR = 0.74; 95% CI 0.54-0.99) and non-ischaemic cardiomyopathy (regional: aOR = 0.64; 95% CI 0.56-0.73, rural: aOR = 0.72; 95% CI 0.59-0.87). Five-year mortality rates were higher in rural patients receiving PPM (urban = 23.7%; 95% CI23.2-24.2, rural = 26.4%; 95% CI 25.8-27.0), ICD (urban = 29.5%; 95% CI 28.2-30.7, rural = 32.5%; 95% CI 31.3-33.8) and CRT (urban = 24.2%; 95% CI 22.9-25.5, rural = 26.9%; 95% CI 25.5-28.3).

Conclusion: Regional and rural patients had less CIED implantation, with higher 5-year rural mortality rates. Our study highlights the geographical disparity that occurs for patients requiring CIED and the need for further examination to determine the underlying causes and address these inequities.

Background: Rheumatic heart disease (RHD) remains a significant public health concern in middle- to low-income countries. Despite advancements in healthcare access and public health measures in Brazil, future projections of RHD burden are essential to guide policy-making. Thus, we projected the national and regional burden of RHD in Brazil through 2050.

Methods: Annual prevalence counts and disability-adjusted life years (DALYs) for RHD from 2000 to 2021 were extracted from the 2021 Global Burden of Disease (GBD) dataset for 10-year age brackets (5-74 years). Age-standardized prevalence (asPR) and DALYs rates (asDALYs) per 100,000 were calculated nationally and regionally. Bayesian age-period-cohort models were used to project trends through 2050, with results reported as medians (25^th, 75^th percentiles) and estimated annual percentage changes (EAPCs).

Results: From 2000 to 2021, Brazil's population grew by 27%. Nationally, the asPR declined slightly from 1,503 to 1,495 per 100,000 [EAPC: -0.04% (95% CI: -0.05, -0.03)], with reductions observed in most regions. However, increases were noted in the North [EAPC: 0.14% (95% CI: 0.13, 0.15)] and Northeast [EAPC: 0.02% (95% CI: 0.01, 0.03)]. Males experienced greater reductions [EAPC: -0.16% (95% CI: -0.19, -0.13)] compared to females, who showed a slight increase [EAPC: 0.05% (95% CI: 0.03, 0.07)]. Projections indicate that asPR will decline nationally to 1,418 per 100,000 by 2050 [EAPC: -0.20% (95% CI: -0.20, -0.19)], with the South and Central West regions reducing the most.The asDALY rates declined from 142 to 104 per 100,000 [EAPC: -1.58% (95% CI: -1.69, -1.46)] during 2000-2021, with all regions showing decreases, particularly the Southeast [EAPC: -1.83% (95% CI: -1.98, -1.69)]. Nationally, projections suggest further reductions to 75 per 100,000 by 2050 [EAPC: -1.17% (95% CI: -1.22, -1.11)].

Conclusion: The burden of RHD in Brazil has decreased nationally and regionally over recent decades. Projections suggest that these trends will continue.

Introduction: Immunization rates against influenza and pneumococcus in Latin America remain lower than expected, particularly in Andean region, Central America, Mexico, and Caribbean region. An incremental correlation between economic strata and educational level and vaccines uptake has been observed. This highlights the need for more comprehensive data to accurately characterize the current health landscape and develop strategies for improvement.

Methods and design: The Inter-American Registry of Influenza and Pneumococcal Vaccination (CorVacc Study) is a cross-sectional survey of the general population conducted across 19 Latin American countries. Adults aged 18 years and older completed a 34-question online survey. The pool was validated within the first 1000 responses. Data were grouped into seven categories: demographics, socioeconomic and educational level, cardiometabolic profile, cardiovascular interventions, medical follow-up and treatments, and COVID-19 vaccination status.

Results: A total of 21,389 responses were obtained, distributed as follows: 8915 from the North, Central, and Caribbean region; 7492 from the Andean region; and 4801 from the Southern Cone region. Influenza vaccination rates were lower in the Andean region (OR: 0.62; 95% CI: 0.50-0.78), the Caribbean (OR: 0.30; 95% CI: 0.23-0.39), and Central America (OR: 0.59; 95% CI: 0.46-0.76) compared with the Southern Cone. Residing in Central America (OR: 3.06; 95% CI: 1.62-5.77) was associated with greater pneumococcal vaccination. The probability of being vaccinated against influenza was higher in men (OR: 1.3; 95% CI: 1.1-1.6) and in individuals with obesity (OR: 1.26; 95% CI: 1.13-1.40). COPD was associated with a lower probability of pneumococcal vaccination (OR: 0.51; 95% CI: 0.33-0.79).

Conclusions: This study highlights the importance of targeted vaccination campaigns to improve coverage, particularly in regions with lower rates. It also underscores the need for enhanced education and awareness of the benefits of vaccination. Tackling barriers such as vaccine hesitancy and misinformation will be essential for raising vaccination rates and, ultimately, for reducing the burden of cardiovascular disease.

Objective: To assess the heart attack (HA) knowledge, awareness, and attitude among adults in Al-Hasa, Saudi Arabia, and to identify gaps in understanding that could hinder prompt medical intervention.

Methods: A descriptive cross-sectional study was conducted using a self-administered questionnaire distributed via Google Forms from January to March 2024. Statistical analysis was performed using IBM SPSS, Version 29, to evaluate associations between demographics and HA awareness.

Results: Participants demonstrated moderate awareness of non-classical HA symptoms such as slurred speech (relative importance index (RII) = 72.88%) and dizziness (66.35%), whereas critical symptoms such as chest pain (47.8%) and shortness of breath (47.25%) were among the least recognized. This suggests a concerning gap in knowledge of the most urgent indicators of HA. Respondents showed higher awareness of non-modifiable risk factors such as family history (RII = 70.99%) and high cholesterol (63.92%) compared to modifiable lifestyle-related risks. Smoking (43.71%) and obesity (43.08%) ranked lowest in awareness, indicating insufficient recognition of preventable contributors to cardiovascular disease. Participants exhibited a high level of hesitation in seeking immediate medical attention during a suspected HA. Social embarrassment (RII = 67.36%) and concerns about healthcare costs (66.08%) were the primary reasons cited for delay. Alarmingly, the belief that one should wait to be 'very sure' before going to the hospital was common (RII = 59.01%), whereas the urgency of symptoms such as persistent chest pain was undervalued (RII = 31.18%). Significant differences in symptom recognition were observed across age groups (e.g., P = 0.001 for jaw/neck/back pain), education levels (e.g., P = 0.028 for pain in arms/shoulders), and marital status (e.g., P = 0.002 for several symptoms). No significant gender-based differences were found.

Conclusion: Al-Hasa population showed good knowledge and awareness of HA symptoms and risk factors; however, significant gaps exist in recognizing less common symptoms and emergency procedures. Poor attitude was shown toward HA seeking medical care. Concerns about cost, embarrassment, and suspicion in the severity of the symptoms appeared to be barriers to seeking timely care.

Background: Myocardial revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) lowers mortality, yet long-term outcomes may vary by socioeconomic status despite broadly similar access to care.

Objective: To examine the association between income-measured in legal monthly minimum wages (MMW)-and five-year survival after revascularization in formally employed Colombians (2012-2018).

Methods: This was a retrospective cohort study using linked national administrative datasets. Income was grouped into quartiles at cohort entry. The primary outcome was five-year mortality. Analyses were stratified by procedure (CABG, PCI). Multivariable Cox models were used to estimate adjusted hazard ratios (aHRs), controlling for age, sex, region, Charlson Comorbidity Index, recent acute myocardial infarction, valve surgery within 30 days, and pre-procedural cardiac rehabilitation (30 days). Socioeconomic gradients were summarized using the Relative Index of Inequality (RII) and the Slope Index of Inequality (SII; absolute difference per 100,000 patients).

Results: Among 8,128 patients (mean age = 55.0 ± 9.3 years; 11.3% women), 2,131 underwent CABG and 5,997 underwent PCI. After CABG, five-year mortality was 13.2% in Q1 vs 7.8% in Q4 (p < 0.01); aHRs (vs Q1) were 0.60 (95% CI = 0.40-0.90) for Q2, 0.56 (0.38-0.84) for Q3, and 0.58 (0.38-0.88) for Q4 (all p ≤ 0.01). After PCI, mortality declined from 11.7% (Q1) to 6.5% (Q4) (p < 0.01); only Q4 remained significant after adjustment (aHR = 0.64; 95% CI = 0.49-0.82; p < 0.01). Inequality indices confirmed the gradient: for CABG, SII = 4.14 per 100,000 (95% CI = 3.30-4.98; p < 0.01) and RII = 1.97 (1.17-3.31; p = 0.01); for PCI, SII = 3.13 per 100,000 (2.74-3.52; p < 0.01) and RII = 1.81 (1.32-2.48; p < 0.01).

Conclusions: Lower income is associated with worse five-year survival after myocardial revascularization, with larger absolute and relative inequalities after CABG than after PCI.

Background: Cardiovascular diseases (CVDs) are the leading global cause of mortality and disability, with prevalence increasing due to aging and risk factors like obesity and hypertension. The retina, rich in microvasculature, provides a unique opportunity to investigate microvascular dysfunction linked to CVDs and other systemic vascular diseases.

Method: This study used a multifaceted approach to assess the genetic correlation and causal relationship between retinal characteristics and CVDs. Linkage disequilibrium score regression (LDSC) and Mendelian randomization (MR) analyses were conducted using genome-wide association study (GWAS) data from the UK Biobank and FinnGen datasets. A cross-sectional study was also conducted to validate the findings, collecting optical coherence tomography (OCT) images from 124 eyes (89 with CVDs and 35 healthy controls). A prediction model is based on least absolute shrinkage and selection operator (LASSO) regression to assess the risk of CVD.

Result: Using LDSC and two-sample MR, we found genetic evidence consistent with a causal effect whereby genetically proxied thinner retinal nerve fiber layer (RNFL) was associated with higher risks of hypertension and myocardial infarction (MI), while genetically proxied thicker photoreceptor inner segment/outer segment (PR-IS/OS) was associated with coronary heart disease and MI (false discovery rate [FDR] thresholds as reported). Genetically proxied thinner retinal pigment epithelium (RPE) showed an inverse association with stroke risk. Several circulating biomarkers-including lipoprotein(a) [Lp(a)], low-density lipoprotein cholesterol (LDL-C), and ApoB-exhibited MR evidence of association with multiple CVDs. In a cross-sectional cohort, retinal layer differences and their relationships with lipids were directionally consistent with the genetic findings.

Conclusion: Retinal structural traits measured by OCT-particularly RNFL, PR-IS/OS, and RPE thickness-are best interpreted as non-invasive markers that reflect systemic vascular biology. Our MR analyses support shared etiologic pathways between retinal microstructure and CVDs rather than implying that retinal damage clinically causes cardiovascular events. Findings warrant validation in larger and more diverse populations and should not be considered definitive proof of causality.

Cardiovascular diseases (CVDs) remain a leading global cause of mortality and disability, with significant disparities observed across countries. This is particularly true in Central and Eastern Europe (CEE), where populations are primarily at high and very high CVD risk. Highlighting modifiable risk factors underscores the urgent need for effective prevention programs. This paper introduces the European Program for Prevention (EPP), an initiative by the International Lipid Expert Panel (ILEP), designed to address these challenges. The EPP aims to enhance awareness and knowledge of validated preventive healthcare solutions implemented in CEE countries, showcase the region's potential for innovative strategies, and evaluate the adaptability of successful programs for broader implementation. The EPP strongly supports the EU Cardiovascular Health Plan, as well as initiatives by the World Heart Federation (WHF) and World Health Organization (WHO), by promoting best practices, early detection, integrated prevention frameworks, training, cross-border cooperation, and policy development. It advocates shifting healthcare priorities towards pre-disease prevention, thus reducing reliance on resource-intensive treatments. The program proposes an optimal CVD prevention system that includes mandatory health education, screening programs for familial hypercholesterolemia and universal Lp(a) screening, and comprehensive check-ups, notably integrated, comprehensive care programs. By leveraging existing validated programs and fostering collaboration, the EPP seeks to reduce the burden of CVD, improve outcomes, and promote cardiovascular health across Europe and beyond.

Background: A novel low-dose triple single-pill combination of antihypertensive drugs (GMRx2) has demonstrated superior blood pressure (BP)-lowering efficacy compared to placebo and dual combinations in short-term randomized double-blind trials.

Objectives: To evaluate the long-term BP-lowering efficacy and safety of GMRx2-based treatment when used in normal clinical care.

Methods: After completing a four-week double-blind randomised phase, participants from Sri Lanka and Nigeria were enrolled into an open-label extension phase (OLE) with follow-up to one year. The OLE involved treatment and uptitration with GMRx2, of ¼, ½ and standard doses of telmisartan/amlodipine/indapamide (i.e., 10/1.25/0.625 mg, 20/2.5/1.25 mg and 40/5/2.5 mg), and add-on antihypertensive drugs if needed to target a home BP goal of <130/80 mm Hg. Home BP monitoring was continued throughout the follow-up and six follow-up clinic visits were conducted. The primary outcome was percentage of participants with home BP control (<130/80 mmHg) at week 52.

Results: From 21 August 2023 to 20 August 2024, 50 participants participated in the OLE, of whom 48 (96%) completed it. The mean age of participants was 49 years and 60% were female. Home and clinic mean BP at enrolment into OLE were 126/79 mmHg and 131/83 mmHg, respectively. At one year, home BP control (<130/80 mmHg) was 60% and clinic BP control (<140/90 mmHg) was 88%. Home mean BP was reduced to 121/78 mmHg after 4 weeks into the OLE and was 120/78 mmHg at one year. For clinic BP, the corresponding values were 126/79 mmHg and 122/77 mmHg. None of the participants discontinued trial treatment due to an adverse event.

Conclusions: In a population with mild-to-moderate hypertension, long-term therapy with GMRx2-based treatment achieved high levels of BP control and was well tolerated.Trial registration: NCT04518306.

Background: Degenerative mitral valve disease (DMVD) is a significant contributor to the global burden of disease. This study aimed to estimate the prevalence, mortality, and disability-adjusted life years (DALYs) rates of DMVD at global, regional, and national levels from 1990 to 2021 and to project its future burden.

Methods: This study extracted three pivotal indicators, including the prevalence, mortality, and DALYs related to DMVD, from the Global Burden of Disease 2021. The average annual percentage change and rate change were utilized to evaluate the changes in the disease burden. Decomposition analyses were conducted to evaluate these changes. In addition, a Bayesian age-period-cohort analysis was performed to forecast the future burden of DMVD.

Results: In 2021, the global age-standardized prevalence rates (ASPRs), age-standardized mortality rates (ASMRs), and age-standardized disability-adjusted life year rates (ASDRs) for DMVD were 182.13 per 100,000 persons [95% uncertainty interval (UI): 169.952, 196.070], 0.456 per 100,000 persons (95% UI: 0.394, 0.514), and 11.362 per 100,000 persons (95% UI: 9.867, 13.611), respectively. Regions with a high sociodemographic index exhibited the most substantial disease burden. Women exhibited lower ASPR than men, but higher ASMR. Decomposition analyses reveal that improvements in DMVD burden were primarily attributable to epidemiological changes; however, it was negatively affected by population growth and aging. Predictive analysis suggests that global projections for DMVD in 2035 estimate approximately 21.41 million (95% UI: 15,718,776, 27,102,848) cases of prevalence, 47,878 (95% UI: 28,449, 67,307) cases of mortality, and 1.20 million (95% UI: 793,487, 1,615,972) cases of DALYs.

Conclusions: The global burden of DMVD, indicated in its age-standardized prevalence, mortality, and DALYs rates, exhibits significant declines. However, significant regional and national variations exist. Findings of our study emphasize the importance of devising targeted public health strategies tailored to different regions, countries, and populations, with the aim of further mitigating DMVD's global impact.