JACC Edge February Issue | Global Health: We Are the World

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Global Health: We Are the World

Where did our famous ❤️ shape come from? In 7th century BCE Cyrene (modern day Libya), our ancestors discovered that the seed of silphium plant could be used as a form of birth control. The heart-shaped seed became instantaneously popular, stamped on currency, and traded across the Ancient World, cementing itself as a global symbol of love and passion.

Journal of the American College of Cardiology

Made to Measure

Meme from pinterest.com

Global health often seems too abstract and removed from the provider-patient interaction, leaving clinicians feeling morose about the future without clear tools to make a difference. However, this is not one of those studies! In 2017, a heroic group of leaders and policy makers at the World Health Organization (WHO) and partner organizations created the WHO HEARTS program to deliver simple, effective hypertension management to LMICs. By 2022, the HEARTS program had scaled to 32 LMICs, involving nearly 400,000 healthcare providers and enrolled 12.2 million patients. Using digital health tools, creating treatment algorithms for antihypertensive medication regimens, focusing on non-pharmacologic behavior change, and engaging primary care providers this program was able to make a sustainable impact on many patients across socioeconomic backgrounds. In a review of the data, 38% of patients were able to demonstrate control of their hypertension (compared to the global average of 11%). This goes to show that small changes can have large impacts!

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Journal of the American College of Cardiology

State of the Union: Global CV Edition

My fellow cardiology enthusiasts, although this state of the union address may look different than what you are used to, I believe our message is equally important. The guiding principle that drives many of us is eloquently summarized in the Victorian Declaration on Heart Health, "We have the scientific knowledge to create a world in which heart disease and stroke are rare." Despite these goals, it's estimated that 34% of the 19.8 million CVD-related deaths occurred before the age of 70 and should have been highly amenable to preventive or secondary treatment. The 2023 Global Burden of CV Diseases and Risks Study, published in partnership with the Journal of the American College of Cardiology (JACC), the Institute for Health Metrics and Evaluation (IHME), and the National Heart, Lung, and Blood Institute (NHLBI) at National Institutes of Health (NIH), highlights global trends in CVD and risk factors to inform future prevention and policy goals. This year, the GBCVD study highlights both the regional variation and disproportionate burden of CVD in lower-and-middle-income countries (LMICs). For example, age-standardized mortality rates between high income countries in the Asia-Pacific are 6 times lower than those of Eastern Europe. Though the news is not all negative, since 1990 there has been a 65.1% decline in household air pollution which contributed to improvements in CVD mortality. By paying attention to and learning from effective strategies, we can better guide research and practice to lower the global CVD burden.

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Journal of the American College of Cardiology

Common Threads

Gif from tenor.com

There are certain truths that I have found to be universal: coffee keeps hospitals running, nothing feels better than getting a perfect view on cardiac ultrasound on the first attempt, and we all seem to have a strong distaste for heart failure (HF) readmissions. Despite numerous articles and studies describing the benefits of early initiation of GDMT, titration of medications, and a plethora of new device therapies, readmissions remain a global problem. Foroutan and colleagues set out to find exactly how common these readmissions are. They poured through over 1.5 million patient records across 18 countries looking at 30-day and 1-year readmission rates for heart failure. In total, they found a mean of 13.2% overall 30-day readmission rate and a mean of 35.7% 1-year readmission rate. Readmission rates were relatively consistent across 5 continents and variation was not explained by the countries' gross domestic product, the amount spent on health care, or comorbidities present. The secret to solving readmissions could be found in Antarctica (since they obviously weren't included in the 5 continents that people actually live in).

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JACC: Cardiovascular Interventions

The Pandemic Papers

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The COVID-19 pandemic had every healthcare worker finding creative ways to cope with limited resources. But while we could improvise with PPE, the same could not be said about certain procedures. A retrospective analysis of the international TAVR registry that included >65,000 procedures across 61 countries noted a significant decline in global TAVR procedural volume, especially during the first wave of the pandemic, with a return to pre-pandemic levels by the third wave of the virus. While this was a global phenomenon, African and Asian countries saw a greater decline in procedural volume. This was likely due to overburdened healthcare systems and patient hesitancy in visiting hospitals. However, improved infrastructure and community immunity through vaccination efforts led to gradual recovery. Irrespective of resources, public health messaging should reinforce the importance of maintaining scheduled CV care, and health care systems should be assessed for and developed to become pandemic-resilient. #StrongerTogether

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JACC: Case Reports

Got Skills?

A 41- year-old female from the Ivory Coast presented to the emergency department with shortness of breath and acute chest pain. 1 week prior to presentation, she had delivered her fourth baby via an uncomplicated spontaneous vaginal delivery. Vitals were significant for HR 104 beats/min and blood pressure of 165/100 mmHg. Physical exam was otherwise unremarkable. Patient was taken to the catheterization lab with the image taken above. What is the most likely cause of her symptoms?

A) Pulmonary Embolism
B) Type 1 Myocardial Infarction
C) Spontaneous Coronary Artery Dissection
D) Aortic Dissection

The correct answer and voting results will be shared in our next issue.

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Read More on Global Health:

How'd You Do?

The answer to last month's quiz was
D. Vitamin Deficiency.
Only 36% answered correctly. Better luck next time.

REVIEW HERE

Have an interesting article or story you want to share, contact us at [email protected] or DM me on Twitter @PratikDoshiMD to be featured in a future edition of JACC Edge!

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JACC Edge Podcast - Global Health: We Are the World

March 7, 2024

Pratik Doshi Hadley Wilson

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JACC Edge Podcast - Global Health: We Are the World

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