Global Heart最新文献

The validity of Apple Watch for measuring heart rate (HR) and oxygen saturation (SpO₂) in patients with cardiac diseases is still unclear. Therefore, this study aimed to investigate the accuracy of the Apple Watch in measuring HR and SpO₂ in patients with cardiac diseases. A cross-sectional study recruited 260 cardiac patients, including 190 with regular heart rhythm and 70 with cardiac arrhythmia. Each patient wore the Apple Watch alongside a Polar HR monitor at rest, during and after mild- to moderate-intensity exercise sessions, and wore the Apple Watch alongside a Contec pulse oximeter at rest and after exercise. The Apple Watch showed excellent validity (ICC = 0.100) in measuring the HR at rest, during mild- to moderate-intensity exercise, and after exercise in cardiac patients, as well as in measuring SpO₂ at rest (ICC = 0.100) and after exercise (ICC = 0.92). However, the validity of the Apple Watch for measuring SpO₂ decreased slightly after exercise (ICC = 0.85; good validity), especially in patients with an irregular heart rhythm. Overall, the Apple Watch appears valid for measuring HR and SpO₂ at rest and after exercise, and for measuring HR during mild- to moderate-intensity training in cardiac patients.

Background: Acute rheumatic fever (ARF) is the precursor to rheumatic heart disease (RHD) following Group A Streptococcal infection. However, many diagnoses of RHD are made in the absence of ARF history. We compared RHD severity between those with and those without a documented history of ARF.

Methods: A retrospective audit of echocardiographic images determined RHD stage at diagnosis and at follow-up based on the 2023 WHF guidelines for the diagnosis of RHD.Individuals aged ≤ 20 years from the Top End of the Northern Territory (NT) of Australia with RHD diagnosis between January 2012 and December 2021 were included.Primary outcome was RHD stage at the time of diagnosis. Secondary outcomes were RHD stage progression or regression. Those with ARF and those with no ARF (noARF) were compared.

Results: Study population (n) of 292 individuals with mean age 11.9 ± 3.8 years. At baseline, the ARF group had more Stage A RHD (28.6% versus 12.0%), while the noARF group had more Stage B (50.0% versus 38.0%), p = 0.009. There was no difference in advanced RHD (Stage C and D combined) between the groups (p = 0.440). Follow-up (median 46 months, IQR: 27-71 months) sample size was 230. Regression of RHD was greater in the ARF group (46% versus 28%, p = 0.014). No difference was found in stage progression (including to surgery), with 21% (32/156) in the ARF group and 15% (11/74) in the noARF group (p = 0.367).

Conclusions: Individuals at all stages of RHD severity were detected amongst those with and without an accompanying diagnosis of ARF. Individuals with first RHD diagnosis accompanied by ARF were more likely to regress. These findings support echocardiographic screening in high-risk populations to detect early RHD that can be treated with secondary antibiotic prophylaxis. Further research is required to understand the reason for differences between the ARF and noARF groups.

Cardiovascular diseases (CVDs) are the leading global cause of mortality, with treatment adherence posing a major barrier to effective prevention and control. Single pill combinations (SPCs), also known as fixed-dose combinations, simplify treatment by combining multiple agents into one pill, improving adherence and reducing cardiovascular risk. This World Heart Federation Roadmap synthesizes the latest clinical evidence and identifies key barriers to SPC implementation, including limited manufacturing, affordability, regulatory complexity, and inconsistent guideline inclusion. Drawing on global expert input and health systems analysis, the Roadmap outlines practical, context-specific solutions to improve access, scale-up, and integration of SPCs into national strategies, especially in low- and middle-income countries. It serves as a tool for policymakers, clinicians, and advocates to drive progress in aligning cardiovascular prevention efforts with evidence-based, people-centred care.

Obesity is a growing global crisis increasing the risk and outcomes of a range of noncommunicable diseases including cardiovascular diseases, type 2 diabetes, cancer, chronic respiratory disease, steatotic liver disease, and kidney disease.Obesity in children tracks into adulthood increasing their risk of noncommunicable diseases including cardiovascular diseases.A growing body of evidence confirms that there are affordable and scalable policies to promote a healthy diet and regular physical activity to prevent overweight and obesity including in children and adolescents.Despite the burden caused by obesity and its preventability, the topic does not appear to be a priority on the agenda of the global public health community and implementation of public health policies to prevent obesity at country level has been patchy.At the upcoming United Nations 4^th High Level Meeting on noncommunicable diseases, Heads of State and Government need to go beyond making political commitments to prevent obesity and, take concrete steps to increase and monitor budget allocations for implementing policies for population wide prevention of physical inactivity and unhealthy diet.Obesity is a chronic disease that affects over one billion people in the world and is a major risk factor for cardiovascular disease, type 2 diabetes, and cancer. It is impossible to advance prevention and control of noncommunicable diseases, without simultaneously halting the rise of obesity. The 2018 political declaration of the 3^rd United Nations General Assembly High-Level Meeting on noncommunicable diseases calls for the Implementation of cost-effective and evidence-based interventions to halt the rise of overweight and obesity, especially childhood obesity. Since then, the evidence supporting the impact of regular physical activity and a healthy diet on the prevention of obesity has become more compelling. However, the prevalence of obesity across all age groups has increased due to the ineffective public policy response, the fierce opposition from commercial actors, and difficulties in navigating implementation challenges. This paper outlines the growing evidence, recent developments, and lessons learnt since 2018 and highlights new opportunities and remaining challenges with regard to prevention of obesity, ahead of the 4th United Nations High-Level Meeting on noncommunicable diseases in September 2025.

Background: The clinical significance of atherosclerotic disease in more than one vascular bed, that is, polyvascular disease, in valvular heart surgery remains poorly understood. This study aims to establish the prevalence and prognostic value of polyvascular disease for long-term outcomes after valvular heart surgery.

Methods: Patients receiving valvular heart surgery at two tertiary centres from January 1, 2010 to December 31, 2021 were identified. We examined the effect of atherosclerotic disease in three major vascular beds, including coronary artery disease (CAD), ischaemic cerebrovascular accidents (CVA) and peripheral vascular disease (PVD), on postoperative major adverse cardiac events (MACE) and all-cause mortality. Polyvascular disease was defined as atherosclerotic disease in ≥2 vascular beds.

Results: Of 3843 patients (mean age 58 ± 13 years; 52% male), 1266 (33%) had atherosclerotic disease in ≥1 vascular beds, including 207 (5.4%) with polyvascular disease. Patients with vascular disease were older with more comorbidities, higher surgical risk and more aortic stenosis. Over a median follow-up of 6.37 years (IQR: 3.40-9.54), patients with polyvascular disease had the greatest long-term MACE risk [HR: 1.68 (1.35-2.10)], followed by those with monovascular disease [HR: 1.43 (1.24-1.65)]. Both monovascular and polyvascular disease independently predicted mortality and MACE. Patients with extracardiac vascular disease had independently greater long-term MACE risk than CAD [HR: 1.56 (1.27-1.92)].

Conclusion: Patients undergoing valvular heart surgery exhibit a high prevalence of vascular disease. The risk of adverse outcomes rises with both the presence and extent of vascular disease, and extracardiac vascular disease confers greater risk of MACE than CAD.

Cardiovascular diseases (CVD), including pre-existing cardiac conditions and hypertensive disorders of pregnancy, are among the leading causes of maternal mortality globally and account for a substantial proportion of preventable deaths in low- and middle-income countries (LMICs). In these settings, women are disproportionately affected by conditions such as rheumatic heart disease, peripartum cardiomyopathy, and severe anemia-related heart failure, yet clinical guidance tailored to LMICs contexts remains limited. This paper presents the findings of a scoping review on CVD in pregnancy guidelines in LMICs. The review seeks to identify and map clinical guidelines from LMICs and international organizations with reach in LMICs that addresses the prevention, screening, and management of cardiovascular diseases (CVD) in pregnancy and examine their scope, content, and specific recommendations for pregnant women. The review followed the JBI methodology. Guidelines on CVD care in pregnancy published between 2011 and 2023 by international or national professional organizations and Ministries of Health from LMICs were searched using databases such as PubMed, Scopus, GIN International library, and individual websites. Data were extracted using a custom-designed MS Excel form, capturing details such as guideline title, year, type, publisher, country, target audience and population, clinical focus, timing, and summary of recommendations. Out of the 90 shortlisted guidelines, 17 were included and 73 were excluded. Of the included guidelines, 3 are on CVDS and 14 are on hypertensive disorders of pregnancy (HDP). They varied in scope, with most focusing on preeclampsia or HDP, but only a few provided comprehensive recommendations across the continuum of cardiovascular care in pregnancy, highlighting major gaps in prevention, screening, and long-term follow-up. Existing guidance remains fragmented with limited coverage of high-burden conditions of LMICs such as rheumatic heart disease. Strengthening clinical practice will require not only adapting global recommendations to local realities but also investing in LMIC-led research and inclusive guideline development that reflects regional priorities and health system capacities.

Obesity is a growing global epidemic with significant implications for cardiovascular diseases (CVD). It couples as an independent risk factor and driver for multiple pathways leading to CVDs. Here we examine obesity's impact on CVD and propose actionable strategies. Data from the NCD Risk Factor Collaboration (NCD-RisC), Global Burden of Disease (GBD) survey, and regional health surveys databases were used. We examined trends in obesity prevalence and CVD mortality attributable to high body mass index (BMI), disaggregated by sex, geography, socioeconomic status, and urban-rural residence. Evidence from national policy initiatives and clinical management guidelines was also reviewed. As of 2022, over 1 billion people globally were living with obesity. Since 1990 the age-standardised obesity prevalence has doubled among women (from 8.8% to 18.5%) and tripled among men (from 4.8% to 14%). Globally, the number of annual CVD deaths attributable to high BMI (25 kg/m² or over) more than doubled between 1990 and 2021, reaching 1.9 million in 2021. Reducing global obesity to 2019 levels could save an estimated US$2.2 trillion annually by 2060. Positive steps have been made in recent years, with the implementation of several global, national and local initiatives that show promise in tackling obesity and CVDs, in addition to the emergence of potentially game-changing medical interventions, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs). Yet, to tackle obesity and associated CVD, there is a need for a holistic approach across clinical and public health interventions that accounts for the multiple determinants of obesity. We recommend the implementation of evidence-based, cost-effective public health measures, and the incorporation of obesity-specific recommendations into cardiovascular guidelines. Addressing the global cardiovascular crisis linked to obesity will require coordinated efforts from policymakers, healthcare systems, and global health organisations.

Background: The burden of degenerative valve disease is increasing globally because of population aging. However, data on this condition is scarce in Nigeria and across Africa.

Objective: Our study evaluated the prevalence, pattern, and associations of aortic sclerosis and degenerative valve disease in a Nigerian population.

Methods: Data of a total of 4030 patients were analyzed retrospectively from the Federal Medical Centre Abuja transthoracic echocardiographic registry from January 2020 to December 2024. Patients were 18 years and above. Aortic sclerosis, degenerative mitral valve disease, calcific aortic valve disease, and degenerative valve disease were defined in accordance with the report of the American Heart Association/American College of Cardiology guidelines.

Results: The mean age of patients was 52 ± 15 years and 53.2% were female. The prevalence rates were 4.2% for aortic sclerosis, 0.2% for degenerative mitral valve disease, 1.2% for calcific aortic valve disease, and 1.3% for degenerative valve disease. Among patients aged 65 years and older, the prevalences rates were higher for aortic sclerosis (13.2%), degenerative mitral valve disease (1.0%), calcific aortic valve disease (3.4%), and degenerative valve disease (3.9%) [P < 0.001]. Only 1.7% and 0.6% of those <65 years had aortic sclerosis and calcific aortic valve disease, respectively. Patients aged 65 years and older, and hypertension had odds ratio (OR) of 7.99 and 3.98 for developing aortic sclerosis, respectively. For calcific aortic valve disease, the OR was higher for patients aged 65 years and older (OR: 4.25), hypertension (OR: 2.48), and left ventricular hypertrophy (OR: 5.35) [P < 0.001].

Conclusion: In this Nigerian echocardiographic registry, age above 65 years and hypertension were associated with aortic sclerosis and calcific aortic valve disease.

Background: Long-term adverse consequences of the COVID-19 infection affect many organ systems, which requires comprehensive understanding of the disease burden and determinants of persistent long COVID-19 symptoms in diverse population. However, data on long COVID complications are sparse, particularly from low- and middle-income countries (LMICs). The World Heart Federation (WHF) global study assessed the incidence of vascular complications, persistent long COVID symptoms and factors associated with mortality and major adverse cardiovascular events (MACE) among patients with COVID-19 up to one year after hospitalization.

Methods: We recruited a total of 2535 patients hospitalized with COVID-19 and followed up to one-year post-hospital discharge. We collected data on long COVID symptoms, quality of life, and clinical outcomes, including new onset diseases, MACE, and mortality at 1-, 3-, 6-, and 9-12 months post-discharge. Descriptive and generalized estimating equation (GEE) regression analysis was performed to assess the factors associated with mortality and MACE.

Findings: The majority of participants were recruited from LMICs (64%) and male (56%) with a mean (SD) age of 59.5 (20.0) years. Among those tested for COVID-19 strain (52%), Omicron strain was the most prevalent (98%). The follow-up rate at one year was 90%. Over half of the participants (56%) reported experiencing at least one major long COVID symptom (fatigue, breathlessness, anxiety, chest pain, and palpitations) at 1-month, and one-quarter participants reported persistent long COVID symptoms at 9-12 months. On the EQ-5D scale, 49% reported difficulties in usual activities, 33% reported anxiety/depression, and 23% reported problems in mobility within the first 6 months. The most frequent new-onset illnesses were pulmonary embolism (8%), kidney disease (4%), and hypertension (3%). The cumulative all-cause mortality rate was 15% (n = 382) at one-year post-discharge. Long COVID symptoms were more common among females, individuals with pre-existing comorbidities, and those with more severe acute illness. Age, obesity, ICU admission, and underlying cardiovascular or pulmonary disease were associated with increased risk of mortality and MACE.

Conclusion: The study showed a substantial burden of mortality and morbidity, and a quarter of patients reported at least one persistent long COVID symptom after one year. Our findings underscore the need for early identification and management of long COVID symptoms in LMICs.

Objective: We performed a within-trial cost-effectiveness analysis of a targeted family-based structured lifestyle modification intervention for cardiovascular risk reduction.

Research design and methods: The PROLIFIC study was an open-label, cluster randomised controlled trial in the families (first-degree relatives and spouses older than age 18 years) of individuals with premature coronary heart disease. Families in the intervention group received a comprehensive package of interventions facilitated by non-physician health workers: screening for cardiovascular risk factors, structured lifestyle interventions, linkage to a primary healthcare facility for individuals with established chronic disease risk factors or conditions, and active follow-up for adherence. The usual care group received one-time counselling and annual screening for risk factors. The cost was estimated from a health system perspective, including intervention and treatment costs. Effectiveness was measured as changes in risk factors and quality-adjusted life years (QALYs) elicited using the EQ-5D-5 L instrument. The time horizon was two years, and we performed one-way and probabilistic sensitivity analyses.

Results: Over two years, the incremental cost for the intervention compared to usual care was Int$ 157.5 per person (intervention group: Int$ 381.6, usual care group: Int$ 224.1), and the incremental QALY gain was 0.014 (0.0166 Vs 0.0027). The within-trial ICER was 11,352 Int$/QALY. Incremental cost per unit reduction in systolic blood pressure, fasting plasma glucose, HbA1c, total cholesterol, and waist circumference were Int$ 28.5, 26.9, 130.8, 178.7, and 39.8, respectively.

Conclusions: A family-based structured lifestyle modification program yields a net gain in quality of life and is cost-effective at a three times gross domestic product per capita threshold. The intervention is expected to be relatively more cost-effective when scaled up to larger populations over longer time horizons. The intervention has the potential for a substantial public health impact if adopted as a strategy at the state or national level.Trial Registration Number: Clinicaltrials.gov, NCT02771873.