In HICs, it has been reported that patients of lower SES have less access to cardiac rehabilitation and lower adherence to healthy lifestyles and secondary prevention drug therapies [40]. 2017;70:1–25. This is due to a decline in competing causes, such as maternal, childhood, and infectious diseases, and aging of the population, along with increases in IHD risk factors, including smoking, unhealthy diet, sedentariness, hypertension, diabetes, and high blood cholesterol, in LLMICs [2]. Heart. Mendis S, Abegunde D, Yusuf S, et al. The WHO has suggested that physicians should be adequately trained to have the proficiency to meet the demands of healthcare systems and the health needs of people while maintaining the systems needed to provide medical care to the sick [70]. Google ScholarÂ. Smith SC, Benjamin EJ, Bonow RO, et al. https://www.un.org/sustainabledevelopment/sustainable-development-goals/. Indian Heart J. USA.gov. Increasing evidence suggests that there are significant differences in the presentation, diagnosis and treatment of ischemic heart disease in women compared to men. Lancet. Accessed 29 Sept 2019. 2011;58:2432–46. At the individual level, identification of people at high multifactorial risk and guideline-driven management of hypertension, LDL cholesterol, and diabetes is required. The final manuscript has been reviewed jointly. High quality acute coronary disease management and secondary prevention for those who have survived the initial coronary event are important and responsible for 30–40% of the IHD mortality decline in HICs [11]. reading food labels to choose healthier products. Procedures such as … Quality of diabetes care in low- and middle-income Asian and middle eastern countries (1993-2012): 20-yar systematic review. Yusuf S, Joseph P, Rangarajan S, et al. PubMed Central  Quality improvement for cardiovascular disease care in low- and middle-income countries: a systematic review. Nat Rev Cardiol. Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial. Nature. Lancet. 2013;9:617-70. doi: 10.2147/VHRM.S37119. Abstract. Manage cookies/Do not sell my data we use in the preference centre. Many of these strategies have been evaluated in clinical trials, with multicomponent interventions being the most effective [31]. It has been argued that better physician education and an enhancement of collaborative care delivery can reduce the health and economic burdens from IHD to a degree not previously realized [69]. Endocrinol Metab (Seoul). Availability and affordability of cardiovascular disease medicines and their impact on use: comparison across high, middle, and low-income countries. Shivashankar R, Kirk K, Kim WC, et al.  |  IHD prevention involves primordial, primary, and secondary prevention [8]. Cookies policy. Health Aff. Women often present with atypical symptoms, and this, in association with a consistent underestimation of their risk for ischemic heart … Global burden of cardiovascular disease. Clinical manifestations of coronary heart disease (CHD) … Kardakis T, Jerdén L, Nyström ME, Weinehall L, Johansson H. BMC Health Serv Res. There are multiple reasons for the lower quality of long-term care in these countries (Table 1). 2018;319:567–78. Bhavnani SP, Parakh K, Atreja A, et al. Nascimento BR, Brant LCC, Marino BCA, Passaglia LG, Ribeiro ALP. Facilities for rapid diagnosis and accessible and affordable care at secondary and tertiary care hospitals for acute coronary care are needed. Rising rural body-mass index is the main driver of global obesity epidemic in adults. Clipboard, Search History, and several other advanced features are temporarily unavailable. Similar data have been reported in more recent registries in LLMICs [31]. Circulation. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Mortality was the highest in those of low SES in LICs (Fig. 2) despite the lower prevalence of risk factors (INTERHEART risk score) [6]; this paradox could be due to the inferior quality of acute and chronic IHD management and poor risk factor control [7]. Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. 2018;104:1390–1. Gupta R, Khedar RS, Gaur K, Xavier D. Low quality cardiovascular care is important coronary risk factor in India. Babu AS, Madan K, Gupta R. Cardiac rehabilitation. 2016;133:187–225. 2002;360:2–3. World Health Organization. In the South Asian cohort of the PURE study, it was reported that patients of low SES (low educational status or low wealth index) with IHD or stroke had the lowest consumption of various evidence-based therapies at approximately 4 years after diagnosis [42]. Article  Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? One of the best things you can do for your heart is to stop smoking or using smokeless... 2. Primary prevention should focus on tackling the social determinants of health as well as policy and individual interventions for risk factor control, supported by task sharing and use of technology. National, regional and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3.0 million participants. Corra U. Cardiac rehabilitation and exercise training. Rosengren A, Smyth A, Rangarajan S, et al. Other risk factors associated with the epidemiological and food transition in LLMICs among the poor are hypertension, type 2 diabetes, hypercholesterolemia, and hypertriglyceridemia [61]. A health-in-all-policies approach has also been suggested by WHO as a strategy to achieve better health [54]. Accessed 8 Aug 2019. Gupta R, Mony P, Shankar K, et al. High quality cardiac rehabilitation and secondary prevention are associated with a decreased incidence of post-discharge coronary events and save lives [33, 34]. Modeling studies in Europe and the USA have reported that 50–60% of the decline in IHD mortality is attributable to prevention strategies at both population and individual levels [10, 11]. 2020 Jun;35(2):217-226. doi: 10.3803/EnM.2020.35.2.217. 2008;371:1435–42. In: Prabhakaran D, Krishnakumar R, Naik N, Kaul U, editors. Despite increased use and sales of statins in India, per capita prescription rates remain far below high-income countries. Quit smoking—or better yet, never start. Niu S, Zhao D, Zhu J, et al. 2019;569:260–4. 2019. https://doi.org/10.1016/S0140-6736(19)32008-2. 2019;216:9–19. BACKGROUND: Evaluation of risk factors associated with coronary artery disease and cardiac health in hemophilia patients is necessary to prevent the onset of ischemic heart disease. Several studies have evaluated the efficacy and effectiveness of such technologies for risk identification and diagnosis, decision support system-based management, and improving adherence to healthy lifestyle and medications using telemedicine, web-based strategies, email, mobile phones, mobile applications, text messaging, and monitoring sensors [77]. More than 16 million Americans have ischemic heart disease – the number one killer of people in the U.S. Baptist Health is an accredited American Association Mission Lifeline Receiving Center, meaning patients being treated for coronary heart disea… New York: Elsevier; 2019. p. 1–18. The quality of primary prevention needs to be improved with policy initiatives to control tobacco, trans-fats, refined carbohydrates, and excessive salt consumption along with the promotion of healthy foods and physical activity. The status of awareness, treatment, and control of these risk factors is low in most LLMICs. 2019;381:1114–23. 11th ed. Indeed, premature onset of IHD, at age less than 50 years, is especially important in LLMICs [4]. Oxford: Oxford University Press; 2019. p. 1209–75. Not applicable. 2017;69:437–51. A population-based study in India reported rates of 10, 7, and 5%, respectively, in hypercholesterolemia awareness, treatment, and control among urban populations [67]. The primordial … Google ScholarÂ. The ability to climb two-to-three flights of stairs without … Joshi R, Thrift AG, Smith C, et al. Important barriers in LLMICs are at healthcare system level (availability, access and affordability of medications), healthcare provider level (quality of medical education, physician shortage, physician inertia, and lack of task-sharing), and patient level (health illiteracy, poverty, and drug costs) [31]. Legal enforcement backed by technology, targets, and timetables are important to ensure the implementation of various policies to protect people of low SES. System-wide interventional studies are needed to clearly identify the type of healthcare systems and healthcare financing models for CVD prevention. The second set of factors emerging in LLMICs are cardiometabolic risk factors driven by increasing generalized and abdominal obesity [58]. Int J Environ Res Public Health. 2000;102(Suppl 3):107–15. Policies to provide universal basic education are present in most LLMICs yet, unless there is a focus on quality education (Table 2), IHD will continue to be high and an important cause of death in populations of lower SES. Nevertheless, there are only limited cardiac rehabilitation programs in LLMICs, none of which involve individuals of low SES [34]; the few that exist are provided by private hospitals, which are too expensive for the average individual. 2016;67:1–12. The first relates to lifestyle factors, including smoking and other forms of tobacco use, alcohol abuse, poor quality diet (consumption of low quantities of fruit and vegetables and high consumption of carbohydrates, trans fats, and foods laced with chemical pollutants), indoor and ambient air pollution, and sedentariness [8]. Value of primordial and primary prevention for cardiovascular disease: a policy statement from the American Heart Association. Long L, Anderson L, Dewhirst AM, He J, Gandhi M, Taylor RS. 2008;372:1661–9. An important strategy for IHD prevention in LLMICs is improvement in the quality of medical education for all healthcare professionals, especially physicians, nurses, and allied health workers [8]. 2011;5:325-80. doi: 10.2147/DDDT.S14934. Task-shifting for cardiovascular risk factor management: lessons from the global Alliance for chronic diseases. 2014;66:280–8. GBD Results Tool. 2014;33:273–82. 2018;70(Suppl 3):s419–30. Legislations exist to control these factors, yet the level of implementation is low. Explaining the decrease in US deaths from coronary disease, 1980-2000. Polypill for cardiovascular disease prevention in an underserved population. Introduction. JAMA Cardiol. Part of N Engl J Med. New Delhi: Wolters Kluver; 2019. p. 728–36. Lancet. WHO study on prevention of recurrences of myocardial infarction and stroke (PREMISE). Furthermore, poverty alleviation and improving health literacy among the general population and heart-literacy among primary care nurses and physicians are important for symptom identification and rapid transport of patients for ACS management [27]. However, the results of most of the initiatives have been equivocal and no study has reported clear reductions in clinical outcomes [32], perhaps because the changes in rates of use of key therapies were modest. Lancet. We believe that improving acute coronary syndrome care and better secondary prevention can significantly reduce IHD mortality in LLMICs [13]. Taylor S; commission on social determinants of health. 1 Mortality from IHD in Western … Some policy initiatives have been implemented in many LLMICs to provide rapid access to high quality ACS care such as, for example, efforts to provide free ambulance services for emergencies, the creation of systems for central telediagnosis and telemonitoring, and rapid transfer of patients to facilities with capabilities for pharmacological reperfusion or coronary interventions for underserved populations in Africa, Latin America, and India [16, 22, 23]. The lancet commission on pollution and health. Studies have reported that countries in the highest quintile of universal health coverage have lower smoking and tobacco use, BP, and hyperglycemia, all of which are evidence of better risk factor control [68]. Swinburn BA, Kraak VI, Allender S, et al. Lancet. Lancet. Global status report on non-communicable diseases 2014. In LLMICs, where physician shortage is widespread, task-sharing strategies with health workers in public education, lifestyle improvement, and medication adherence can lead to better control of risk factors [72]. Schwalm JR, McCready T, Lamelas P, et al. 2009;373:1341–51. Implementing myocardial infarction systems of care in low/middle income countries. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other vascular disease: 2011 update. In China, a prescription audit among stable IHD patients from a nationally representative sample reported that a low SES was independently associated with lower rates of use of aspirin, clopidogrel, beta-blockers, and statins [44]. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyorala K, Keil U, EUROASPIRE Study Group. Article  PubMed  2018;391:2029–35. Geldsetzer P, Manne-Goehler J, Marcus M-E, et al. All these risk factors are widely prevalent in LLMICs, especially among those of low SES [51]. Leading a heart-healthy lifestyle can help keep your arteries strong, elastic and smooth, and allow for maximum blood flow. Modifiable risk factors, cardiovascular disease, and mortality in 155,722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Global burden of metabolic Risk factors for chronic diseases collaborating group (cholesterol). BMC Medicine Cardiovascular diseases (CVD), especially ischemic heart disease (IHD), are the most common causes of death and morbidity worldwide, and more than 80% of deaths occur in low- and … Google ScholarÂ. Medical education of physicians, nurses, and health workers should be strengthened, along with similar approaches in educating patients and their families. Drug Des Devel Ther. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. volume 17, Article number: 209 (2019) No funds received for this publication. Finally, a focus on the social determinants of health, such as education and better healthcare financing using health-in-all-policies approach, are also important. Yusuf S, Islam S, Chow CK, et al. 2009;157:709–15. Exercise based cardiac rehabilitation for adults with stable angina. Exercise based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Landrigan PJ, Fuller R, Acosta NJR, et al. Yusuf S, Rangarajan S, Teo K, et al. Maintain a healthy weight. Lancet. 3rd ed. NCD. 2015;107:203–23. Ischemic heart disease develops when cholesterol particles in the blood begin to accumulate on the walls of the arteries that supply blood to the heart… Prevention in Ischaemic Heart Disease (IHD) 30 Jun 2017 Prof. Massimo F. Piepoli Dr. Ugo Corra Dr. Jeroen Hendriks Preventive measures in risk factor control, recommended for patients with ischaemic heart disease… ACS registries from LLMICs have reported delays in diagnosis due to diversion to a primary care practitioner, which delays admission to a hospital within the required time for various evidence-based treatments; such delays are more common among those of low SES [19]. Geneva: WHO; 2014. Int J Crit Ill Inj Sci. Additionally, hypercholesterolemia is widely prevalent in many LLMICs [62]. https://doi.org/10.1016/j.jacc.2017.09.491. Evaluation of community health worker led intervention in control of cardiovascular risk factors in rural populations in India: a cluster randomized trial. Get the latest research from NIH: https://www.nih.gov/coronavirus. Khaing W, Vallibhakara SA, Attia J, McEvoy M, Thakkinstian A. 2019;394:585–96. Stanton AV, James K, Brennan MM, O'Donovan F, Buskandar F, Shortall K, El-Sayed T, Kennedy J, Hayes H, Fahey AG, Pender N, Thom SAM, Moran N, Williams DJ, Dolan E. Sci Rep. 2020 Sep 22;10(1):15444. doi: 10.1038/s41598-020-71801-5. NIH Polypills for primary prevention of cardiovascular disease. A comprehensive survey. Prospective data from 21 HICs, MICs and LICs in the PURE study has shown that age- and sex-standardized cardiovascular mortality is more than threefold higher in individuals of low SES in LLMICs compared to in HICs [6]. Conversely, important strategies that have been shown to enhance cardiac rehabilitation and secondary prevention services in LLMICs are the creation of infrastructure, universal health coverage, free medicines, physician empowerment, task-sharing with nurses and community health workers, patient and family education, and family participation in care [31, 45]. Educational status categories (≤ primary, secondary and college) and age- and sex-standardized cardiovascular mortality in high-income, middle-income and low-income countries in the Prospective Urban Rural Epidemiology (PURE) study (21 countries, n = 160,299) [6]. Chronic ischemic heart disease, or myocardial ischemia, is when blood flow to your heart is restricted, typically by a complete or partial blockage of your coronary arteries.. However, high-quality randomized clinical trials and economic evaluation of technology-supported interventions are not yet available [26]. Keep to a healthy weight. Teaching of public health in medical schools: report of the regional meeting, Bangkok, Thailand. Cite this article. Ford ES, Ajani UA, Croft JB, et al. Elevated serum cholesterol concentrations, hypertension and cigarette smoking are among the standard risk factors associated with ischemic heart disease. Curr Cardiol Rep. 2016 Jun;18(6):56. doi: 10.1007/s11886-016-0728-7. Herein, we initially focus on gaps in the quality of acute IHD management and secondary prevention and then highlight the importance of primary prevention in LLMICs, especially among the more vulnerable individuals of lower SES. The WHO Global Status Report on Non-communicable Diseases has reported that hypertension prevalence is high in sub-Saharan Africa, South Asia, and East Asia, while diabetes is epidemic in South, East, and West Asia [61]. Smart steps to take: 1. avoiding saturated … Am Heart J. In LLMICs, older age, female sex, non-smokers, and greater education and income were associated with improved BP control. 2018;3:e001092. Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. JAMA. By using this website, you agree to our 2018 Apr 2;18(1):227. doi: 10.1186/s12913-018-3023-z. In those with hypertension, 73.6% had had their BP measured, 39.2% were aware of their diagnosis, 29.9% received treatment, and 10.3% had it under control. Lancet Glob Health. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II and III surveys in eight European countries. 2009;373:929–40. BMC Public Health. 2017;70:2696–718. Lianov L, Johnson M. Physician competencies for prescribing lifestyle medicine. If you have CAD, your health care team may suggest the following steps to help lower your risk for heart attack or worsening heart disease: Lifestyle changes , such as eating a healthier (lower sodium, lower fat) diet, increasing physical activity, reaching a healthy weight… Bull World Health Organ. Enable it to take advantage ischemic heart disease prevention the guidelines and Delphi study for the Multifactorial Fall risk Assessment Community-Dwelling! 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