Global Heart最新文献

Background: Heart failure (HF) affects approximately 64.3 million people worldwide. Despite notable progress over the past two decades in advancing the understanding of heart failure in Africa-a condition often more lethal than many cancers-important knowledge gaps persist. These include outdated data on access to care and a lack of information regarding the incidence, aetiology, availability, and affordability of HF medications.

Objectives: To prospectively characterise the contemporary incidence, epidemiology, clinical presentation, and health outcomes of acute HF among a large, representative cohort of patients presenting to hospitals across diverse communities in Africa.

Methods: The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF II) is a pragmatic, multicentre, observational cohort study coordinated by the Pan-African Society of Cardiology (PASCAR). All 27 PASCAR member countries were invited to participate, along with over 5,000 clinicians from the PASCAR database. The survey comprises two components. First, a platform collecting data on each hospital's catchment population, human resources, presence of specialised cardiology services, availability of diagnostic tools, and access to essential heart failure treatments. Second, a prospective observational study capturing all acute heart failure presentations to participating hospitals over seven weekdays within an 8-week period (from the start of surveillance). Data were collected on clinical characteristics and outcomes to discharge, 30 days, and six months. The study commenced in mid-2024 and includes approximately 50 hospitals across 16 countries spanning all major regions of the African continent.

Conclusions: When completed, THESUS-HF II will be the largest and most comprehensive study of acute HF to date in Africa. It will provide invaluable insights into the contemporary characteristics and burden of acute HF in Africa, whilst indicating what is needed to improve health care planning and, ultimately, patient outcomes.

Background: Elevated low-density lipoprotein cholesterol (LDL-C) levels are a leading risk factor for atherosclerotic cardiovascular disease (ASCVD), a major global cause of illness and death. Patients' qualitative insights about experiences, priorities, and needs are essential for creating more targeted, patient-centered quality improvement interventions.

Objectives: To document the experiences of people with high levels of low-density LDL-C in three countries.

Methods: Qualitative study of 60-min in-depth interviews with 50 adult patients from Australia, Brazil, and the United States. The study was overseen by a Steering Committee comprising patients, patient advocates, researchers, and cardiologists. The interviews explored pathways and barriers to high LDL-C diagnosis; the burden of managing high LDL-C and the awareness of the association between high LDL-C and cardiovascular risks. The data were analyzed by applying a structured, team-based approach to coding qualitative data.

Results: There were three main pathways to diagnosing high cholesterol: routine physical exams conducted by primary care providers; symptomatic presentations or incidental findings during emergency visits and through a healthcare visit for another condition, frequently diabetes. Healthcare providers' communication styles influenced patients' perceptions of their conditions. Two-thirds of participants (n = 33) attempted lifestyle changes after their high cholesterol diagnosis, but work schedules and daily routines posed barriers to maintaining healthy habits. Some participants who experienced ASCVD events waited hours or days before seeking care, assuming their symptoms were not serious. After diagnosis of an ASCVD event, many patients feared death and worried about their families' futures. When asked about potential improvements to their current therapy, 21 patients mentioned reduced administration frequency.

Conclusions: This pilot study provides insights into patients' experiences living with and managing elevated LDL-C. It describes opportunities for policymakers and healthcare providers to improve the detection of elevated LDL-C and support patients in understanding risks and strategies for reducing the risk of ASCVD events.

Introduction: The high burden of blood pressure-related cardiovascular diseases in Bangladesh is potentially caused by excessive dietary sodium and insufficient potassium intake. Our objective is to estimate dietary salt and potassium intake among Bangladesh rural and urban adults from urinary excretion of sodium and potassium.

Methods: We conducted a cross-sectional study between December 2017 and June 2018, including participants aged 30-59 years from three urban and three rural sites in Bangladesh. Data included urinary excretion of sodium and potassium estimated from one 24-hr urine collection and blood pressure measurements.

Results: Among 840 enrolled participants, complete data was available in 509 individuals. Mean age was 43.0 (SD ±7.9) years; 20.9% had hypertension, 50.9% were women, and 50.9% resided in urban areas. Mean systolic and diastolic blood pressure were 118.6 (SD ± 16.6) mmHg and 76.3 (SD ± 11.3) mmHg, respectively. Overall, the mean urinary sodium excretion was 3.9 g/day (95% CI = 3.8 to 4.0), corresponding to a mean salt intake of 9.7 g/day (95% CI = 9.4-10.1). Mean urinary potassium excretion was 1.4 g/day (95% CI = 1.3-1.4), corresponding to an estimated mean dietary potassium intake of 2.0 g/day. Men and urban residents had slightly but non-significantly higher sodium and potassium excretion than women and rural residents.

Conclusion: In Bangladesh, salt intake exceeded WHO's recommended <5g/day limit, while potassium intake was substantially lower than the recommended intake of ≥ 3.5g/day for adults. Promoting low-sodium and potassium-rich diets through nationwide campaigns and policies, including advocating for accessible low-sodium and potassium-enriched salt substitutes, is recommended to mitigate cardiovascular disease risks.

Background: The prevalence of hypertension (HT) and blood pressure (BP) control varies among ethnic-racial groups, but studies on this issue and correlations between BP and body mass index (BMI) in the black Brazilian population are scarce.

Methods: Cross-sectional study in individuals included in the First Brazilian Hypertension Registry. Relationships between variables were analysed by a binary logistic regression analysis.

Results: The study evaluated 2.191 (82.9%) non-Afro-descendant participants and 452 (17.1%) Afro-descendants. The median age was 61.9 years (55.3% women), the BMI was 28.4 kg/m² and the waist circumference (WC) was 93 cm in the former cohort. In the Afro-descendant group, the median age was 62.5 years (57.5% women), the was BMI 29.8 kg/m² and the was WC 98 cm. A significant correlation was identified between BMI and office diastolic BP (DBP) (R = 0.126; p = 0.007) in Afro-descendants. These individuals had 1.40 times the chance of being obese compared to those of other ethnicities (95% CI: 1.14-1.72; p < 0.001). Afro-descendant men had 0.78 times fewer chance of being obese compared to women (95% CI: 0.66-0.90; p = 0.002), and 1.49 times higher chance (95% CI = 1.21-1.82; p < 0.001) of having uncontrolled BP, with no differences with Afro-descendant women (HR 0.91; 95% CI = 0.78-1.07; p < 0.258).

Conclusion: No correlations were found between office BP, BMI and WC, except for a very weak correlation between DBP and BMI in the Brazilian Afro-descendants, although they were 1.40 times more likely to be obese. In contrast, a significant correlation between SBP and BMI was observed in the non-Afro-descendants. Differences in blood pressure control were not identified between the sexes within each group, but only between ethnic groups, with people of African descent having a 1.49 times greater risk of uncontrolled hypertension compared to non-Afro-descendants.

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Most people can reduce their CVD risk through lifestyle improvements and medication. Having low health literacy is a barrier to CVD prevention and management and is associated with worse health outcomes. Knowledge is a key component of health literacy, but there is no standard way for clinicians to assess this to tailor education about CVD. The aim of this review was to identify available CVD knowledge tests and evaluate their quality.

Methods: Electronic database searches were conducted using Medline, CINAHL, PsycINFO and PsycTESTS between inception and October 2022. Identified tools were assessed using the Psychometric Grading Framework (PGF) to assess the quality of included tests.

Results: A total of 28 studies were identified, of which 18 were original test development papers and 10 were language translation papers. The five most common domains were CVD risk factors, nutrition, heart physiology, physical activity, and treatment options. Three papers achieved an A grading on the PGF. Only one test provided a guide to classify patients based on the results.

Conclusions: This review identified 15 additional knowledge assessment tools compared to previous research, including some available in multiple languages. Clinicians can access a wide range of CVD knowledge assessment tools to understand and respond to patient knowledge levels, but some are higher quality than others. Alternative tools may be needed to assess specific risk factor and condition knowledge. Further work is needed to tailor CVD knowledge tests for populations lower health literacy, and to validate the tests against health outcomes to improve clinical practice.

Prospero: CRD42022370227.

What is known: Having low health literacy is associated with worse cardiovascular outcomes.Knowledge is a key component of health literacy, but there is no standard way to assess this for CVD.An assessment of the quality and reliability of CVD knowledge tests could support clinicians to tailor patient education to health literacy needs.

What the study adds: We identified 15 additional tests development papers that were not captured in earlier reviews of CVD knowledge tests.There are multiple high quality CVD knowledge tests available to clinicians, and tests available in different languages.These tests may be used to tailor patient education to individual health literacy needs.

Background: Pulmonary arterial hypertension (PAH) is a severe vascular disorder with a multifactorial etiology, including potential genetic predispositions. Understanding the causal relationship between autoimmune diseases and the risk of developing PAH can inform clinical strategies for prevention and treatment.

Methods: We conducted a two-sample Mendelian Randomization (MR) analysis to evaluate the causal effect of genetic predisposition to five autoimmune diseases (systemic lupus erythematosus [SLE], rheumatoid arthritis [RA], inflammatory bowel disease [IBD], multiple sclerosis [MS], and type 1 diabetes [T1D]) on the risk of PAH. This involved employing various MR methods (IVW, MR-Egger, Weighted median, Simple mode, and Weighted mode), as well as conducting tests for heterogeneity and horizontal pleiotropy.

Results: The analysis revealed a significant association between genetic predisposition to RA and IBD with an increased risk of PAH (RA: OR = 1.28, 95% CI [1.01-1.61], p = 0.042; IBD: OR = 1.29, 95% CI [1.01-1.64], p = 0.043). However, no association was observed between genetically determined MS, SLE, and T1D with the risk of PAH (MS: p = 0.876; SLE: p = 0.564; T1D: p = 0.061). Additionally, tests for heterogeneity and pleiotropy provided no evidence of their influence, suggesting the robustness of these associations. Reverse MR analysis also indicated no significant effect of PAH on the genetic susceptibility to these autoimmune diseases.

Conclusion: The findings suggest a possible genetic causative link between RA and IBD and the risk of developing PAH. Conversely, genetic predisposition to MS, SLE, and T1D does not appear to influence PAH risk. Understanding these relationships may offer insights into the pathophysiology of PAH and inform screening strategies within at-risk populations.

Background and aim: Cardiovascular diseases (CVD), including coronary artery disease (CAD), myocardial infarction (MI), atrial fibrillation (AF), and ischemic stroke (IS), are major causes of morbidity and mortality worldwide. Immune cells play crucial roles in CVD, but causal links between immune cell subtypes and CVD risk remain unclear. This study used Mendelian randomization (MR) to investigate these associations.

Methods and results: Exposure data were analyzed with a P < 1 × 10^-5 threshold, excluding linkage disequilibrium SNPs. MR of 731 immune cell types used the inverse variance weighted (IVW) method, with pleiotropy and heterogeneity tests. Lipid profiles (HDL, LDL, VLDL, triglycerides) were assessed as mediators.Increased CD27 on unswitched memory B cells, CD28^- DN T cells, and CX3CR1 on CD14^- CD16⁺ monocytes raised CVD risk, while CD28 on Tregs and HLA DR⁺⁺ monocytes were protective. For CAD, CD24⁺ CD27⁺ %B cells and SSC-A on HLA DR⁺ NK cells were protective, with certain T cells increasing risk. Similar trends were observed for MI, AF, and IS. Reverse MR showed no CVD effects on these positive immune traits. Lipid profiles mediated CVD risk, with HDL protective and LDL, VLDL, and triglycerides increasing risk. Mediation analyses showed LDL and triglycerides partially mediated CX3CR1-monocyte effects on MI risk. Functional enrichment identified cytokine signaling and inflammation in CVD.

Conclusions: Our findings highlight immune cell subtypes and lipid traits in CVD risk. Regulatory T cells and protective phenotypes are therapeutic targets, while LDL and triglycerides mediate immune-disease pathways, emphasizing immune-lipid interactions for targeted therapies.

Background: Available evidence suggests that the epidemiology of heart failure (HF) in sub-Saharan Africa (SSA) might be changing. However, there is a scarcity of contemporary data on the epidemiology and prognosis of hospitalized HF patients in Cameroon despite improvements in the treatment of HF and the changing epidemiology of HF in SSA in the last decade.

Objective: To examine the contemporary characteristics, the in-hospital outcomes, and their predictors in patients hospitalized for decompensated HF in Buea, South West region of Cameroon.

Methods: We conducted an observational prospective cohort study. We included consecutive patients hospitalized for HF from March 2021 to March 2024. Multivariate logistic regression analyses were performed to determine factors associated with in-hospital mortality and prolonged length of hospital stay (LOS). A p-value < 0.05 was considered statistically significant.

Results: Out of the 477 patients included, 254 (53.2%) were females. The mean age was 60.3 ± 16.5 years. The most common co-morbidities were hypertension (55.6%), atrial fibrillation (20.8%), diabetes mellitus (17.6%), and chronic kidney disease (14.1%). The most common causes of heart failure were hypertensive heart disease (41.7%), ischemic heart disease (15%), cor pulmonale (11.9%), and dilated cardiomyopathy (9%). The median length of stay (LOS) was seven days. Factors that increased odds of prolonged LOS were atrial fibrillation (OR = 2.04, CI: 1.26-3.35; p = 0.005). Factors that reduced odds of prolonged LOS were valvular heart disease (VHD) (OR = 0.49, CI: 0.26-0.91; p = 0.023), systolic blood pressure (SBP) (OR = 0.99 per 1 mmHg increment, CI: 0.98-0.99; p = 0.005), and natremia (OR = 0.96 per 1 unit increment, CI: 0.93-0.99; p = 0.010). In-hospital mortality was 11.9%. Factors that increased odds of in-hospital mortality were VHD (OR = 2.40, CI: 1.02-5.64; p = 0.045) and dobutamine administration (OR = 4.37, CI: 1.11-17.16; p = 0.034). Factors that reduced odds of mortality were SBP (OR = 0.99, CI = 0.98-0.99; p = 0.033), natremia (OR = 0.93, CI: 0.89-0.97; p < 0.001), and glomerular filtration rate (OR = 0.98 per 1 unit increment, CI: 0.97-0.99; p = 0.001).

Conclusion: The causes of HF are still predominantly hypertensive, but there is an increasing contribution of ischemic heart disease. There is a need to improve hypertension control and other risk factors for ischemic heart disease in SSA.

Objective: This study aimed to assess the feasibility and cost-effectiveness of hand-held echocardiography-based screening for Stage B or C heart failure among individuals with hypertension and/or diabetes at the High-tech Area Fangcao Community Health Service Center and the Tianfu New Area Huayang Community Health Service Center in Chengdu, China, with the objective of promoting early diagnosis and intensified care.

Methods: Patients with hypertension and/or diabetes registered and cared for at two community health service centers (CHSCs; Chengdu, China) with no history of clinical heart failure were recruited between October 2021 and December 2021. By combining symptom assessment (dyspnea and/or edema) and N-terminal-probrain natriuretic peptide (NT-proBNP ≥ 125 pg/ml as the cut-off) levels with HHE for any indexed abnormality in the dedicated semi-quantitative protocol, patients were categorized into heart failure (HF) Stages A, B, and C. The diagnostic accuracy and cost-effectiveness of several pre-specified screening strategies were compared.

Results: Of the 423 patients (70 ± 9 years; males, 46.6%) enrolled, 166 (39.2%) were symptomatic and 106 (25.1%) exhibited elevated NT-proBNP levels. Hand-held echocardiography (HHE) abnormalities were detected in 286 (67.0%) patients, with interventricular septum thickening (47.0%) being the most common finding, followed by left atrial enlargement (30.0%). Left ventricular systolic dysfunction was identified in 18 (4.3%) patients. A total of 240 (56.7%) patients were reclassified as HF Stage B and 59 (13.9%) as Stage C. The stepwise strategy of using symptoms for initial stratification, followed by the selection of HHE or NT-proBNP in different circumstances, resulted in 100% accuracy and a 31.3% reduction in costs.

Conclusions: HHE-based focused HF screening allows for the early identification of numerous cases of Stage B and mild Stage C HF in high-risk populations. A stepwise screening strategy incorporating symptoms, NT-proBNP, and HHE is feasible and cost-effective and should be adopted in community-based primary care settings.