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| 2. |
- Kaptoge, S., et al.
(författare)
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World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions
- 2019
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Ingår i: Lancet Global Health. - : Elsevier BV. - 2214-109X. ; 7:10
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Tidskriftsartikel (refereegranskat)abstract
- Background To help adapt cardiovascular disease risk prediction approaches to low-income and middle-income countries, WHO has convened an effort to develop, evaluate, and illustrate revised risk models. Here, we report the derivation, validation, and illustration of the revised WHO cardiovascular disease risk prediction charts that have been adapted to the circumstances of 21 global regions. Methods In this model revision initiative, we derived 10-year risk prediction models for fatal and non-fatal cardiovascular disease (ie, myocardial infarction and stroke) using individual participant data from the Emerging Risk Factors Collaboration. Models included information on age, smoking status, systolic blood pressure, history of diabetes, and total cholesterol. For derivation, we included participants aged 40-80 years without a known baseline history of cardiovascular disease, who were followed up until the first myocardial infarction, fatal coronary heart disease, or stroke event. We recalibrated models using age-specific and sex-specific incidences and risk factor values available from 21 global regions. For external validation, we analysed individual participant data from studies distinct from those used in model derivation. We illustrated models by analysing data on a further 123 743 individuals from surveys in 79 countries collected with the WHO STEPwise Approach to Surveillance. Findings Our risk model derivation involved 376 177 individuals from 85 cohorts, and 19 333 incident cardiovascular events recorded during 10 years of follow-up. The derived risk prediction models discriminated well in external validation cohorts (19 cohorts, 1 096 061 individuals, 25 950 cardiovascular disease events), with Harrell's C indices ranging from 0.685 (95% CI 0 . 629-0 741) to 0.833 (0 . 783-0- 882). For a given risk factor profile, we found substantial variation across global regions in the estimated 10-year predicted risk. For example, estimated cardiovascular disease risk for a 60-year-old male smoker without diabetes and with systolic blood pressure of 140 mm Hg and total cholesterol of 5 mmol/L ranged from 11% in Andean Latin America to 30% in central Asia. When applied to data from 79 countries (mostly low-income and middle-income countries), the proportion of individuals aged 40-64 years estimated to be at greater than 20% risk ranged from less than 1% in Uganda to more than 16% in Egypt. Interpretation We have derived, calibrated, and validated new WHO risk prediction models to estimate cardiovascular disease risk in 21 Global Burden of Disease regions. The widespread use of these models could enhance the accuracy, practicability, and sustainability of efforts to reduce the burden of cardiovascular disease worldwide. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.
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- Murphy, A., et al.
(författare)
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Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study
- 2018
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Ingår i: Lancet Global Health. - 2214-109X. ; 6:3
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Tidskriftsartikel (refereegranskat)abstract
- Background There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. Findings The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1.7), Tanzania (0-3.6), and Zimbabwe (0-5.1), to 49.3% in Canada (44.4-54.3). Proportions receiving at least one drug varied from 2.0% (95% CI 0.5-6.9) in Tanzania to 91.4% (86.6-94.6) in Sweden. There was significant (p<0.05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. Interpretation Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. Copyright (c) The Author(s). Published by Elsevier Ltd.
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| 4. |
- Tromp, J., et al.
(författare)
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World Heart Federation Roadmap for Digital Health in Cardiology
- 2022
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Ingår i: GLOBAL HEALTH. - : UBIQUITY PRESS LTD. - 2211-8160 .- 2308-4553 .- 2211-8179. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- More than 500 million people worldwide live with cardiovascular disease (CVD). Health systems today face fundamental challenges in delivering optimal care due to ageing populations, healthcare workforce constraints, financing, availability and affordability of CVD medicine, and service delivery. Digital health technologies can help address these challenges. They may be a tool to reach Sustainable Development Goal 3.4 and reduce premature mortality from non-communicable diseases (NCDs) by a third by 2030. Yet, a range of fundamental barriers prevents implementation and access to such technologies. Health system governance, health provider, patient and technological factors can prevent or distort their implementation. World Heart Federation (WHF) roadmaps aim to identify essential roadblocks on the pathway to effective prevention, detection, and treatment of CVD. Further, they aim to provide actionable solutions and implementation frameworks for local adaptation. This WHF Roadmap for digital health in cardiology identifies barriers to implementing digital health technologies for CVD and provides recommendations for overcoming them.
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| 5. |
- Agarwal, Anubha, et al.
(författare)
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Toward a Universal Definition of Etiologies in Heart Failure : Categorizing Causes and Advancing Registry Science
- 2024
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Ingår i: Circulation Heart Failure. - : American Heart Association. - 1941-3289 .- 1941-3297. ; 17:4
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Forskningsöversikt (refereegranskat)abstract
- Heart failure (HF) is a well-described final common pathway for a broad range of diseases however substantial confusion exists regarding how to describe, study, and track these underlying etiologic conditions. We describe (1) the overlap in HF etiologies, comorbidities, and case definitions as currently used in HF registries led or managed by members of the global HF roundtable; (2) strategies to improve the quality of evidence on etiologies and modifiable risk factors of HF in registries; and (3) opportunities to use clinical HF registries as a platform for public health surveillance, implementation research, and randomized registry trials to reduce the global burden of noncommunicable diseases. Investment and collaboration among countries to improve the quality of evidence in global HF registries could contribute to achieving global health targets to reduce noncommunicable diseases and overall improvements in population health.
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| 6. |
- Hahn, RG, et al.
(författare)
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Reducing blood transfusions
- 2019
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Ingår i: Paediatric anaesthesia. - : Wiley. - 1460-9592. ; 29:7, s. 773-774
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 7. |
- Hemi, Alla, et al.
(författare)
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Cognitive flexibility moderates the efficacy of a visuospatial intervention following exposure to analog trauma
- 2023
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Ingår i: Journal of Behavior Therapy and Experimental Psychiatry. - : Elsevier. - 0005-7916 .- 1873-7943. ; 81
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Tidskriftsartikel (refereegranskat)abstract
- Background and objectives: Intrusive memories are the hallmark feature of Post-Traumatic-Stress-Disorder (PTSD). Recent studies show that a visuospatial intervention after viewing traumatic films reduces intrusive memories in healthy individuals. However, many individuals still exhibit high levels of symptoms following such an intervention, warranting continued investigation into specific characteristics moderating intervention effect. One such candidate is cognitive-flexibility, defined as the ability to update behavior according to contextual demands. The present study examined the interactive effect of cognitive-flexibility and a visuospatial intervention on intrusive memories, predicting that higher flexibility would be associated with stronger intervention effects.Methods: Sixty participants (Mage = 29.07, SD = 4.23) completed a performance-based paradigm evaluating cognitive-flexibility, watched traumatic films, and were allocated to either an intervention or a no-task control group. Intrusions were assessed by means of laboratory and ambulatory assessment, and the intrusion subscale of the Impact-of-Events-Scale-Revised (IES-R).Results: Participants in the intervention group experienced fewer laboratory intrusions than the control group. However, this effect was moderated by cognitive-flexibility: Whereas individuals with below-average cognitiveflexibility did not benefit from the intervention, it was significantly beneficial for individuals with average and above-average cognitive-flexibility. No group differences emerged in the number of ambulatory intrusions or IESR scores. However, cognitive-flexibility was negatively correlated with IES-R scores across both groups.Limitations: The analog design may limit the extent of generalization to real-world traumatic events.Conclusions: These results point to a potentially beneficial effect of cognitive-flexibility on intrusion development, particularly in the context of visuospatial interventions.
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