Background:Sleep duration is associated with various health outcomes like metabolic disturbances and mortality, but the underlying mechanisms remain unclear. Objectives:To investigate the link between sleep duration, metabolic markers, and mortality using data from the China Kadoorie Biobank (CKB) and the UK Biobank (UKB). Methods:Sleep duration was self-reported, and metabolic markers were quantified using nuclear magnetic resonance spectroscopy. The outcomes of interest were all-cause and cause-specific mortality. Linear regression was conducted to assess the association between sleep duration and metabolic markers, which were further compared with the association between metabolic markers and all-cause and cause-specific mortality using Cox models. Results:In both cohorts, sleep duration showed positive associations with all-cause and cause-specific mortality after adjustment. A total of 17 metabolic markers-encompassing lipoprotein subclasses in high-density lipoprotein cholesterol, relative lipoprotein lipid concentrations in very-low-density lipoproteins, cholesterol, and ketone bodies-were significantly associated with sleep duration and mortality. In general, the associations of sleep duration with metabolic markers and of these markers with mortality showed similar patterns for lipoprotein subclasses and relative lipoprotein lipid concentrations, whereas contrary patterns were observed for cholesterol and ketone bodies in the CKB. Furthermore, significant associations were also observed in the UKB cohort, with metabolic markers presenting generally consistent association patterns with sleep duration and mortality. Gender-specific analyses revealed significant links in females in the CKB and in both genders in the UKB. Sensitivity analyses confirmed the stability of these associations. Conclusions:Our findings suggest that lipid metabolism may partially explain the effect of sleep duration on mortality. These insights highlight the potential of targeted metabolic interventions to mitigate the risks associated with abnormal sleep patterns, especially when modifying sleep duration itself is challenging, and the projected health burden associated with sleep disorders could be reduced through metabolic-focused strategies. Lay Summary:What question did this study address, and why does it matter? This study examined whether sleep duration is associated with metabolic markers and whether these markers, in turn, are associated with mortality risk, using data from two large population-based cohorts in China and the UK. Sleep problems are becoming increasingly common worldwide, and identifying metabolic pathways that may link sleep to health outcomes could inform future prevention strategies. Where was the study done and what were the main results? The study used data from the China Kadoorie Biobank (CKB) and the UK Biobank (UKB). In both cohorts, sleep duration was associated with changes in specific metabolic markers, including lipoprotein subclasses, cholesterol, and ketone bodies. These metabolic changes were further associated with all-cause and cause-specific mortality. While lipoprotein subclasses showed broadly consistent patterns across the two cohorts, cholesterol and ketone bodies exhibited contrary associations with mortality in the CKB compared to the UKB. Sex-specific differences were also observed, particularly in the CKB cohort, where significant associations were found only in women. What do these findings mean in practice? These findings suggest that lipid metabolism may play a role in the relationship between sleep duration and mortality. This raises the possibility that metabolic monitoring or targeted interventions-such as lifestyle or dietary modifications-could potentially help reduce the health risks associated with abnormal sleep duration, particularly in settings where sleep modification itself is challenging. However, further research is needed to determine whether these associations are causal and to explore their underlying mechanisms.
Background:Heart valve disease is a growing cause of mortality and disability worldwide, disproportionately burdening low- and middle-income countries (LMICs), where rheumatic heart disease remains a major etiology and cardiac surgical capacity covers less than 2% of the estimated need. Population-level outcome data after valve surgery in LMICs are virtually absent. We leveraged Brazil's universal health system to quantify how income, geography, and disease etiology are associated with survival after valve replacement surgery. Methods:Five Brazilian public health databases covering outpatient care (SIA), hospital admissions (SIH), mortality records (SIM), the cancer registry (RHC), and a social vulnerability index (IVS Atlas) were linked to a single individual-level longitudinal record, with a proof-of-life algorithm correcting right-censoring bias. All patients undergoing valve replacement surgery between January 2015 and December 2024 were included. Results:Among 63,426 patients (mean age 56.9 ± 15.2 years; median follow-up 1,023 days), the in-hospital mortality rate was 8.6% and the five-year mortality was 30.1%. Income and geography were significantly associated with survival: the highest income quartile had significantly lower mortality than the lowest quartile in the adjusted Cox model (HR 0.82; 95% CI 0.76-0.89; p < 0.001), and in-hospital mortality exceeded 25% in low-volume municipalities in the North region. Valve lesion subtype predicted outcomes differentially across time horizons, and reoperation was associated with worse survival (HR 1.48; 95% CI 1.37-1.58; p < 0.001). Conclusion:Income, geography, and valve-specific risk factors are important factors associated with survival after valve surgery in Brazil's public health system, reflecting structural conditions shared across LMICs. The linkage framework offers a scalable model for cardiovascular outcome surveillance in resource-constrained settings. Lay Summary:Each year, thousands of Brazilians undergo heart valve surgery through the public health system. Using data from over 63,000 patients treated between 2015 and 2024, we found that survival after valve surgery in Brazil is substantially worse than in wealthier countries and that outcomes differ markedly depending on which valve is affected and why. Patients who required a second surgery fared worse, and those living in regions with fewer surgical centers faced higher mortality. These findings highlight critical gaps in cardiac surgical care, which can guide resource allocation and policy in Brazil and similar settings.
Background:Acute kidney injury (AKI) is a significant complication among patients with heart failure with reduced ejection fraction (HFrEF). Once AKI occurs, therapeutic options are limited to supportive care, underscoring the clinical importance of early identification of patients at risk. This study sought to identify independent predictors of AKI development in geriatric HFrEF patients and subsequently establish a clinically applicable bedside risk quantification. Method:A total of 1,496 elderly patients (≥60 years) diagnosed with HFrEF at Guangdong Provincial People's Hospital from January 2010 to December 2024 were enrolled according to predefined inclusion/exclusion criteria and stratified into an AKI group (n = 300) and a non-AKI group (n = 1196). Relevant parameters were screened using LASSO (Least Absolute Shrinkage and Selection Operator) regression, and risk factors for AKI in HFrEF patients were identified through univariate and multivariate logistic regression analyses. A nomogram was developed based on multivariate logistic regression results, accompanied by a corresponding heatmap. The predictive accuracy of the nomogram was evaluated using receiver operating characteristic (ROC) curves and calibration plots, while its clinical utility was demonstrated through decision curve analysis (DCA). Result:This study identified four independent predictors of AKI in patients with HFrEF, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), uric acid (UA), CRP (C-reaction protein) and urea. A nomogram was developed based on these factors. The evaluation results demonstrated that the model exhibited good diagnostic accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.721 (95% CI: 0.658-0.785). The calibration curve and DCA further indicated that the model possesses favorable clinical applicability. Conclusion:This study developed and validated a nomogram model for predicting AKI in patients with HFrEF. Clinicians can utilize this model to optimize clinical decision-making based on individualized patient characteristics, enabling personalized risk stratification for therapeutic interventions and prognostic evaluations.
An Unprecedented Confluence of Science, Selfless Service, and the World Heart Federation's Mission of Cardiovascular Health for All On 29 September 2025, the World Heart Federation (WHF) marked the silver jubilee-25 years-of World Heart Day in what might seem an unlikely setting for a global cardiovascular organization: Prasanthi Nilayam in Puttaparthi, India, an internationally recognized epicenter of free, world-class medical care and humanistic service. The choice was deliberate. For an organization whose mission is 'cardiovascular health for everyone, everywhere,' it was most fitting to celebrate this milestone in a place where that principle has been quietly practiced, at scale and at no cost, for decades. For most of its history, the WHF has marked World Heart Day through campaigns centered initially only in its headquarters in Geneva, and subsequently in capitals and at multilateral fora, where global policy is debated and shaped. By contrast, Prasanthi Nilayam sits closer to village life than to ministries of health, and closer to patients' daily realities than to conference halls. Precisely for that reason, it offered a real-life model of how values-driven policy translates into free, high-quality cardiovascular care, prevention, and community engagement on the ground. The timing was equally symbolic: the 25th anniversary of World Heart Day coincided with the centenary celebrations of Sri Sathya Sai Baba, whose guiding maxim-'Love All, Serve All; Help Ever, Hurt Never'-has, for decades, animated an integrated, free-of-cost healthcare ecosystem that mirrors the WHF's founding pledge that cardiovascular health should be a right, not a privilege, regardless of background, religion, caste, or means.
Background:Hypertension is a major public health challenge in Bangladesh, yet population-level blood pressure control remains poorly characterized. This study estimated changes in population-level hypertension control between the Bangladesh Demographic and Health Survey (BDHS) 2017-18 and BDHS 2022 and examined sociodemographic variation and socioeconomic inequality in hypertension control. Methods:Nationally representative BDHS 2017-18 (n = 13,131) and BDHS 2022 (n = 14,296) data were analyzed using a cross-sectional design. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or antihypertensive medication use. Population-level control was defined as blood pressure <140/90 mmHg among hypertensive individuals in the population. Adjusted control rates and sociodemographic variation were estimated using pooled survey-weighted multivariable logistic regression with marginal standardization. Socioeconomic inequality was assessed using the concentration index (CnI), slope index of inequality (SII), and relative index of inequality (RII). Findings:Among individuals with hypertension, control increased from 12.5% (95% CI: 11.3-13.8) in 2017-18 to 19.3% (17.5-21.2) in 2022, alongside increases in awareness from 42.4% (40.5-44.4) to 54.3% (51.9-56.6) and treatment from 37.0% (35.2-38.9) to 44.6% (42.1-47.0). Hypertension prevalence was 27.5% (26.5-28.5) in 2017-18 and 20.5% (19.6-21.4) in 2022. Adjusted control improved across most sociodemographic groups, with the largest increases among older adults (+6.5%), females (+6.3%), urban residents (+6.8%), individuals with higher education (+7.3%), and residents of Sylhet (+7.9%) and Chattogram (+7.2%) divisions. Socioeconomic inequality also increased between 2017-18 and 2022, with a persistent pro-rich pattern (CnI: 0.11 to 0.13; SII: 8.5% to 15.1%; RII: 1.99 to 2.22). Conclusion:Population-level hypertension control in Bangladesh improved between survey rounds, although socioeconomic and geographic disparities persisted. Differences in survey implementation and measurement methods warrant cautious interpretation of changes over time. Strengthening equitable primary care and medication access may help sustain improvements and reduce disparities.
Background:Rheumatic heart disease (RHD) remains a preventable cause of cardiovascular morbidity/mortality, disproportionately affecting socioeconomically disadvantaged populations. While largely controlled in high-income countries, RHD persists in low- and middle-income countries and may remain underrecognized among migrants from endemic regions in Europe, where systematic surveillance data are lacking. This study aimed to explore the implementation and diagnostic yield of echocardiographic screening in a migrant population and to contextualize these findings through a scoping review of European RHD research. Methods:We conducted a single-center pilot study in Munich, Germany, screening 150 recently-arrived migrants (aged 5-26 years) from RHD-endemic regions using 2023 World Heart Federation (WHF) echocardiographic criteria. Medical history was documented. Furthermore, we conducted a scoping literature review of European studies reporting RHD published since 2000, in accordance with Cochrane and PRISMA guidelines (PROSPERO ID: CRD42024538000). Results:Among screened participants (mean age 20.0 ± 5.9 years), ten (6.8%) showed abnormalities warranting confirmatory echocardiography according to the WHF protocol for RHD diagnosis, with mitral regurgitation being the most frequent finding. No participant had a prior diagnosis of RHD. Screening was integrated into routine health examinations without any obvious disruption of routine workflows. The scoping review identified 86 publications, predominantly from Turkey and Italy, highlighting fragmented research, methodological heterogeneity, limited prevalence data, and a focus on surgical management rather than early detection. No multicenter screening studies in asymptomatic at-risk populations were identified, limiting a more accurate assessment of disease burden. Conclusions:This study suggests that systematic echocardiographic screening for RHD in high-risk migrant populations in Europe may facilitate the identification of individuals with echocardiographic abnormalities requiring confirmatory evaluation. Combined with the fragmented European literature, these findings underscore the need for harmonized surveillance, larger multicenter studies, and careful evaluation of targeted screening approaches into migrant health programs to inform future epidemiologic and implementation research. Lay Summary:What question did this study address, and why does it matter?: This study asked whether echocardiographic screening for rheumatic heart disease (RHD) can be implemented in migrant health assessments in Europe, and whether such screening could contribute to a better understanding of RHD in a potentially high-risk population. In addition, we sought to explore whether existing research suggests that RHD may be under-recognized in selected high-risk populations in Europe, particularly in the context of migration from endemic regions. To address this, we reviewed the current European literature to assess the extent of research activity and available evidence on RHD.Where was the study done, and what were the main results?: The study was conducted in Munich, Germany, where 150 recently-arrived migrants aged 5-26 years underwent echocardiographic screening as part of a pilot program. Approximately 7% of participants showed cardiac abnormalities that may require further evaluation, although these findings do not represent confirmed diagnoses. In addition, a scoping review of 86 publications from across Europe was performed to contextualize the pilot findings within the broader European RHD literature. The literature was highly fragmented, with most studies originating from a small number of countries. Many focused on hospital-based management rather than early detection, and only a few addressed screening in at-risk populations such as migrants.What do these findings mean in practice?: Given that early identification of RHD could help prevent long-term cardiac complications, echocardiographic screening may be a relevant component of routine migrant health assessments to identify individuals requiring further diagnostic evaluation. RHD may still be present in select high-risk groups in Europe, but appears to be insufficiently systematically monitored. Since current European evidence remains limited and fragmented, we recommend that larger studies be conducted to determine whether targeted screening should be implemented more widely.
An ageing population means more people are living longer with cardiovascular disease. As a result, health systems face sustained pressures to provide effective long-term care. Cardiac rehabilitation has evolved from group-based exercise-based programs to comprehensive secondary prevention, with a growing focus on supporting lifelong cardiovascular health. The World Heart Federation (WHF) recently published a Roadmap that advances this shift by reframing cardiovascular rehabilitation around person-centred, future-focused care, and identifying five key recommendations: prioritise lifelong health, strengthen patient and clinician engagement, adopt new models of care, build workforce capacity, and advance advocacy and policy. This paper outlines practical implementation strategies to support adoption of the WHF Roadmap on Cardiac Rehabilitation (a pathway to improve lifelong cardiovascular health) in diverse real-world settings. We present adaptable approaches at the patient, clinician, and system levels, focusing on how cardiovascular rehabilitation can be embedded across the continuum of care with modernised concepts and terminology. Key strategies include integrating rehabilitation earlier and more consistently into care pathways, leveraging data for continuous quality improvement, and aligning funding mechanisms and policy frameworks to enable sustainable delivery. Importantly, implementation must remain responsive to local contexts, including variations in resources, workforce capacity, and population needs. Robust research strategies are also outlined that evaluate approaches to translate global priorities into routine practice and support the concept of being the lifelong cardiovascular health program for all.
Background:Electrocardiographic (ECG) criteria for detecting left ventricular hypertrophy (LVH) have largely been derived from non-African populations. Their diagnostic performance in Black African adults with untreated hypertension remains uncertain. Objective:To evaluate the diagnostic performance of established ECG-LVH criteria compared with echocardiographically assessed left ventricular mass index (LVMI) in Black African adults with untreated, uncomplicated hypertension enrolled in the coArtHA trial. Methods:In this subanalysis, we included 1,125 participants from rural Tanzania and Lesotho who underwent baseline 12-lead ECG and focused transthoracic echocardiography (fTTE). LVH was defined as LVMI > 95 g/m² in women, and >115 g/m² in men. Diagnostic performance of multiple ECG-LVH criteria was assessed using correlation analyses, sensitivity and specificity estimates, receiver-operating characteristic (ROC) analysis, including calculation of the area under the ROC curve (AUROC), and precision-recall curves (PRC). Results:Echocardiographic LVH was present in 56 (5%) participants. Across continuous ECG indices, Cornell voltage product adjusted by +0.8 mV in women showed the strongest association with LVMI (Spearman's rho = 0.37, p < 0.001). Among evaluated criteria, Cornell voltage product-based measures demonstrated the most consistent diagnostic performance across evaluated metrics, with an AUROC of approximately 0.76. Using established cut-off values, this criterion yielded a sensitivity of 64% and a specificity of 80%, whereas voltage-only criteria, including Multi-Ethnic Study of Atherosclerosis (MESA)- and Sokolow-Lyon-based indices, showed limited accuracy in this setting. Exploratory analyses of alternative cut-off values demonstrated the expected sensitivity-specificity trade-offs. Conclusions:In this cohort of hypertensive Black African adults, ECG criteria showed a moderate association with LVMI by echocardiography. Among established ECG criteria, Cornell voltage product-based measures demonstrated the most consistent diagnostic performance. Diagnostic characteristics were strongly influenced by cut-off selection and clinical context, underscoring the need for population-specific evaluation and external validation of ECG criteria for LVH in African settings. Trial registration:Clinicaltrials.gov NCT04129840. Registered on October 17, 2019 (https://www.clinicaltrials.gov/).
Background:Socioeconomic inequalities in cardiovascular risk persist despite declining mortality. We examined the prevalence of cardiovascular risk factors and lifestyle behaviors across educational levels in men and women from a Mediterranean population. Methods:Cross-sectional analysis of adults aged 35-74 years from a population-based sample in north-eastern Spain. Risk factors and lifestyle were assessed with standardized measurements and validated questionnaires. Educational attainment was categorized as primary, secondary, or university. Analyses were sex-stratified; age-adjusted linear and logistic regression models were applied. Results:We included 943 adults (52.3% women). Among men, secondary and university education (vs. primary) were associated with lower LDL-cholesterol [β -11.76 (95% CI -21.68 to -1.83) and -17.83 (-28.03 to -7.63) mg/dL], lower odds of hypercholesterolemia [OR = 0.43 (0.20-0.90) for both], smoking [OR = 0.57 (0.33-0.97) and 0.53 (0.30-0.95)], and higher odds of high Mediterranean diet adherence [OR = 2.08 (1.04-4.16) and 3.05 (1.51-6.14)]. Among women, secondary and university education (vs. primary) were associated with lower body mass index [β -1.81 (-2.85 to -0.77) and -2.52 (-3.63 to -1.40) kg/m2] and lower odds of overweight/obesity [OR = 0.47 (0.29-0.76) and 0.34 (0.20-0.56)]. Lower odds of hypertension [OR = 0.44 (0.22-0.87)] and high Mediterranean diet adherence [OR = 2.14 (1.12-4.09)] were also more likely in university-educated women. Conclusions:Higher educational attainment was associated with healthier lifestyles and more favorable cardiometabolic profiles. Educational gradients were broader in women-spanning adiposity, blood pressure, glycemia, and lipidemia-whereas, in men, they mainly affected lipidemia and diet.
Rheumatic heart disease (RHD) requires long-term secondary antibiotic prophylaxis to prevent disease progression, yet sustained patient engagement remains challenging in many low- and middle-income countries. Within Uganda’s first integrated decentralized RHD control program, Accelerating Delivery of Rheumatic Heart Disease Preventive Services in Uganda (ADUNU), we applied a human-centered design (HCD) approach to co-develop strategies for improving engagement in care. Using two Group Level Assessment sessions (with n = 43 stakeholders) and three design focus group discussions (n = 23 stakeholders), participants identified and prioritized feasible implementation strategies. Strategies were synthesized into four domains: community integrated follow-up, structured patient health education and counselling, provider capacity and service delivery improvement, and strengthening stock planning for medicine availability. These co-developed strategies directly address barriers related to missed appointments, limited understanding of RHD, provider-patient interactions, and medicine stockouts within decentralized primary care settings. This participatory approach generated contextually grounded strategies, ready for prospective testing within decentralized RHD programs.
The Nigeria Hypertension Control Initiative (NHCI) launched a national treatment program in 2020, guided by the HEARTS technical package for cardiovascular disease prevention in primary care. This study presents a thematic analysis of key informant interviews with primary care experts from Abuja, Kano, and Ogun, exploring NHCI implementation experiences. Using a structured qualitative approach, we analyzed responses across four domains: service delivery, medication procurement and availability, task shifting, and broader program aspects. Findings highlight improvements in service delivery, medication access, task shifting, and health-seeking behavior. However, challenges persist, including incomplete training, user fees, administrative burdens, and logistical barriers such as transportation costs and stockouts. Despite these issues, satisfaction with the standardized treatment protocol was high. Task shifting was well-received, easing pressure on senior staff but underscoring the need for continued training. Recommendations include integrating diabetes care, decentralizing medication sourcing, and enhancing training to strengthen NHCI’s efficiency and sustainability in resource-limited settings.
This narrative review synthesizes nearly two centuries of evidence linking Streptococcus pyogenes infection to acute rheumatic fever (ARF), the prerequisite for the development of rheumatic heart disease (RHD). Using the Bradford Hill criteria for causality and the Oxford Centre for Evidence-Based Medicine levels of evidence, we critically evaluate historical and contemporary data pertaining to this relationship. Strong evidence demonstrates that untreated S. pyogenes infection increases ARF incidence, while antibiotic treatment reduces incidence across diverse populations and settings. Moderate evidence supports the temporal sequence from infection to ARF and the exclusivity of S. pyogenes as ARF’s causal precursor. Weaker but biologically coherent data suggest an underlying mechanism consistent with post-infectious autoimmune disease. Although foundational evidence is robust, key gaps remain, particularly the need for contemporary prospective data in high-risk populations and clarity on the contribution of skin infections. Strengthening this evidence base is essential as S. pyogenes vaccines advance toward licensure and ARF-specific policy indications.
Background:The C-reactive protein-triglyceride-glucose index (CTI) and depression are each associated with elevated cardiovascular disease (CVD) risk. However, evidence on long-term cumulative CTI exposure and its joint effect with depression remains limited. Methods:This prospective cohort study included participants from the 2015 baseline of the China Health and Retirement Longitudinal Study, with follow-up in 2018 and 2020. Cox proportional hazards models were used to examine associations between a combined cumulative CTI-depression indicator and incident CVD, as well as their interaction. Restricted cubic splines were used to assess dose-response relationships across depression status. The predictive performance of the composite indicator was compared with individual components using integrated discrimination improvement and net reclassification improvement. Subgroup and sensitivity analyses were conducted. Results:Participants were categorized according to cumulative CTI level and depression status. Compared with individuals with low cumulative CTI and no depression, all other groups exhibited significantly higher risks of CVD, demonstrating a clear graded association. These associations remained robust after multivariable adjustment. In the primary fully adjusted model, participants with high cumulative CTI and depression had the highest CVD risk (HR = 1.83, 95% CI 1.53-2.20, p < 0.01). Categorical analyses suggested possible effect modification by depression status. In addition, the combined cumulative CTI-depression indicator demonstrated improved predictive performance compared with either component alone. The primary associations remained broadly consistent across subgroup and sensitivity analyses, although evidence for possible effect modification varied across alternative analytical approaches. Conclusions:The combined cumulative CTI-depression indicator was strongly and consistently associated with increased CVD risk, exhibiting graded associations with possible effect modification by depression. This joint measure captures cumulative metabolic-inflammatory burden and psychological distress and may provide complementary information for cardiovascular risk stratification beyond the individual components.
Background and Aim: Worldwide, heart-related conditions, including myocardial infarction (MI), persist as the leading cause of morbidity and mortality. The aim is to compare three-year mortality outcomes and identify causes of death among post-MI patients who received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods: This registry-based retrospective cohort with follow-up study analyzed data from 3,542 PCI and 3,244 CABG patients treated post-MI between 2020 and 2024 in two hospitals in Baghdad. Kaplan-Meier curves (log-rank test) were used for unadjusted comparison. Cox proportional hazards regression was employed to compare threeyear all-cause mortality, adjusting for baseline demographic and clinical covariates. Results: Baseline characteristics differed significantly, with CABG patients being older and having a higher prevalence of certain risk factors. Crude observed mortality during available follow-up was 7.99% for PCI and 11.19% for CABG; Kaplan-Meier analysis showed significantly different unadjusted survival distributions by log-rank test. However, after adjusting for baseline covariates, there was no significant difference in the hazard of three-year all-cause mortality between patients undergoing CABG and PCI (adjusted hazard ratio [aHR] = 1.12, 95% CI = 0.93-1.35, p = 0.280). Significant independent predictors of mortality included age (aHR = 1.04 per year), diabetes mellitus (aHR = 1.45), and renal complications (aHR = 1.70). Non-cardiovascular causes accounted for the majority of deaths in both groups (56.06% post-PCI, 50.11% post-CABG). Conclusion: In this observational cohort, adjusted three-year mortality was not significantly different between PCI and CABG, with non-cardiac causes accounting for the largest proportion of deaths. Due to potential confounding by indication, these findings represent observational associations rather than clinical equivalence. Both remain vital revascularization strategies, with selection guided by individualized heart-team assessment.
Background: Digital health interventions (DHIs) offer major potential for improving cardiovascular disease (CVD) primary and secondary prevention, but their adoption by healthcare providers (HCPs) remains inconsistent. Objective: To identify barriers and facilitators to DHI uptake in CVD primary and secondary prevention from HCPs’ perspectives. Methods: We conducted a systematic review of studies published between 2020 and 2024 that investigated HCPs’ perceptions of DHI implementation for CVD primary and secondary prevention. We appraised individual study quality using a validated tool. We performed a qualitative synthesis of reported barriers and facilitators, categorized according to country income level and according to the World Heart Federation Roadmap domains: HCPs, patients, technology, and health systems. Results: We included 125 primary studies (101 qualitative, 15 quantitative, 9 mixed methods). The most frequently cited barrier was excessive workload, both from existing responsibilities and additional tasks introduced by DHIs. The leading facilitator was the perceived positive clinical impact of DHIs—such as improved adherence, reduced hospital readmissions, and better outcomes. HCP motivation, adequate training, and system integration also facilitated adoption. Many factors—like effects on HCP-patient relationships and workflow—functioned as either barriers or facilitators, depending on the setting. Patient-related barriers included limited digital access and literacy; facilitators included perceived gains in patient-centered care. Health system factors such as organizational structure, financing, and policy support were commonly mentioned, with mixed views. Technology-related facilitators included usability, adaptability, and integration with electronic records; instability was a key barrier. Conclusions: This is the first systematic review to synthesize post-COVID-19 literature on HCPs’ perceptions of DHIs in CVD primary and secondary prevention. While offering a rich, global overview, limitations include a predominance of qualitative studies and lack of data from low-income countries. Effective implementation must address workload, align with workflows, and build trust through training and leadership. LAY SUMMARY This research analyzed 125 studies from 33 countries to understand the factors that influence healthcare professionals’ uptake of digital health tools, such as apps and wearable devices, for preventing cardiovascular disease. The leading facilitator for adoption is the perceived positive clinical impact; doctors and nurses are highly motivated to use digital tools when they help patients follow treatments better, reduce hospital readmission rates, and improve overall heart health. The most significant barrier is the perceived excessive workload. While some digital health tools can be time-saving, many providers feel that they add burdensome technical tasks to their already busy schedules, which undermines their acceptance. Uptake is also influenced by patient-related factors, such as digital literacy and internet access, as well as technological factors like how easily a tool integrates into existing hospital computer systems. To improve the future of cardiovascular care, digital tools should be co-designed with clinicians to ensure they fit seamlessly into daily work routines and are supported by proper training and strong institutional leadership.
Background: While life expectancy (LE) in the Netherlands has increased over recent decades, it is not always accompanied by good health, particularly among individuals with adiposity. As adiposity is a major risk factor for cardiovascular disease (CVD), previous studies have explored its association with LE and CVD burden, but findings remain heterogeneous. Objective: To assess the association between adiposity and LE in adults, with and without CVD. Methods: We used data from the longitudinal Doetinchem Cohort Study (DCS), including 2,323 participants aged 50–70 years (49% women). Adiposity categories were determined (low, increased, high and very high) based on the combination of body mass index (BMI) and waist circumference (WC) thresholds for overweight and obesity based on the AACE/ACE definitions. CVD and mortality were assessed via linkage to hospital and death registries. A multistate life table approach estimated total and CVD-specific LE using transition rates between three health states—CVD-free to CVD, CVD-free to death, and CVD to death—incorporating prevalences and adjusted hazard ratios (HRs) for adiposity categories by sex and CVD status. Results: LE did not differ between adiposity categories at age 50 in both men and women. Men with very high adiposity had a 2.6-year lower LE free of CVD compared to men in the low adiposity category (difference: –2.6 years, 95% CI: –3.6, –1.5), and lived more years with CVD (difference: 2 years, 95% CI: 0.9, 2.9). Men in any adiposity category lived more years with CVD than women in a similar category. In women, there were no differences in CVD-specific LE between the adiposity categories. Conclusion: Men in the very high adiposity category lived more years with CVD compared to those in the low category. These findings highlight the need for targeted cardiovascular prevention in men with very high adiposity to delay CVD onset and promote a healthy lifespan.
Background: Rheumatic heart disease (RHD) and atrial fibrillation (AF) are major global health burdens. AF affects up to one-third of individuals with RHD, yet clinical guidelines lack recommendations for AF screening in this population. Aim: To identify and review current guidelines/policies for AF and RHD to assess whether recommendations are made for AF screening in patients with RHD, thereby identifying any policy gaps. Methods: A narrative policy content review was conducted. This included: guidelines, consensus statements, position statements and policy documents regarding AF or RHD. Documents were identified through searches in MEDLINE, national/international cardiovascular society websites and citation tracking. A narrative synthesis approach was used to review content. Results: A total of 29 documents were identified (16 focussed on AF; 13 on RHD). Of the 16 AF-focussed documents, 13 recommended AF screening in the general population in high-risk groups, based on age and comorbidities. Only one, the 2021 Asia Pacific Heart Rhythm Society (APHRS) AF practice guidance, explicitly recommended AF screening in higher-risk patients with RHD. The 13 RHD-focussed documents acknowledged AF as a frequent complication, particularly in advanced valvular disease, but none specifically recommended screening. Conclusion: This review highlights a clear gap in current guidelines and policies for AF screening in those with RHD. Although AF is a common complication of RHD, only one policy document was identified that provided specific recommendations for AF screening in patients with RHD. Further work is needed to inform and develop appropriate AF screening guidelines tailored to RHD populations in different settings.
Background:Familial hypercholesterolemia (FH) is a common autosomal dominant disorder associated with a substantially increased risk of atherosclerotic cardiovascular disease. In low- and middle-income countries (LMICs), universal FH screening is often impractical, highlighting the need for targeted screening strategies embedded within existing health systems. Objectives:To evaluate the detection yield and real-world implementation feasibility of a stepwise targeted FH screening strategy in a resource-limited setting. Methods:This multi-component implementation study included retrospective and prospective hospital-based screening of patients with premature coronary artery disease (CAD), followed by a geographically targeted community-based screening program linked to a genetically confirmed FH index case in Vietnam. FH was assessed using the Dutch Lipid Clinic Network criteria, with LDL-C thresholds applied for community-level screening. Results:Among patients with premature CAD, phenotypic FH was identified in 2.5% and 8.3% of the retrospective and prospective cohorts, respectively. The higher detection rate in the prospective cohort may reflect more systematic phenotyping. In the community screening, 59.1% of eligible individuals participated, and 10.6% had LDL-C levels ≥ 4.9 mmol/L. Conclusions:A stepwise targeted FH screening strategy-initiated in clinical populations and extended via geographically targeted community screening-demonstrates feasibility and potential scalability in resource-limited settings and may provide a pragmatic framework for integration into national NCD programs in LMICs. Highlights:- Targeted screening strategies may enhance the detection of FH in resource-limited settings where universal screening is not feasible.- Patients with premature coronary artery disease represent a high FH detection rate.- Geographically targeted community-based screening linked to FH index cases enables identification of individuals with markedly elevated LDL-C levels.- A stepwise approach combining hospital-based and community-based screening may provide a scalable model for FH detection in LMICs.
