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Goldstein D, Kiplagat J, Taderera C, Whitehouse ER, Chimbetete C, Kimaiyo S, Urasa S, Paddick SM, Godfrey C. Person-centred care for older adults living with HIV in sub-Saharan Africa. Lancet HIV 2024:S2352-3018(24)00123-1. [PMID: 38996592 DOI: 10.1016/s2352-3018(24)00123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 07/14/2024]
Abstract
More than a fifth of people living with HIV in the US President's Emergency Plan for AIDS Relief-supported programmes are older individuals, defined as aged 50 years and older, yet optimal person-centred models of care for older adults with HIV in sub-Saharan Africa, including screening and treatment for geriatric syndromes and common comorbidities associated with ageing, remain undefined. This Position Paper explores the disproportionate burden of comorbidities and geriatric syndromes faced by older adults with HIV, with a special focus on women. We seek to motivate global interest in improving quality of life for older people with HIV by presenting available research and identifying research gaps for common geriatric syndromes, including frailty and cognitive decline, and multimorbidity among older people with HIV in sub-Saharan Africa. We share two successful models of holistic care for older people with HIV that are ongoing in Zimbabwe and Kenya. Lastly, we provide policy, research, and implementation considerations to best serve this growing population.
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Affiliation(s)
- Deborah Goldstein
- Office of HIV/AIDS, US Agency for International Development, Washington, DC, USA.
| | - Jepchirchir Kiplagat
- Moi University, College of Health Sciences, Eldoret, Kenya; USAID AMPATH Uzima, Eldoret, Kenya
| | | | | | | | - Sylvester Kimaiyo
- Moi University, College of Health Sciences, Eldoret, Kenya; USAID AMPATH Uzima, Eldoret, Kenya
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Stella-Maria Paddick
- Translational and Clinical Medicine Research Institute, Newcastle University, Newcastle, UK
| | - Catherine Godfrey
- Global Health Security and Diplomacy Bureau, Department of State, Washington, DC, USA
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2
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Timóteo AT, Barbas Albuquerque F, Lacerda Teixeira B. Pericardium, epicardial adipose tissue, and heart failure with preserved ejection fraction: Pathophysiology, quantification and treatment target. Int J Cardiol 2024; 412:132303. [PMID: 38944349 DOI: 10.1016/j.ijcard.2024.132303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 05/15/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
Heart failure is an important cause of mortality and morbidity worldwide. Heart failure with preserved ejection fraction (HFpEF) incidence and prevalence is increasing, and the phenotype associated with obesity is the most frequent. Epicardial adipose tissue (EAT) is directly associated with systemic obesity and several previous studies have shown a clear link between EAT and HFpEF. Moreover, the restriction induced by the pericardium is also linked to HFpEF. In this review we will describe the epidemiological association between the pericardium, EAT and HFpEF, how to quantify EAT, what are the pathophysiological mechanism to explain theses association and how can the pericardium and EAT be a treatment target in patients with HFpEF.
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Affiliation(s)
- Ana Teresa Timóteo
- Cardiology Department, Santa Marta Hospital, Unidade Local de Saúde São José, Lisbon, Portugal; NOVA Medical School, NOVA Lisbon University, Portugal.
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Vervoort D, Wang R, Li G, Filbey L, Maduka O, Brewer LC, Mamas MA, Bahit MC, Ahmed SB, Van Spall HGC. Addressing the Global Burden of Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol 2024; 83:2690-2707. [PMID: 38897679 DOI: 10.1016/j.jacc.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 06/21/2024]
Abstract
Cardiovascular diseases (CVDs) are responsible for approximately 35% of all deaths in women. In 2019, the global age-standardized CVD prevalence and mortality of women were 6,403 per 100,000 and 204 per 100,000, respectively. Although the age- and population-adjusted prevalence has decreased globally, opposite trends are evident in regions of socioeconomic deprivation. Cardiovascular health and outcomes are influenced by regional socioeconomic, environmental, and community factors, in addition to health care system and individual factors. Cardiovascular care in women is commonly plagued by delayed diagnoses, undertreatment, and knowledge gaps, particularly in women-specific or women-predominant conditions. In this paper, we describe the global epidemiology of CVD and highlight multilevel determinants of cardiometabolic health. We review knowledge and health care gaps that serve as barriers to improving CVD outcomes in women. Finally, we present national, community, health care system, and research strategies to comprehensively address cardiometabolic risk and improve outcomes in women.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ruoting Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Lynaea Filbey
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Omosivie Maduka
- Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Nigeria
| | - LaPrincess C Brewer
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Minnesota Center for Health Equity and Community Engagement Research, Rochester, Minnesota, USA
| | - Mamas A Mamas
- Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | | | - Sofia B Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Harriette G C Van Spall
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Ontario, Canada; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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4
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Jalloh MB, Bot VA, Borjaille CZ, Thabane L, Li G, Butler J, Zannad F, Granger CB, Van Spall HGC. Reporting quality of heart failure randomized controlled trials 2000-2020: Temporal trends in adherence to CONSORT criteria. Eur J Heart Fail 2024; 26:1369-1380. [PMID: 38623814 DOI: 10.1002/ejhf.3229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/25/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
AIM Heart failure (HF) is a major cause of morbidity and mortality in older adults. Randomized controlled trials (RCTs) inform HF policy and practice, but the accurate interpretation of results is contingent on clear and transparent reporting. The CONsolidated Standards Of Reporting Trials (CONSORT) statement serves as a guide to RCT reporting. We evaluated the quality of reporting in HF RCTs in high-impact journals by assessing their adherence to CONSORT. METHODS AND RESULTS We searched MEDLINE, EMBASE and CINAHL for HF RCTs published in high-impact journals 2000-2020. We assessed the proportion of CONSORT criteria that individual HF RCTs adhered to, and used the Jonckheere-Terpstra test to examine temporal trends in adherence. Multivariable linear regression explored the association between trial characteristics and adherence to CONSORT. Primary analysis assessed adherence to CONSORT 2010 update. A sensitivity analysis assessed adherence to the original (1996) CONSORT criteria. Among 221 RCTs analysed, the mean (standard deviation [SD]) adherence was suboptimal overall (mean [SD] adherence 69.7 [11.5]%) (5513/7913 criteria), with a temporal increase in adherence over the 20-year period (p < 0.001). Factors associated with adherence included publication after versus during/before 2010 (β = 10.17, 95% confidence interval [CI] 7.64-12.70; p < 0.001); two-group parallel individual-level randomization versus other (including multi-group or cluster randomization) (β = 5.81, 95% CI 2.88-8.73; p < 0.001); and multicentre versus single-centre trials (β = 7.26, 95% CI 3.25-11.27; p < 0.001). There was no difference in trial adherence to the updated CONSORT (2010) versus the original (1996) CONSORT criteria, and temporal trends in adherence to both sets of criteria were similar, likely due to overlap between the two sets of criteria. Trials with greater adherence to CONSORT were published in higher impact factor journals, with a positive correlation (r = 0.312; p < 0.001). CONCLUSION The quality of reporting in HF RCTs, as measured by CONSORT adherence, has improved over time but remains suboptimal.
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Affiliation(s)
- Mohamed B Jalloh
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Veronica A Bot
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joseph's, Hamilton, ON, Canada
| | - Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- University of Mississippi, Jackson, MS, USA
| | - Faiez Zannad
- Université de Lorraine, INSERM and Centre Hospitalier Régional Universitaire, Nancy, France
| | | | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joseph's, Hamilton, ON, Canada
- Baim Institute for Clinical Research, Boston, MA, USA
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5
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Guerra PG, Simpson CS, Van Spall HGC, Asgar AW, Billia P, Cadrin-Tourigny J, Chakrabarti S, Cheung CC, Dore A, Fordyce CB, Gouda P, Hassan A, Krahn A, Luc JGY, Mak S, McMurtry S, Norris C, Philippon F, Sapp J, Sheldon R, Silversides C, Steinberg C, Wood DA. Canadian Cardiovascular Society 2023 Guidelines on the Fitness to Drive. Can J Cardiol 2024; 40:500-523. [PMID: 37820870 DOI: 10.1016/j.cjca.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Cardiovascular conditions are among the most frequent causes of impairment to drive, because they might induce unpredictable mental state alterations via diverse mechanisms like myocardial ischemia, cardiac arrhythmias, and vascular dysfunction. Accordingly, health professionals are often asked to assess patients' fitness to drive (FTD). The Canadian Cardiovascular Society previously published FTD guidelines in 2003-2004; herein, we present updated FTD guidelines. Because there are no randomized trials on FTD, observational studies were used to estimate the risk of driving impairment in each situation, and recommendations made on the basis of Canadian Cardiovascular Society Risk of Harm formula. More restrictive recommendations were made for commercial drivers, who spend longer average times behind the wheel, use larger vehicles, and might transport a larger number of passengers. We provide guidance for individuals with: (1) active coronary artery disease; (2) various forms of valvular heart disease; (3) heart failure, heart transplant, and left ventricular assist device situations; (4) arrhythmia syndromes; (5) implantable devices; (6) syncope history; and (7) congenital heart disease. We suggest appropriate waiting times after cardiac interventions or acute illnesses before driving resumption. When short-term driving cessation is recommended, recommendations are on the basis of expert consensus rather than the Risk of Harm formula because risk elevation is expected to be transient. These recommendations, although not a substitute for clinical judgement or governmental regulations, provide specialists, primary care providers, and allied health professionals with a comprehensive list of a wide range of cardiac conditions, with guidance provided on the basis of the level of risk of impairment, along with recommendations about ability to drive and the suggested duration of restrictions.
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Affiliation(s)
- Peter G Guerra
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
| | | | - Harriette G C Van Spall
- McMaster University, Hamilton Health Sciences Centre, Hamilton, Ontario, Canada, and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Anita W Asgar
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Phyllis Billia
- University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Julia Cadrin-Tourigny
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Santabhanu Chakrabarti
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher C Cheung
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Annie Dore
- Université de Montréal, Institut de Cardiologie de Montréal, Montréal, Québec, Canada
| | - Christopher B Fordyce
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pishoy Gouda
- University of Alberta, Edmonton, Alberta, Canada
| | - Ansar Hassan
- Mitral Center of Excellence, Maine Medical Center, Portland, Maine, USA
| | - Andrew Krahn
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica G Y Luc
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susanna Mak
- University of Toronto, Sinai Health, Toronto, Ontario, Canada
| | | | | | - Francois Philippon
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - John Sapp
- Dalhousie University, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Hôpital Laval, Laval, Québec, Canada
| | - David A Wood
- Division of Cardiology and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Prasad SB, Atherton JJ. Learning from our differences: insights from a global heart failure registry. Lancet Glob Health 2024; 12:e344-e345. [PMID: 38218198 DOI: 10.1016/s2214-109x(23)00593-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024]
Affiliation(s)
- Sandhir B Prasad
- Department of Cardiology, Royal Brisbane and Women's Hospital and University of Queensland Faculty of Medicine, Brisbane, QLD 4029, Australia; School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital and University of Queensland Faculty of Medicine, Brisbane, QLD 4029, Australia; Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.
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7
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Averbuch T, Lee SF, Zagorski B, Mebazaa A, Fonarow GC, Thabane L, Van Spall HGC. Effect of a transitional care model following hospitalization for heart failure: 3-year outcomes of the Patient-Centered Care Transitions in Heart Failure (PACT-HF) randomized controlled trial. Eur J Heart Fail 2024; 26:652-660. [PMID: 38303550 DOI: 10.1002/ejhf.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/17/2023] [Accepted: 12/25/2023] [Indexed: 02/03/2024] Open
Abstract
AIMS Patients are at high risk of death or readmission following hospitalization for heart failure (HF). We tested the effect of a transitional care model that included month-long nurse-led home visits and long-term heart function clinic visits - with services titrated to estimated risk of clinical events - on 3-year outcomes following hospitalization. METHODS AND RESULTS In a pragmatic, stepped-wedge cluster randomized trial, 10 hospitals were randomized to the intervention versus usual care. The primary outcome was a composite of all-cause death, readmission, or emergency department (ED) visit. Secondary outcomes included components of the primary composite outcomes, HF readmissions and healthcare resource utilization. There were 2494 patients (50.4% female) with mean age of 77.7 years. The primary outcome was reached in 1040 (94.2%) patients in the intervention and 1314 (94.5%) in the usual care group at 3 years. The intervention did not reduce the risk of the primary composite outcome (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.81-1.05) nor the component outcomes overall, although numerically reduced the risk of ED visits in women but not men (HR 0.79, 95% CI 0.63-1.00 vs. HR 0.98, 95% CI 0.80-1.19; sex-treatment interaction p = 0.23). The uptake of guideline-directed medical therapy was no different with the intervention than with usual care, with the exception of sacubitril/valsartan, which increased with the intervention (3.3% vs 1.5%; relative risk 6.2, 95% CI 1.92-20.06). CONCLUSIONS More than 9 of 10 patients hospitalized for HF experienced all-cause death, readmission, or ED visit at 3 years. A transitional care model with services titrated to risk did not improve the composite of these endpoints, likely because there were no major differences in uptake of medical therapies between the groups. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02112227.
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Affiliation(s)
- Tauben Averbuch
- Department of Cardiology, University of Calgary, Calgary, AB, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton, ON, Canada
| | - Brandon Zagorski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Alexandre Mebazaa
- Department of Anesthesia and Critical Care-APHP, AM: Université Paris Cité; MASCOT Inserm, Paris, France
| | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute of St. Joe's, Hamilton, ON, Canada
| | - Harriette G C Van Spall
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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8
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Walli-Attaei M, Joseph P, Johansson I, Sliwa K, Lonn E, Maggioni AP, Mielniczuk L, Ross H, Karaye K, Hage C, Pogosova N, Grinvalds A, McCready T, McMurray J, Yusuf S. Characteristics, management, and outcomes in women and men with congestive heart failure in 40 countries at different economic levels: an analysis from the Global Congestive Heart Failure (G-CHF) registry. Lancet Glob Health 2024; 12:e396-e405. [PMID: 38218197 DOI: 10.1016/s2214-109x(23)00557-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND There is a paucity of data on the clinical characteristics, management, and outcomes of women compared with men with heart failure in low-income and middle-income countries compared with high-income countries. We examined sex differences in risk factors, clinical characteristics, and treatments, and prospectively assessed the risk of heart failure hospitalisation and mortality in patients with heart failure in 40 high-income, middle-income, and low-income countries. METHODS Participants aged 18 years or older with heart failure were enrolled from Dec 20, 2016, to Sept 9, 2020 in the prospective Global Congestive Heart Failure (G-CHF) study from 257 centres in 40 high-income, middle-income, and low-income countries. Participants were followed up until May 25, 2023. We recorded the demographic characteristics, medical history, and treatments of participants. We prospectively recorded data on heart failure hospitalisation and mortality by sex in the overall study, according to country economic status, and according to level of left ventricular ejection fraction (LVEF). FINDINGS 23 341 participants (9119 [39·1%] women and 14 222 [60·1%] men) were recruited and followed up for a mean of 2·6 years (SD 1·4). The mean age of women in the study was 62 years (SD 17) compared with 64 years (14) in men. Fewer women than men had an LVEF of 40% or lower (51·7% women vs 66·2% men). By contrast, more women than men had an LVEF of 50% or higher (33·2% women vs 18·6% men). Hypertensive heart failure was the most common aetiology in women (25·5% women vs 16·8% men), whereas ischaemic heart failure was the most common aetiology in men (45·6% men vs 26·6% women). Signs and symptoms of congestion were more common in women than men: 42·6% of women had a New York Heart Association functional class of III or IV compared with 37·9% of men. The use of heart failure medications and cardiac tests did not differ systematically between the sexes, although implantable cardioverter defibrillator (ICD) implantation was lower among women than men (8·7% women vs 17·2% men). The adjusted risk of heart failure hospitalisation was similar in women and men (women-to-men adjusted hazard ratio [HR] 0·99 [95% CI 0·92-1·05]). This pattern was consistent within groups of countries categorised by economic status, geographical region, and by LVEF level. However, women had a lower adjusted risk of mortality (women-to-men adjusted HR 0·79 [95% CI 0·75-0·84]) despite adjustments for prognostic factors-a pattern which was consistently observed across groups of countries irrespective of economic status, geography, and LVEF levels of patients. INTERPRETATION The underlying cause of heart failure and ejection fraction phenotype differ between women and men, as do the severity of symptoms. Heart failure treatments (except ICD use) were not consistently in favour of one sex. Paradoxically, while the rates of hospitalisations were similar among women and men, the risk of death was lower among women. These patterns were consistent regardless of the economic status of the countries. The higher mortality among men is unexplained and warrants further study. FUNDING Bayer.
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Affiliation(s)
- Marjan Walli-Attaei
- Population Health Research Institute and Hamilton Health Sciences, Hamilton, ON, Canada; Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Isabelle Johansson
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Karen Sliwa
- Cape Heart Institute, University of Cape Town, Cape Town, South Africa
| | - Eva Lonn
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Aldo P Maggioni
- ANMCO Research Center-Heart Care Foundation, Florence, Italy
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Heather Ross
- Peter Munk Cardiac Centre, Ted Rogers Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Kamilu Karaye
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Camilla Hage
- Karolinska Institutet, Department of Medicine, Cardiology Unit, Stockholm, Sweden
| | - Nana Pogosova
- Medical Research Center of Cardiology named after E.I. Chazov, Moscow, Russia
| | - Alex Grinvalds
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - John McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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9
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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10
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Wu S, Li Y, Zhang Y, Su X, Zuo Y, Chen G, Xu G, Chen S, He Y, Wang A. Sex and Age Differences in the Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and Heart Failure: A Prospective Cohort Study. Circ Heart Fail 2024; 17:e010841. [PMID: 38348678 DOI: 10.1161/circheartfailure.123.010841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/20/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Metabolic dysfunction-associated fatty liver disease (MAFLD) is a risk factor for heart failure (HF) occurrence, but it remains unclear whether the association between MAFLD and HF differs in different sexes and ages. METHODS A total of 96 576 participants of Kailuan Study were included. MAFLD was defined as presence of hepatic steatosis and metabolic dysfunction and classified as mild and significant by ultrasound. Hazard ratios (HRs) were calculated by Cox regression models. RESULTS After a median follow-up of 14.0 years, 2939 participants developed HF. Adjusting for confounding factors, mild-MAFLD (HR, 1.27 [95% CI, 1.16-1.39]) and significant-MAFLD (HR, 1.45 [95% CI, 1.31-1.63]) were associated with a higher risk of HF in all participants, and the risk differed by sex (Pinteraction<0.05) and age (Pinteraction<0.001). Compared with non-MAFLD participants, in women, significant-MAFLD was associated with an 84% (HR, 1.84 [95% CI, 1.43-2.37]) increased risk of HF; however, in men, the risk was 36% (HR, 1.36 [95% CI, 1.20-1.53]). In participants under 45 years, mild-MAFLD and significant-MAFLD had a 55% (HR, 1.55 [95% CI, 1.07-2.25]) and 172% (HR, 2.72 [95% CI, 1.87-3.97]) increased risk of HF; however, in participants over 65 years, even significant-MAFLD did not associate with a higher risk of HF (HR, 1.11 [95% CI, 0.92-1.34]). Afterwards, we stratified all participants by both sex and age and found that the risk of MAFLD-associated HF decreased with age in men (Pinteraction<0.05) and women (Pinteraction<0.05), but the sex difference in this risk was only present in participants younger than 45 years (Pinteraction<0.05). CONCLUSIONS MAFLD greatly increased the risk of HF in women, especially young women. With increasing age, MAFLD-related risk of HF decreased and the difference between men and women disappeared.
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Affiliation(s)
- Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China (S.W., S.C.)
| | - Yuhao Li
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.L., Y.Z., X.S., G.X.)
| | - Yijun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
| | - Xin Su
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.L., Y.Z., X.S., G.X.)
| | - Yingting Zuo
- Department of Clinical Epidemiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital (Y.Z.), Capital Medical University, China
| | - Guojuan Chen
- Department of Neurology, Beijing Tiantan Hospital (G.C., A.W.), Capital Medical University, China
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (G.C.), Capital Medical University, China
| | - Guozheng Xu
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, China (Y.L., Y.Z., X.S., G.X.)
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China (S.W., S.C.)
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, (Y.L., Y.Z., X.S., G.X., Y.H.), Capital Medical University, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital (G.C., A.W.), Capital Medical University, China
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11
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Yogeswaran V, Hidano D, Diaz AE, Van Spall HGC, Mamas MA, Roth GA, Cheng RK. Regional variations in heart failure: a global perspective. Heart 2023; 110:11-18. [PMID: 37353316 DOI: 10.1136/heartjnl-2022-321295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
Heart failure (HF) is a global public health concern that affects millions of people worldwide. While there have been significant therapeutic advancements in HF over the last few decades, there remain major disparities in risk factors, treatment patterns and outcomes across race, ethnicity, socioeconomic status, country and region. Recent research has provided insight into many of these disparities, but there remain large gaps in our understanding of worldwide variations in HF care. Although the majority of the global population resides across Asia, Africa and South America, these regions remain poorly represented in epidemiological studies and HF trials. Recent efforts and registries have provided insight into the clinical profiles and outcomes across HF patterns globally. The prevalence of HF and associated risk factors has been reported and varies by country and region ranges, with minimal data on regional variations in treatment patterns and long-term outcomes. It is critical to improve our understanding of the different factors that contribute to global disparities in HF care so we can build interventions that improve our general cardiovascular health and mitigate the social and economic cost of HF. In this narrative review, we hope to provide an overview of the global and regional variations in HF care and outcomes.
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Affiliation(s)
| | - Danelle Hidano
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andrea E Diaz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Newcastle, UK
| | - Gregory A Roth
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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12
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Averbuch T, Esfahani M, Khatib R, Kayima J, Miranda JJ, Wadhera RK, Zannad F, Pandey A, Van Spall HGC. Pharmaco-disparities in heart failure: a survey of the affordability of guideline recommended therapy in 10 countries. ESC Heart Fail 2023; 10:3152-3163. [PMID: 37646297 PMCID: PMC10567666 DOI: 10.1002/ehf2.14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/03/2023] [Accepted: 06/21/2023] [Indexed: 09/01/2023] Open
Abstract
AIMS Heart failure with reduced ejection fraction (HFrEF) is treatable but guideline-directed medical therapy (GDMT) may not be affordable or accessible to people living with the disease. METHODS AND RESULTS In this cross-sectional survey, we investigated the price, affordability, and accessibility of four pivotal classes of HFrEF GDMT: angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB) or angiotensin-neprilysin inhibitors (ARNI); beta-blockers; mineralocorticoid receptor antagonists (MRA); and sodium glucose co-transporter 2 inhibitors (SGLT2i). We sampled online or community pharmacies in 10 countries across a range of World Bank income groups, assessing mean 30 day retail prescription prices, affordability relative to gross national income per capita per month, and accessibility. We reported median price ratios relative to the International Reference Standard. We performed a literature review to evaluate accessibility to GDMT classes through publicly funded drug programmes in each country. HFrEF GDMT prices, both absolute and relative to the international reference, were highest in the United States and lowest in Pakistan and Bangladesh. The most expensive drug was the ARNI, sacubitril/valsartan, with a mean (standard deviation, SD) 30 day price ranging from $11.06 (0.81) in Pakistan to $611.50 (3.54) in United States. The least expensive drug was the MRA, spironolactone, with a mean (SD) 30 day price ranging from $0.18 (0.00) in Pakistan to $12.32 (0.00) in England. Affordability (SD) of quadruple therapy-ARNI, beta-blockers, MRA, and SGLT2i-was best in high-income and worst in low-income countries, ranging from 1.49 (0.00)% of gross national income per capita per month in England to 232.47 (31.47)% in Uganda. Publicly funded drug programmes offset costs for eligible patients, but ARNI and SGLT2i were inaccessible through these programmes in low- and middle-income countries. Price, affordability, and access were substantially improved in all countries by substituting ARNI for ACEi/ARB. CONCLUSIONS There was marked variation between countries in the retail price of HFrEF GDMT. Despite higher prices in high-income countries, GDMT was more accessible and affordable than in low- and middle-income countries. Publicly funded drug programmes in lower income countries increased affordability but limited access to newer HFrEF GDMT classes. Pharmaco-disparities must be addressed to improve HFrEF outcomes globally.
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Affiliation(s)
- Tauben Averbuch
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Meisam Esfahani
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Rani Khatib
- Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
- Department of CardiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - James Kayima
- Department of MedicineMakerere University College of Health SciencesKampalaUganda
- Department of CardiologyUganda Heart InstituteKampalaUganda
| | - Juan Jaime Miranda
- Department of Medicine, School of MedicineUniversidad Peruana Cayetano HerediaLimaPeru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano HerediaLimaPeru
- The George Institute for Global Health, University of New South WalesSydneyNew South WalesAustralia
| | - Rishi K. Wadhera
- Section of Health Policy and Equity at the Richard A. and Susan F. Smith Center for Outcomes ResearchBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Faiez Zannad
- Department of Cardiovascular DiseaseUniversity of LorraineVandoeuvre‐Les‐NancyFrance
| | - Ambarish Pandey
- Department of MedicineUniversity of Texas SouthwesternDallasTexasUSA
| | - Harriette G. C. Van Spall
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonOntarioCanada
- Research Institute of St. Joseph'sHamiltonOntarioCanada
- Population Health Research InstituteHamiltonOntarioCanada
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13
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Jalloh MB, Averbuch T, Kulkarni P, Granger CB, Januzzi JL, Zannad F, Yeh RW, Yancy CW, Fonarow GC, Breathett K, Gibson CM, Van Spall HGC. Bridging Treatment Implementation Gaps in Patients With Heart Failure: JACC Focus Seminar 2/3. J Am Coll Cardiol 2023; 82:544-558. [PMID: 37532425 PMCID: PMC10614026 DOI: 10.1016/j.jacc.2023.05.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 08/04/2023]
Abstract
Heart failure (HF) is a leading cause of death and disability in older adults. Despite decades of high-quality evidence to support their use, guideline-directed medical therapies (GDMTs) that reduce death and disease burden in HF have been suboptimally implemented. Approaches to closing care gaps have focused largely on strategies proven to be ineffective, whilst effective interventions shown to improve GDMT uptake have not been instituted. This review synthesizes implementation interventions that increase the uptake of GDMT, discusses barriers and facilitators of implementation, summarizes conceptual frameworks in implementation science that could improve knowledge uptake, and offers suggestions for trial design that could better facilitate end-of-trial implementation. We propose an evidence-to-care conceptual model that could foster the simultaneous generation of evidence and long-term implementation. By adopting principles of implementation science, policymakers, researchers, and clinicians can help reduce the burden of HF on patients and health care systems worldwide.
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Affiliation(s)
- Mohamed B Jalloh
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tauben Averbuch
- Department of Cardiology, University of Calgary, Calgary Alberta, Canada
| | | | - Christopher B Granger
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - James L Januzzi
- Baim Institute for Clinical Research, Boston, Massachusetts, USA; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Faiez Zannad
- Université de Lorraine, INSERM and Centre Hospitalier Régional Universitaire, Nancy, France
| | - Robert W Yeh
- Baim Institute for Clinical Research, Boston, Massachusetts, USA; Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Clyde W Yancy
- Baim Institute for Clinical Research, Boston, Massachusetts, USA; Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, Indiana, USA
| | - C Michael Gibson
- Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Baim Institute for Clinical Research, Boston, Massachusetts, USA; Research Institute of St Joseph's, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada.
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14
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Yang R, Huang J, Zhao Y, Wang J, Niu D, Ye E, Yue S, Hou X, Cui L, Wu J. Association of thiamine administration and prognosis in critically ill patients with heart failure. Front Pharmacol 2023; 14:1162797. [PMID: 37033650 PMCID: PMC10076601 DOI: 10.3389/fphar.2023.1162797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Thiamine deficiency is common in patients with heart failure, and thiamine supplement can benefit these patients. However, the association between thiamine administration and prognosis among critically ill patients with heart failure remains unclear. Thus, this study aims to prove the survival benefit of thiamine use in critically ill patients with heart failure. Methods: A retrospective cohort analysis was performed on the basis of the Medical Information Mart of Intensive Care-Ⅳ database. Critically ill patients with heart failure were divided into the thiamine and non-thiamine groups depending on whether they had received thiamine therapy or not during hospitalization. The association between thiamine supplement and in-hospital mortality was assessed by using the Kaplan-Meier (KM) method and Cox proportional hazard models. A 1:1 nearest propensity-score matching (PSM) and propensity score-based inverse probability of treatment weighting (IPW) were also performed to ensure the robustness of the findings. Results: A total of 7,021 patients were included in this study, with 685 and 6,336 in the thiamine and non-thiamine groups, respectively. The kaplan-meier survival curves indicated that the thiamine group had a lower in-hospital mortality than the none-thiamine group. After adjusting for various confounders, the Cox regression models showed significant beneficial effects of thiamine administration on in-hospital mortality among critically ill patients with heart failure with a hazard ratio of 0.78 (95% confidence interval: 0.67-0.89) in the fully adjusted model. propensity-score matching and probability of treatment weighting analyses also achieved consistent results. Conclusion: Thiamine supplement is associated with a decreased risk of in-hospital mortality in critically ill patients with heart failure who are admitted to the ICU. Further multicenter and well-designed randomized controlled trials with large sample sizes are necessary to validate this finding.
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Affiliation(s)
- Rui Yang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiasheng Huang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yumei Zhao
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jia Wang
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Dongdong Niu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Enlin Ye
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Suru Yue
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xuefei Hou
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lili Cui
- Guangdong Key Laboratory of Age-Related Cardiac and Cerebral Diseases, Institute of Neurology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- *Correspondence: Jiayuan Wu, ; Lili Cui,
| | - Jiayuan Wu
- Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Guangdong Engineering Research Center of Collaborative Innovation Technology of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- *Correspondence: Jiayuan Wu, ; Lili Cui,
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