Epidemiology of Cardiovascular Diseases in Morocco: A Systematic Review

Knowledge, attitudes, and practices of cardiac rehabilitation among physiotherapists in Morocco

Cardiovascular disease is a growing challenge worldwide, and Morocco is no exception. Despite its growing popularity, cardiac rehabilitation is still largely underutilized. In order to improve the provision of cardiac rehabilitation, a study of the knowledge, attitudes, and practices of physiotherapists in Morocco, key players in cardiac rehabilitation, is described. This assessment highlights existing skill gaps and enables the necessary corrective measures to be identified. This cross-sectional study included Moroccan physiotherapists working in different institutions (public and private) in different regions of Morocco. A total of 145 valid questionnaires were collected (33% response rate). The results showed that 72.4% of respondents had a medium level of knowledge of cardiac rehabilitation, 93.8% had a positive attitude, and 73% of physiotherapists said they sometimes practiced cardiac rehabilitation. Subgroup analysis showed that the lower the level of education, the more negative the knowledge and practice of rehabilitation. The results also showed that physiotherapists working in education sector and private clinics had better practice than those working in hospitals.

Predictors of mortality in heart failure patients with reduced or mildly reduced Ejection Fraction: The CASABLANCA HF Study

BACKGROUND

Heart failure (HF) poses a significant public health challenge throughout the world and Morocco. Our objective was to delineate the epidemiological characteristics of Moroccan patients living with chronic heart failure and to identify prognostic factors correlated with CHF mortality.

RESULTS

A total of 1344 patients participated in this study, with survival rates at 3, 6, and 10 years recorded at 75.2%, 60%, and 34%, respectively. During the follow-up, 886 patients succumbed, representing a mortality rate of 65.9%. A Cox regression model, utilizing baseline candidate variables, was developed to predict cardiovascular (CV) mortality. Predictors all of which had a P value less than 0.05 included age, left ventricular ejection fraction (EF) at commencement (< 35%), hypertension, male sex, anemia, creatinine levels, and the number of hospitalizations due to HF decompensation. Notably, the frequency of hospitalizations emerged as the most potent predictor of mortality, with an HR of 2.5 (95% CI [2-2.9]). Almost 90% of patients with three or more readmissions for HF decompensation experienced mortality by the follow-up's conclusion.

CONCLUSIONS

This study offers valuable insights into risk factors and clinical outcomes in HF patients in Morocco. Factors such as male gender, advanced age, a history of hypertension, lower systolic blood pressure, rehospitalizations for HF decompensation, low left ventricular ejection fraction, anemia, and elevated creatinine levels were associated with increased mortality. Medical and health services managers should be aware of the substantial burden and future challenges posed by HF in Morocco, prompting the adoption of multidisciplinary strategies for its management and care.

Biotechnological strategies overcoming limitations to H. pluvialis-derived astaxanthin production and Morocco's potential

Haematococcus pluvialis is the richest source of natural astaxanthin, but the production of H. pluvialis-derived astaxanthin is usually limited by its slow cell proliferation and astaxanthin accumulation. Efforts to enhance biomass productivity, astaxanthin accumulation, and extraction are ongoing. This review highlights different approaches that have previously been studied in microalgal species for enhanced biomass productivity, as well as optimized methods for astaxanthin accumulation and extraction, and how these methods could be combined to bypass the challenges limiting natural astaxanthin production, particularly in H. pluvialis, at all stages (biomass production, and astaxanthin accumulation and extraction). Biotechnological approaches, such as overexpressing low CO2 inducible genes, utilizing complementary carbon sources, CRISPR-Cas9 bioengineering, and the use of active compounds, for biomass productivity are outlined. Direct astaxanthin extraction from H. pluvialis zoospores and Morocco's potential for microalgal-based astaxanthin production are equally discussed. This review emphasizes the need to engineer an optimized H. pluvialis-derived astaxanthin production system combining two or more of these strategies for increased growth, and astaxanthin productivity, to compete in the larger, lower-priced market in aquaculture and nutraceutical sectors.

Genetically predicted cardiovascular diseases could increase the risk of erectile dysfunction: a bidirectional Mendelian randomization

PURPOSE

Erectile dysfunction (ED) often appears concomitantly with cardiovascular diseases (CVDs). However, the causal relationship between ED and CVDs is still unclear. This study aimed to investigate the causal effects between CVDs and ED using bidirectional Mendelian randomization (MR).

METHODS

ED data (6175 cases and 217,630 controls) were obtained from the IEU OpenGWAS project. Seven types of CVDs were acquired in our study, including stroke (Sample size = 440,328), myocardial infection (Sample size = 184,305), coronary heart disease (Sample size = 86,995), hypertension (Sample size = 36,683), heart failure (Sample size = 208,178), atrial fibrillation (Sample size = 1,030,836), and coronary artery disease (Sample size = 141,217). Inverse variance weighted (IVW) was selected as the primary method for MR analysis.

RESULTS

IVW results indicated that stroke (OR = 1.14, 95% CI = 1.02-1.29, P = 0.025), coronary artery disease (OR = 1.09, 95% CI = 1.02-1.16, P = 0.013), coronary heart disease (OR = 1.07, 95% CI = 1.01-1.13, P = 0.017), myocardial infection (OR = 1.09, 95% CI = 1.02-1.17, P = 0.011), and atrial fibrillation (OR = 1.06, 95% CI = 1.00-1.12, P = 0.04) were causally associated with ED. The reverse MR analysis suggested that ED did not influence the prevalence of CVDs.

CONCLUSION

These findings highlighted CVDs as causal risk factors for ED, but ED did not directly result in the development of CVDs. Regular monitoring of the erectile function of individuals with CVDs, along with implementing appropriate preventive measures, might help reduce the incidence of ED and enhance the sexual well-being of patients with CVDs.

Physical activity level and sedentary time determinants among Moroccan hypertensive patients

INTRODUCTION

Hypertension is closely associated with an inactive lifestyle. Physical activity and/or exercise have been shown to delay the development of hypertension. This study aimed to assess the level of physical activity and sedentary time, and its determinants among Moroccan Hypertensive patients.

PATIENTS AND METHODS

A cross-sectional study was conducted between March and July 2019 including 680 hypertensive patients. We administered international physical activity questionnaire in face-to-face interview to assess the level of physical activity and sedentary time.

RESULTS

The results showed that only 43.4% of participants met recommended physical activity levels (≥ 600 MET min/week). Adherence to physical activity recommendations was observed more in male participants (p = 0.035), in participants aged less than 40 years (p = 0.040) and those aged between 41 and 50 years (p = 0.047). The average sedentary time was 37.19 ± 18.92 hours per week. This time was significantly longer in people aged 51 and over, in married, divorced, and widowed people, and in those with low levels of physical activity.

CONCLUSIONS

The level of physical inactivity and the sedentary time was high. In addition, participants with a high-level sedentary lifestyle had a low level of physical activity. Educational actions should be undertaken among this group of participants to prevent the risks associated with inactivity and sedentary behavior.

The national moroccan registry of ST-elevation myocardial infarction (MR-MI)

BACKGROUND

MR-MI is the first national Moroccan ST-elevation myocardial infarction (STEMI) registry. Its objectives are to assess patient management modalities and highlight the clinical and therapeutic characteristics of this pathology in all cardiology centres on a national scale.

METHODS

Adult patients presenting with STEMI within 5 days of symptoms onset were enrolled over a period of 18 weeks from April to August 2018. 57 cardiology centres distributed in 22 cities in Morocco participated in the study, including 5 university hospitals, representing 70% of Moroccan centres managing STEMI patients. A case report form was sent to the investigators in both electronic and paper forms. Sociodemographic, clinical, management, revascularization, and follow-up data were collected.

RESULTS

A total of 809 patients were recruited. The population was mostly male (74.8%) with an average age of 62.6 ± 11.6 years. The most common risk factors were smoking (38.3%) arterial hypertension (30.7%), and diabetes (28%). 30% of patients were admitted within the first 6 h of symptoms onset and early revascularization was performed on 49.6%. Mortality rate was 5.2% in-hospital and 3.2% at the one-month follow-up.

CONCLUSION

MR-MI is the first Moroccan STEMI registry on a national scale. Relevant management delays are much longer than other countries, and less than 50% of the patients that present on time benefit from early revascularization. Efforts remain to be done on the optimal diagnosis and treatment of STEMI.

Morocco's Healthcare System: Achievements, Challenges, and Perspectives

Despite progress in recent years, access to quality medical care remains a significant issue, particularly in rural areas. The unequal distribution of resources, inadequate funding, healthcare worker shortages, and the rise of non-communicable diseases pose substantial challenges. However, implementing universal health coverage and improving key health indicators demonstrate notable achievements. To further enhance the healthcare system, perspectives such as addressing resource disparities, increasing funding and the healthcare workforce, managing non-communicable diseases, embracing digital technologies, strengthening public healthcare, and focusing on prevention and health education are proposed. These perspectives offer a global vision for improving Morocco's healthcare system's efficiency, inclusiveness, and quality, ultimately ensuring equitable access to healthcare services for all citizens.

Predictive Classifier for Cardiovascular Disease Based on Stacking Model Fusion

The etiology of cardiovascular disease is still an unsolved world problem, and high morbidity, disability, and mortality are the main characteristics of cardiovascular diseases. There is, therefore, a need for effective and rapid early prediction of likely outcomes in patients with cardiovascular disease using artificial intelligence (AI) techniques. The Internet of Things (IoT) is becoming a catalyst for enhancing the capabilities of AI applications. Data are collected through IoT sensors and analyzed and predicted using machine learning (ML). Existing traditional ML models do not handle data inequities well and have relatively low model prediction accuracy. To address this problem, considering the data observation mechanism and training methods of different algorithms, this paper proposes an ensemble framework based on stacking model fusion, from Support Vector Machines (SVM), K-Nearest Neighbor (KNN), Logistic Regression (LR), Random Forest (RF), Extra Tree (ET), Gradient Boosting Decision Tree (GBDT), XGBoost, LightGBM, CatBoost, and Multilayer Perceptron (MLP) (10 classifiers to select the optimal base learners). In order to avoid the overfitting phenomenon generated by the base learners, we use the Logistic Regression (LR) simple linear classifier as the meta learner. We validated the proposed algorithm using a fused Heart Dataset from several UCI machine learning repositories and another publicly available Heart Attack Dataset, and compared it with 10 single classifier models. The experimental results show that the proposed stacking classifier outperforms other classifiers in terms of accuracy and applicability.