Global Heart最新文献

Background: Chagas disease (ChD), a neglected tropical disease caused by Trypanosoma cruzi, affects around 7.5 to 10 million people globally, primarily in Latin America. Chronic Chagas cardiomyopathy (CCM) is the most severe clinical form, leading to substantial cardiovascular morbidity and mortality. Despite existing guidelines, fragmented health systems, low provider awareness, and limited access to care hinder effective disease management.

Objectives: We aimed to define the key components of the CCM quality of care (structure, process, and outcomes) for main clinical activities at the three levels of care.

Methods: We applied the Donabedian model to define essential components of ChD care at primary, secondary, and tertiary levels. Key recommendations from the World Heart Federation (WHF) roadmap and evidence-based guidelines were used to identify core services at each level. We also examined two case studies that demonstrate successful implementation of innovative screening and management models.

Results: Essential components of ChD care were identified at all levels. Primary care plays a central role in early diagnosis and timely treatment. Secondary care addresses complications through imaging and targeted therapy, while tertiary care provides advanced interventions and rehabilitation. Although structural gaps persist, the implementation of systematic processes and clearly defined outcomes is key to strengthening the quality, continuity, and equity of care.

Conclusions: A comprehensive, structured approach to ChD care is essential to improving outcomes. Successful models illustrate that scalable, resource-appropriate interventions can enhance diagnosis and treatment. Integration into routine health systems, supported by universal health coverage, improved data systems, and implementation research, is critical to closing the care gap and advancing equity in cardiovascular health.

Background: Pre-clinical studies demonstrated lipids and lipoproteins influence T-cell phenotype. Several large cohort studies have also observed that plasma lipids and lipoproteins are associated with white blood cell and lymphocyte counts. However, there are little data on the relationships of lipids or lipoproteins with lymphocyte subsets in large, community-based, multi-ethnic cohorts.

Objectives: The purpose of this study was to evaluate associations of plasma lipid and lipoprotein fractions with circulating lymphocyte subsets in participants of the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods: MESA recruited 6,814 adults (aged 45-84 years) free of clinical cardiovascular disease at the baseline exam between 2000-2002. This study included 1,735 participants (49% male, 36% White) with lipoprotein and immune cell phenotyping data at baseline. Multivariable linear regression models evaluated associations between lipoprotein concentration (analyzed per 1-standard deviation (SD) increment) and lymphocyte subsets.

Results: Following correction for multiple hypothesis testing (p < 0.0006), higher high-density lipoprotein (HDL)-cholesterol was associated with higher proportions of memory B-cells, while HDL-lipoprotein concentration was associated with lower pan B-cells. In analyses not corrected for multiple hypothesis testing (p < 0.05), higher concentrations of total-cholesterol, low-density lipoprotein (LDL) cholesterol and LDL-lipoproteins, triglycerides and triglyceride-rich lipoproteins were associated with higher proportions of several T-cell subsets associated with inflammation and senescence. Conversely, a higher concentration of HDL-lipoproteins were associated with lower proportions of senescence-associated T-cells.

Conclusions: These results indicate plasma lipids and lipoproteins may play a role in influencing circulating immune cells. If confirmed in longitudinal studies, these findings may have implications for the development of therapeutics targeting inflammation in patients with elevated lipids.

Background: Heart transplantation (HT) remains the definitive treatment for advanced heart failure that is refractory to both medical and invasive therapies. Although global registries offer extensive data on survival outcomes, there is a relative paucity of information regarding HT outcomes in Latin America (LATAM), particularly in Colombia.

Methods: This study analyzed adult patients who underwent HT between 1995 and 2024, using data obtained from an institutional HT registry (RETRAC) in Cali, Colombia. Survival outcomes were evaluated using Kaplan-Meier curves and Cox proportional hazards models.

Results: We included 260 patients who underwent HT in this 29-year cohort from a LATAM country. The median age at transplantation was 51 years, and 77.7% were male. The primary etiologies were idiopathic/dilated cardiomyopathy (IDC) (41.3%), ischemic cardiomyopathy (IC) (27.0%), and valvular heart disease (VHC) (9.7%). The most prevalent comorbidities were hypertension (HTN) (48.3%), diabetes mellitus (DM) (18.9%), and chronic kidney disease (CKD) (13.1%). The overall median survival following HT was 7.4 years. One-year survival was 74.6% (n = 194), five-year survival was 56.9% (n = 147), and ten-year survival was 46.9% (n = 122). Survival differed significantly by age and sex, with patients aged <40 years demonstrating the highest median survival (8.4 years) and those aged ≥60 years the lowest (2.2 years) (p = 0.038). The 40- to 49-year age group exhibited the most pronounced reduction in survival; however, this effect was attenuated after adjustment. Among patients under 40 years, females had significantly higher mortality compared to males (p = 0.0078), with younger males exhibiting better survival. Additionally, patients transplanted between 2016 and 2020 had higher survival rates. CKD was identified as a significant independent risk factor for increased mortality (hazard ratio (HR) = 1.79; 95% CI: 1.15-2.79; p = 0.01).

Conclusions: HT patients in Colombia exhibit demographic and clinical profiles comparable to global cohorts; however, they demonstrate lower survival rates and poorer clinical outcomes compared to international registries, such as the International Society for Heart and Lung Transplantation registry. Nonetheless, clinical outcomes are more favorable than those reported in other studies from the LATAM region. CKD emerged as a significant independent predictor of mortality. These findings highlight the need for region-specific strategies aimed at improving HT outcomes in LATAM.

Background: This study aims to assess the burden of aortic aneurysm (AA) among individuals aged 55 years and older from 1990 to 2021 at global, regional, and national levels.

Methods: Data from the Global Burden of Disease (GBD) 2021 were analyzed to estimate disability-adjusted life years (DALYs), deaths, age-standardized DALYs rates (ASDR), age-standardized mortality rates (ASMR), and average annual percentage change (AAPC) associated with AA. We employed Joinpoint regression to characterize temporal trends in the AA burden, decomposition analysis to quantify the contributions of key drivers, the Slope Index of Inequality (SII) and Concentration Index of Inequality (CII) to assess health disparities, frontier analysis to benchmark development-stratified achievable disease control levels, and a Bayesian Age-Period-Cohort (BAPC) model to project AA burden trajectories through 2050.

Results: Between 1990 and 2021, global deaths and DALYs due to AA among individuals aged 55 years and older increased by 73.92% and 62.57%, respectively. In contrast, ASMR and ASDR exhibited a declining trend, with AAPC values of -1.07 and -1.12, respectively. Population growth showed strong correlations with increased deaths and DALYs. SII and CII decreases indicated diminished transnational disparities in AA burden. Projections for 2050 indicate a continued rise in deaths and DALYs, while ASMR and ASDR are expected to decline further.

Conclusions: Although global ASMR and ASDR for AA declined from 1990 to 2021, the absolute number of deaths and DALYs increased, with notable regional variations in disease burden. Targeted public health interventions and optimized resource allocation are essential to mitigate the burden of AA.

Non-communicable diseases (NCDs) account for 70% of global mortality and are responsible for over 38 million deaths annually, with cardiovascular disease (CVD) constituting most of these fatalities. While traditional risk factors for CVD have long been recognized, there is growing evidence that a rising prevalence of ubiquitous environmental risk factors (ERFs) may play an increasingly significant role in the genesis and rising prevalence of NCDs. ERFs include many interconnected anthropogenic exposures with cumulative compound health impacts, including air pollution, noise exposure, artificial light at night, plastic pollution, chemical pollution and the various effects of climate change, such as heat extremes, desert storms, floods and wildfires. Urbanization has intensified the impact of many ERFs and created intense exposure environments, highlighting the urgency and the opportunity to address these for maximum public health benefit. Impactful intervention often requires regulatory and policy-driven efforts addressing the genesis of exposures and minimizes their health impact, particularly in vulnerable populations who may contribute the least but may be impacted the most. Solutions must involve the development of resiliency and adaptation measures to a changing world, where the probability of sudden catastrophic and cascading events is much more likely. Political will and international cooperation are essential in establishing and enforcing regulations that promote cleaner air and water, quieter and natural biodiverse environments, and sustainable infrastructure in urban, and rural medical facilities. Integration of planetary and environmental health into cardiovascular care will be vital in reducing the burden of NCDs globally. By addressing the root causes of environmental stressors, it is possible to reduce the incidence of CVDs and promote healthier, just and sustainable societies.

Objective: Progressed medical techniques improved the life expectancy of congenital heart disease (CHD) population. Intellectual developmental disability (IDD) has progressively been a raised concern. This study aimed to comprehensively analyze the global burden, regional and age-specific differences, temporal trends, and economic cost of IDD attributable to CHD.

Methods: This study was a secondary analysis of the Global Burden of Disease Study 2021 and World Development Indicators. The burden of IDD attributable to CHD was evaluated with prevalence, disability-adjusted life years, and estimated annual percentage change across global, socioeconomic, geographic, and age-specific subgroups. Joinpoint regression models were used to describe the temporal trends. Economic cost models were developed to estimate both direct and indirect costs.

Results: In 2021, an estimated 1.05 million people lived with IDD attributable to CHD worldwide. Low-middle social-demographic index (SDI) regions were mostly affected. South Asia experienced the highest prevalence (0.30 million) among all geographic subregions. Children under the age of five were more susceptible to IDD attributable to CHD. The temporal trends varied across different SDI regions and age subgroups. The health-related expenditure of direct costs was disproportional with the burden of IDD attributable to CHD, which also contributed to a substantial income loss in the future.

Conclusions and policy implications: Socioeconomic disadvantage and younger age are associated with a higher burden of IDD attributable to CHD. Efforts for both reducing CHD mortality and improving neurodevelopmental outcomes should be coordinately allocated.

Objective: To determine the feasibility of home blood pressure telemonitoring (HBPT) in Kenya and explore its effects on blood pressure (BP) regulation, self-reported drug adherence, patient- and healthcare provider satisfaction, and required telemonitoring time investment.

Methods: Six-month single-arm interventional feasibility study. Hundred adults with newly diagnosed or known hypertension with an office BP > 140/90 mmHg were provided with a BP machine and were enrolled in an HBPT program. Primary outcome was BP control (% BP < 140/90 mmHg) between baseline and T = 6 months (SPRINT standardized in-office blood pressure measurement). Secondary outcomes included self-reported adherence (MARS-5 scale), patient- and healthcare provider satisfaction (TUQ and MAUQ questionnaires), and efficiency (time spent processing the blood pressure telemonitoring data).

Results: Between March 2024 and January 2025, 100 patients gave informed consent to participate in the study. Eighty-four patients (mean age 54, SD = 14, 73% females) completed the six-month follow-up and were included in the final analysis. Blood pressure control improved from 0% to 72% after six months (P < 0.0001). Median MARS-5 score at baseline was 25 (IQR 25-25) and remained 25 (IQR 25-25) at T = 6 months. Patient satisfaction scores were high with a median mHealth App Usability Questionnaire (MAUQ) score (range 1-7) of 7 (IQR 6.97-7) and a median Telehealth Usability Questionnaire (TUQ) (range 1-7) score of 6.95 (IQR 6.86-7). Patients participated for an average of 9.2 months in the telemonitoring program and required an E-nurse time investment of 51.7 minutes to process BP data.

Conclusions: HBPT is feasible and improved BP control in a rural setting with limited time investments and high patient- and healthcare provider satisfaction rates.

Trial registration: This study is registered with the Pan African Clinical Trial registration (pactr.samrc.ac.za, trial ID: PACTR202408912454189).

Background: The clinical epidemiology of hypertension (HTN) in rural Thailand has not been fully reported. We describe factors associated with HTN control and cardiovascular (CV) outcomes in rural Thai communities.

Methods: We conducted a cross-sectional study in Thai rural areas in 2024 using a multistage sampling scheme. Eligible participants included adults with HTN receiving care from 36 primary care units across four geographical regions. We used multilevel logistic regression modeling to examine factors associated with HTN control.

Results: We included 1000 participants (68.3% women; mean age, 64.2 years). The HTN control rate was 63.9%, using a threshold of <140/90 mmHg for defining HTN control. When using optimal blood pressure thresholds (<130/80 mmHg for ages 20-64 years; <140/80 mmHg for ages ≥65 years), the HTN control rate was even lower at 47.8%. Factors associated with uncontrolled HTN included younger age, residence in the southern region, no school attendance, adding extra salt to food, low physical activity levels, and obesity. Prevalence of cardiovascular diseases (CVD) in people with HTN was as follows: stroke (10.3%), ischemic heart disease (1.4%), atrial fibrillation (1.2%), and left ventricular hypertrophy (6.0%). A high or very high 10-year CVD risk (i.e., > 20% risk over 10 years) was predicted in 7.9% of individuals with HTN: 12.7% in males and 5.0% in females. Elevated low-density lipoprotein (LDL) cholesterol (≥100 mg/dL) was present in 58.7% of participants; 51.5% had a body mass index of ≥25 kg/m². Life's Essential 8 CV health was categorized as poor, moderate, and high for 8.8%, 83.3%, and 7.8% of participants, respectively.

Conclusions: We highlight a need for improving HTN control in rural Thailand and have identified sociodemographic, lifestyle, and metabolic factors that are associated with a lack of HTN control. Cardiovascular complications remain a significant concern for this population.

Background: Rheumatic heart disease (RHD) is a preventable cause of premature death among young individuals in low- and middle-income countries. Education is a key strategy to alleviate the burden of this disease. We aimed to assess the acceptability and knowledge gain of a series of low-literacy education flipcharts, presented during screening in high-burden areas of Brazil.

Methods: Four low-literacy flipcharts were developed over three years and taught over 36 months to patients, community, school children, and health and education professionals, mostly in the state of Minas Gerais. In-person training and education workshops were assessed through printed surveys. Post-education surveys (for patients and community members), and post-training surveys (for healthcare and education professionals) were conducted from January 2023 to December 2025. A knowledge test, delivered at pre-training, post-training and three-month follow-up, was incorporated from January 2024 to March 2025.

Results: Flipchart training was delivered to 1,317 healthcare and education professionals, while 1,292 patients and community members and 2,585 school students received education using the flipcharts. There was a statistically significant (p < 0.01) improvement in knowledge about rheumatic fever (RF) and RHD among healthcare and education professionals participating in the pre- and post-training survey (n = 511): RF as the cause of RHD (64% vs 95%), use of benzathine penicillin G (43% vs 98%), and frequency of antibiotic prophylaxis (21% vs 77%). The improvement from baseline was sustained at follow-up. Over the entire study period, 98% of survey respondents (2,134) reported learning something new, and 94% (2,041) intended to share the learnings with their peers or community.

Conclusion: Culturally adapted, low-literacy educational flipcharts were successfully integrated into an existing RHD screening program in Brazil. The tool was well accepted among people living with RHD, their providers, and at-risk communities, with significant knowledge gain for healthcare and education professionals.