ガイドライン解説 AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease : 2011 update

Dr. Prabhakaran receives grants for a training program of primary care physicians from multiple pharmaceutical sources (MSD and Abbott) to train primary care physicians in evidence-based manageReducing Cardiovascular Mortality Through Prevention and Management of Raised Blood Pressure A World Heart Federation Roadmap Alma J. Adler*, Dorairaj Prabhakarany, Pascal Bovetz, Dhruv S. Kazix, Giuseppe Manciak, Vash Mungal-Singh{, Neil Poulter Geneva, Switzerland; London, United Kingdom; New Delhi, India; Lausanne, Switzerland; San Francisco, CA, USA; Milan, Italy; and Cape Town, South Africa

https://globalheartjournal.com/articles/10.1016/j.gheart.2015.04.006/galley/282/download/

Reducing Cardiovascular Mortality Through Prevention and Management of Raised Blood Pressure A World Heart Federation Roadmap

Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems–strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.

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Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project

Rheumatic heart disease (RHD) is a preventable non-communicable condition that disproportionately affects the world's poorest and most vulnerable. The World Heart Federation Roadmap for improved RHD control is a resource designed to help a variety of stakeholders raise the profile of RHD nationally and globally, and provide a framework to guide and support the strengthening of national, regional and global RHD control efforts. The Roadmap identifies the barriers that limit access to and uptake of proven interventions for the prevention and control of RHD. It also highlights a variety of established and promising solutions that may be used to overcome these barriers. As a general guide, the Roadmap is meant to serve as the foundation for the development of tailored plans of action to improve RHD control in specific contexts.

https://globalheartjournal.com/articles/10.1016/j.gheart.2016.12.001/galley/419/download/

The WHF Roadmap for Reducing CV Morbidity and Mortality Through Prevention and Control of RHD

Background Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America. Objectives This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke. Methods In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model. Results Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among stroke patients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention. Conclusions There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially.

https://globalheartjournal.com/articles/10.1016/j.gheart.2016.06.001/galley/55/download/

Secondary CV Prevention in South America in a Community Setting: The PURE Study

The World Heart Federation (WHF) commenced a Roadmap initiative in 2015 to reduce the global burden of cardiovascular disease and resultant burgeoning of healthcare costs. Roadmaps provide a blueprint for implementation of priority solutions for the principal cardiovascular diseases leading to death and disability. Atrial fibrillation (AF) is one of these conditions and is an increasing problem due to ageing of the world's population and an increase in cardiovascular risk factors that predispose to AF. The goal of the AF roadmap was to provide guidance on priority interventions that are feasible in multiple countries, and to identify roadblocks and potential strategies to overcome them. Since publication of the AF Roadmap in 2017, there have been many technological advances including devices and artificial intelligence for identification and prediction of unknown AF, better methods to achieve rhythm control, and widespread uptake of smartphones and apps that could facilitate new approaches to healthcare delivery and increasing community AF awareness. In addition, the World Health Organisation added the non-vitamin K antagonist oral anticoagulants (NOACs) to the Essential Medicines List, making it possible to increase advocacy for their widespread adoption as therapy to prevent stroke. These advances motivated the WHF to commission a 2020 AF Roadmap update. Three years after the original Roadmap publication, the identified barriers and solutions were judged still relevant, and progress has been slow. This 2020 Roadmap update reviews the significant changes since 2017 and identifies priority areas for achieving the goals of reducing death and disability related to AF, particularly targeted at low-middle income countries. These include advocacy to increase appreciation of the scope of the problem; plugging gaps in guideline management and prevention through physician education, increasing patient health literacy, and novel ways to increase access to integrated healthcare including mHealth and digital transformations; and greater emphasis on achieving practical solutions to national and regional entrenched barriers. Despite the advances reviewed in this update, the task will not be easy, but the health rewards of implementing solutions that are both innovative and practical will be great.

https://globalheartjournal.com/articles/10.5334/gh.1023/galley/1007/download/

World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update

Erratum: Reducing Premature Cardiovascular Morbidity and Mortality in People with Atherosclerotic Vascular Disease: The World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease (Glob Heart (2015)10 (99-110))

In the Americas, CVD represents about 38% of noncommunicable disease deaths. A roadmap for secondary prevention in Latin America and the Caribbean is warranted. Simple and practical guidelines should be developed and implemented. PAHO proposes a realistic and efficient prevention coalition plan in Latin America to fight CVD. The inclusion of the health system through health workers is highly recommended for a successful nationwide preventive program.

https://globalheartjournal.com/articles/10.1016/j.gheart.2017.05.002/galley/73/download/

Pablo Perel

Papers

World Heart Federation Roadmap on Atrial Fibrillation - A 2020 Update

Erratum: Reducing Premature Cardiovascular Morbidity and Mortality in People with Atherosclerotic Vascular Disease: The World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease (Glob Heart (2015)10 (99-110))

Challenges and Opportunities to Scale Up Cardiovascular Disease Secondary Prevention in Latin America and the Caribbean