Global Heart最新文献

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.

Background: Cardiometabolic diseases (CMD), including ischemic heart disease, stroke, and type 2 diabetes, have caused an enormous global healthcare burden. Beyond traditional risk factors, female reproductive factors may also be associated with CMD. However, comprehensive evaluations of female reproductive factors related CMD is limited.

Methods: A total of 189,411 women with no prior CMD from the UK Biobank cohort from 2007 to 2010 were included and followed until December 2022. Associations between reproductive factors and CMD were analyzed using Cox proportional hazards models with adjustment for potential confounders based on the directed acyclic graph (DAG).

Results: During a median follow-up of 13.2 years, 17,251 incident CMD events occurred. Compared to menarche at age 12-13 years, <12 years and >13 years had a higher risk of CMD (HR <12 year (y) vs 12-13 y: 1.04 [95% CI, 1.01-1.08]; >13 y vs 12-13 y: 1.08 [1.04-1.13]). Earlier age at menopause was related to a higher risk of CMD (HR <46 y vs 50-51 y: 1.22 [1.15-1.29]; 46-49 y vs 50-51 y: 1.08 [1.03-1.14]), and a short reproductive lifespan (HR <33 y vs 36-38 y: 1.19 [1.13-1.25]; 33-35 y vs 36-38 y: 1.08 [1.03-1.14]). Younger age at first live birth (HR <22 y vs 24-26 y: 1.18 [1.12-1.24]; 22-23 y vs 24-26 y: 1.06 [1.00-1.12]) and last live birth (HR <26 y vs 29-30 y: 1.12 [1.06-1.18]) were associated with higher risk. Women with three or four children (HR 3-4 children: 1.21 [1.15-1.28]) and those with more than four children (HR >4 children: 1.27 [1.07-1.52]) were associated with higher risk of CMD. Recurrent pregnancy loss was associated with a 39% and 14% higher risk of CMD, respectively.

Conclusion: Female reproductive factors are associated with CMD, independent of traditional risk factors. These reproductive factors could inform clinical screening and improve cardiometabolic risk assessment in women.

Peer-reviewed publications using local data are critical for understanding disease burdens, generating evidence, and shaping policies tailored to community needs. Although low- and middle-income countries (LMICs) account for 80% of cardiovascular disease (CVD) deaths, they contribute only 2.8% of CVD publications. To address this gap, the US Centers for Disease Control and Prevention (CDC) and partners launched the Emerging Authors Program for Global Cardiovascular Research (EAP), supporting early- to mid-career LMIC practitioners. EAP coordinated mentorship, provided virtual writing tools, training, technical support, and financial assistance for open access. Between 2019 and 2023, three waves engaged 33 authors from 11 countries, resulting in 31 published manuscripts in six journals, with support from 23 global mentors. The success was driven by committed mentors, motivated authors, local collaboration, accessible resources, and strong communication. Strengthening LMIC authors' writing and publication skills is essential for advancing rigorous research and global health equity in scientific publishing.

Background: Single-pill combination (SPC) therapy improves hypertension control; however, its implementation in primary care settings remains limited. In Nigeria, there is insufficient evidence on factors influencing SPC uptake, particularly from the perspective of healthcare workers (HCWs). This study examined the implementation of SPC medications for hypertension treatment by nonphysician HCWs at primary healthcare facilities (PHCs) in Nigeria.

Methods: An explanatory sequential mixed methods study was conducted, building on a cluster randomized controlled trial embedded within the Hypertension Treatment in Nigeria Program. The trial compared SPC medications with free-equivalent combination therapies across 60 PHCs (January-June 2021). A subsequent qualitative component (September-December 2021) included two focus group discussions from 30 PHCs assigned to the SPC arm of the trial and five key informant interviews. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was used to assess implementation outcomes and identify facilitators and barriers. Integration of quantitative and qualitative findings was guided by the RE-AIM Qualitative Evaluation for Systematic Translation framework (QuEST).

Results: All 30 PHCs assigned to dispense SPCs adopted the medications (Reach/Adoption). Effectiveness: Blood pressure control (<140/90 mm Hg) was 54% (95% CI: 0.52, 0.56) in the SPC arm and 48% (95% CI: 0.46, 0.50) in the free-equivalent arm (cluster-adjusted p = 0.29). Monthly SPC use ranged from 21-37% across sites (Implementation), and 49% of patients remained in care at six months (Maintenance). Facilitators included training on SPC protocols, simplicity of dispensing the regimen, and perceived improvements in patient adherence. Challenges included SPC stockouts and concerns regarding nonphysician HCW capacity to manage complex cases. Policymakers identified the potential role of a Drug Revolving Fund (DRF) to support sustained SPC supply.

Conclusions: The findings indicate favorable implementation outcomes associated with SPC use by nonphysician HCWs in PHCs. Addressing supply challenges, maintaining training, and providing supportive supervision may be important for sustaining SPC-based hypertension treatment.

Objective: Dyslipidaemia is a leading preventable cause of global cardiovascular disease (CVD) burden, responsible for over four million deaths each year (1). A scoping review took a worldwide perspective and assessed recent World Health Organization (WHO) guidance documents, other national or regional guidelines, and randomized controlled trial evidence supporting dyslipidaemia management best practices.

Methods: Review of WHO guidance documents included aspects of dyslipidaemia management, but none provided a detailed and comprehensive approach. Of 11 non-WHO national or regional dyslipidaemia guidelines, nine met pre-defined inclusion criteria and were reviewed in depth. Structured electronic searches of MEDLINE found 27 systematic reviews of randomized clinical trials supporting dyslipidaemia management guideline priority topics.

Findings: This scoping review found overall consistency in the recommendations of regional and national dyslipidaemia guideline recommendations. Guidelines varied in terms of approach to assessing patient CVD risk and recommendations to treat with non-statin lipid-lowering therapy (LLT). Robust randomized trial evidence supports that a dyslipidaemia management guideline focuses on priority areas including approach to patient selection for LLT efficacy and safety, selection of initial LLT drugs and dose intensity, timing of LLT monitoring, and LLT management in specific high-risk groups (familial hypercholesterolemia, diabetes, chronic kidney disease, HIV and other inflammatory diseases, and older adults). Few regional or national guidelines provided practical implementation recommendations or cost-effectiveness assessments; less clinical trial evidence was found for the priority topic of equitable treatment.

Conclusion: Taking a global perspective, this scoping review describes the scope and depth of the current evidence base informing best practice management of dyslipidaemia for the primary and secondary prevention of CVD.

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.