BACKGROUND AND AIMS:Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovascular disease (CVD) primary prevention population from healthcare and societal perspectives. METHODS:We constructed and validated a multi-state microsimulation Markov model for a population of 10,000 individuals aged between 40 and 69 years without CVD, selected randomly from the UK Biobank. The model evaluated Lp(a) testing in individuals not initially classified as high-risk based on age, diabetes status, or the SCORE-2 algorithm. Those with an Lp(a) level ≥105 nmol/L (50 mg/dL) were treated as high risk (initiation of a statin plus blood pressure lowering). The Lp(a) testing intervention was compared to standard of care. The primary analyses were conducted from the Australian and UK healthcare perspectives in 2023AUD/GBP. A cost adaptation method estimated cost-effectiveness in multiple European countries, Canada, and the USA. RESULTS:Among 10,000 individuals, 1,807 had their treatment modified from Lp(a) testing. This led to 217 and 255 quality-adjusted life years gained in Australia and the UK, respectively, with corresponding incremental cost-effectiveness ratios of 12,134 (cost-effective) and -3,491 (cost-saving). From a societal perspective, Lp(a) testing saved $85 and £263 per person in Australia and the UK, respectively. Lp(a) testing was cost-saving among all countries tested in the cost adaptation analysis. CONCLUSIONS:Lp(a) testing in the primary prevention population to reclassify CVD risk and treatment is cost-saving and warranted to prevent CVD.

On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a public call to action regarding the increased risk of adverse cardiovascular health outcomes in transgender and gender diverse (TGD) individuals. The aim of this article is to unpack the numerous factors that contribute to this, such as the social stigma faced by members of the TGD community, their reduced access to clinical care, and the scarcity of research regarding the unique needs of their community, which makes it difficult for clinicians to provide individualized medical care. Decreasing the incidence of adverse cardiovascular events among TGD individuals requires interventions such as educational reform in the medical community, an increase in inclusive research studies, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

Informed by the almost unimaginable unmet need for cardiac surgery in the developing regions of the world, leading surgeons, cardiologists, editors in chief of the major cardiothoracic journals as well as representatives of medical industry and government convened in December 2017 to address this unacceptable disparity in access to care. The ensuing “Cape Town Declaration” constituted a clarion call to cardiac surgical societies to jointly advocate the strengthening of sustainable, local cardiac surgical capacity in the developing world. The Cardiac Surgery Intersociety Alliance (CSIA) was thus created, comprising The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), the European Association for Cardio-Thoracic Surgery (EACTS) and the World Heart Federation (WHF). The guiding principle was advocacy for sustainable cardiac surgical capacity in low-income countries. As a first step, a global needs assessment confirmed rheumatic heart disease as the overwhelming pathology requiring cardiac surgery in these regions. Subsequently, CSIA published a request for proposals to support fledgling programs that could demonstrate the backing by their governments and health care institution. Out of 11 applicants, and following an evaluation of the sites, including site visits to the 3 finalists, Mozambique and Rwanda were selected as the first Pilot Sites. Subsequently, a mentorship and training agreement was completed between Mozambique and the University of Cape Town, a middle-income country with a comparable burden of rheumatic heart disease. The agreement entails regular video calls between the heart teams, targeted training across all aspects of cardiac surgery, as well as on-site presence of mentoring teams for complex cases with the strict observance of “assisting only.” In Rwanda, Team Heart, a US and Rwanda-based non-governmental organization (NGO) that has been performing cardiac surgery in Rwanda and helping to train the cardiac surgery workforce since 2008, has agreed to continue providing mentorship for the local team and to assist in the establishment of independent cardiac surgery with all that entails. This involves intermittent virtual conferences between Rwandan and US cardiologists for surgical case selection. Five years after CSIA was founded, its “Seal of Approval” for the sustainability of endorsed programs in Mozambique and Rwanda has resulted in higher case numbers, a stronger government commitment, significant upgrades of infrastructure, the nurturing of generous consumable donations by industry and the commencement of negotiations with global donors for major grants. Extending the CSIA Seal to additional deserving programs could further align the international cardiac surgical community with the principle of local cardiac surgery capacity-building in developing countries.

Rheumatic and congenital heart disease, cardiomyopathies, and hypertensive heart disease are major causes of suffering and death in low- and lower middle-income countries (LLMICs), where the world's poorest billion people reside. Advanced cardiac care in these counties is still predominantly provided by specialists at urban tertiary centers, and is largely inaccessible to the rural poor. This situation is due to critical shortages in diagnostics, medications, and trained healthcare workers. The Package of Essential NCD Interventions - Plus (PEN-Plus) is an integrated care model for severe chronic noncommunicable diseases (NCDs) that aims to decentralize services and increase access. PEN-Plus strategies are being initiated by a growing number of LLMICs. We describe how PEN-Plus addresses the need for advanced cardiac care and discuss how a global group of cardiac organizations are working through the PEN-Plus Cardiac expert group to promote a shared operational strategy for management of severe cardiac disease in high-poverty settings.

On World Heart Day 2022, the Mexican Society of Cardiology, the Inter-American Society of Cardiology, and the World Heart Federation collaborated on a communication regarding the increased risk of adverse cardiovascular health outcomes in trans -gender and gender-diverse (TGD) individuals. This document, called the Tijuana Declaration, urged the global cardiovascular community to work toward understanding and mitigating this problem. This article aims to unpack the numerous factors that lead to it. An example is the social stigma faced by members of the TGD community, which leads to increased stress and risk for cardiovascular complications. TGD patients are also more likely to have insufficient access to health care, and those that do receive care are often faced with providers that are not adequately educated about the unique needs of their community. Finally, there is some evidence to suggest that gender-affirming hormone therapies have an impact on cardiovascular health, but stud-ies on this subject often have methodological concerns and contradictory findings. Decreasing the incidence of adverse cardio-vascular events in this community requires interventions such as educational reform in the medical community, an increase in research studies on this topic, and broader social initiatives intended to reduce the stigma faced by TGD individuals.

Cardiovascular health is essential to achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG3.4. Barriers include inequalities and a lack of political will and prioritization. A comprehensive approach is needed to reduce the global burden of cardiovascular disease and to achieve SDG3.4. The World Heart Federation addresses the determinants of cardiovascular disease and mobilizes the global community through roadmaps, roundtables and advocacy.

Over the past several decades, the prevalence of cardiovascular disease (CVD) has nearly doubled, and alcohol has played a major role in the incidence of much of it. Alcohol has also been attributed in deaths due to infectious diseases, intentional and unintentional injuries, digestive diseases, and several other non-communicable diseases, including cancer. The economic costs of alcohol-associated health outcomes are significant at the individual as well as the country level. Risks due to alcohol consumption increase for most cardiovascular diseases, including hypertensive heart disease, cardiomyopathy, atrial fibrillation and flutter, and stroke. The widespread message for over 30 years has been to promote the myth that alcohol prolongs life, chiefly by reducing the risk of coronary heart disease (CHD). Lack of universal advice and stringent policy measures have contributed towards increased uptake and easy availability of alcohol. The WHO has called for a 10% relative reduction in the harmful use of alcohol between 2013-2025. However, lack of investment in proven alcohol control strategies, as well as persistence of misinformation and industry interference, have hindered the efforts of public health professionals to make sufficient progress in reducing alcohol related harms and death.

Cardiovascular disease (CVD) is the world’s number one cause of death, claiming an estimated 18.6 million lives in 2019 [1]. That statistic is staggering. Most importantly, an estimated 80 percent of deaths from heart disease and stroke could be avoided with early interventions that span the continuum from education and prevention to diagnosis and treatment. As the COVID-19 pandemic has proven, health data is a powerful tool for use across the continuum of care. Some initiatives, such as Our World in Data [2], demonstrated the potential for the use of data to understand the spread of disease, spot emerging trends, identify the most vulnerable populations, and evaluate the impact of various clinical and public health interventions.

RESULTS: The CSIA is an international alliance consisting of representatives from major cardiothoracic surgical societies and the World Heart Federation. Activities have included meetings at annual conferences, exhibit hall participation for advertisement and recruitment and publication of selection criteria for cardiac surgery centres to apply for CSIA support. Criteria focused on local operating capacity, local championing, governmental and facility support, appropriate identification of a specific gap in care and desire to engage in future research. Eleven applications were received for which 3 finalist sites were selected and site visits conducted. The 2 selected sites were Hospital Central Maputo (Mozambique) and King Faisal Hospital Kigali (Rwanda).

BACKGROUND:Rheumatic heart disease affects more than 33,000,000 individuals, mostly from low- and middle-income countries. The Cape Town Declaration on Access to Cardiac Surgery in the Developing World was published in August 2018, signaling the commitment of the global cardiac surgery and cardiology communities to improving care for rheumatic heart disease patients.METHODS:As the Cape Town Declaration formed the basis for which the Cardiac Surgery Intersociety Alliance was formed, the purpose of this article is to describe the history of the Cardiac Surgery Intersociety Alliance, its formation, ongoing activities, and future directions, including the announcement of selected pilot sites.RESULTS:The Cardiac Surgery Intersociety Alliance is an international alliance consisting of representatives from major cardiothoracic surgical societies and the World Heart Federation. Activities have included meetings at annual conferences, exhibit hall participation for advertisement and recruitment, and publication of selection criteria for cardiac surgery centers to apply for Cardiac Surgery Intersociety Alliance support. Criteria focused on local operating capacity, local championing, governmental and facility support, appropriate identification of a specific gap in care and desire to engage in future research. Eleven applications were received for which three finalist sites were selected and site visits conducted. The two selected sites were Hospital Central Maputo (Mozambique) and King Faisal Hospital Kigali (Rwanda).CONCLUSIONS:Substantial progress has been made since the passing of the Cape Town Declaration and the formation of the Cardiac Surgery Intersociety Alliance, but ongoing efforts with collaboration of all committed parties-cardiac surgery, cardiology, industry, and government-will be necessary to improve access to life-saving cardiac surgery for rheumatic heart disease patients.

While the number of deaths caused by COVID-19 continues to climb towards 5 million,1WorldometerCovid-19 coronavirus pandemic.https://www.worldometers.info/coronavirus/Date: 2021Date accessed: September 23, 2021Google Scholar cardiovascular disease (CVD) claims around 18·6 million lives every year.2WHOCardiovascular diseases (CVDs).https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)Date: June 11, 2021Date accessed: September 20, 2021Google Scholar Yet the COVID-19 pandemic has accelerated the uptake of digital health, creating an opportunity to strengthen the response to CVD. With the increasing access to the internet, and through telemedicine and artificial intelligence (AI)-enabled devices, advances in digital health provide an impetus to improve access and achieve greater equity in health care for the millions of people at risk of or living with CVD,3Pogosova N Yufereva Y Sokolova O Yusubova A Suvorov A Saner H Telemedicine intervention to improve long-term risk factor control and body composition in persons with high cardiovascular risk: results from a randomized trial: telehealth strategies may offer an advantage over standard institutional based interventions for improvement of cardiovascular risk in high-risk patients long-term.Glob Heart. 2021; 16: 21PubMed Google Scholar particularly those in lower-resource settings with limited access to in-person treatment. Although this digital transformation is not a magic bullet, it could help redraw the health-care landscape by improving access to care for underserved populations and by reducing pressures on overloaded health-care systems. Digital technologies can also empower people by providing them with more control of their wellbeing in sickness and in health.4Battineni G Sagaro GG Chintalapudi N Amenta F The benefits of telemedicine in personalized prevention of cardiovascular diseases (CVD): a systematic review.J Pers Med. 2021; 11: 658Crossref PubMed Scopus (23) Google Scholar A trial in the UK of a digital health tool for the management of hypertension is a good example.5McManus R J Little P Stuart B et al.Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial.BMJ. 2021; 372m4858Crossref PubMed Scopus (93) Google Scholar The technology facilitates self-monitoring of blood pressure and includes reminders and predetermined drug changes combined with support for behaviour change. The study showed that the tool led to better control of systolic blood pressure after 1 year than usual care.5McManus R J Little P Stuart B et al.Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial.BMJ. 2021; 372m4858Crossref PubMed Scopus (93) Google Scholar The increasing application of AI to the electrocardiogram is another example of harnessing AI in the management of CVD.6Siontis KC Noseworthy PA Attia ZI Friedman PA Artificial intelligence-enhanced electrocardiography in cardiovascular disease management.Nat Rev Cardiol. 2021; 18: 465-478Crossref PubMed Scopus (282) Google Scholar The potential of remote CVD management has been highlighted in the COVID-19 pandemic when face-to-face medical consultations have not been possible in many settings. Lessons learned—both positive and negative—from this move to digitally enabled care can facilitate the use of digital health for the prevention and management of CVD worldwide. Digital health also has a part to play in addressing health inequalities and increasing access to health-care in low-resource settings. For instance, as digital health expands, governments need to reconsider approaches to investment in medical training and in technology infrastructure and access. The results of a digital health trial in a community hospital with a limited number of doctors in rural Kenya are an indicator of what could be achieved.7Kamotho CG Bukachi F Telemedicine is an effective way to manage cardiovascular disease in rural Kenya and to achieve universal healthcare.Eur Heart J. 2020; 41 (ehaa946.3485.)Google Scholar Patients were able to consult doctors and specialists online about their health, including their blood pressure. The study showed that telemedicine was effective in improving control of systolic blood pressure and gave patients access to quality, affordable medication.7Kamotho CG Bukachi F Telemedicine is an effective way to manage cardiovascular disease in rural Kenya and to achieve universal healthcare.Eur Heart J. 2020; 41 (ehaa946.3485.)Google Scholar There are challenges in relation to awareness, accessibility, and availability of the necessary technology that will need to be overcome on the path to increased use of digital health. Access to digital technology and network infrastructure in low-income and middle-income countries is insufficient. There are about 3·7 billion people, mostly in lower-income countries, who are offline.8International Telecommunication UnionMeasuring digital development facts and figures.https://www.itu.int/en/ITU-D/Statistics/Documents/facts/FactsFigures2020.pdfDate: 2020Date accessed: September 22, 2021Google Scholar Wherever it takes place, it is crucial that advances in digital health do not exacerbate inequality in health care. Furthermore, not all technological innovation is necessarily good and it is important to understand what is the problem that needs solving and ensure that the collection of data and evidence is reliable, impactful, and secure. Much digital health research takes place in selected populations in high-income countries. Thus, AI-derived algorithms are influenced by the gender, ethnicity, age, and socioeconomic status of the sampled population.9Weissglass DE Contextual bias, the democratization of healthcare, and medical artificial intelligence in low- and middle-income countries.Bioethics. 2021; (published online Aug 30.)https://doi.org/10.1111/bioe.12927Crossref PubMed Scopus (10) Google Scholar, 10Banerjee A Chen S Fatemifar G et al.Machine learning for subtype definition and risk prediction in heart failure, acute coronary syndromes and atrial fibrillation: systematic review of validity and clinical utility.BMC Med. 2021; 19: 85Crossref PubMed Scopus (32) Google Scholar If we are to make global recommendations, then we need the same quality of data everywhere, representing all people. The development of digital health affords an opportunity to redress this imbalance and equalise the data framework for CVD and other diseases. Consideration also needs to be given to the impacts of digital health on the relationship between patient and doctor. With patients potentially owning much more of their health data, the dialogue with doctors is likely to change. However, the growth of digital health should never compromise trust between patients and doctors, which is essential for good practices and outcomes. Digital health solutions are not a panacea and they can only complement a fully funded and staffed health system. Hand in hand with maintaining trust between practitioners and patients, the journey towards routine use of digital health care has already started. On Sept 29, 2021, the World Heart Federation, its members, and the wider community come together to celebrate World Heart Day. This year the call to action is "Use Heart to Connect". Digital health can help connect every heart everywhere and thus bring us one step closer to achieving cardiovascular health for everyone. We declare no competing interests.

Background Despite declines in deaths from rheumatic heart disease (RHD) in Africa over the past 30 years, it remains a major cause of cardiovascular morbidity and mortality on the continent. We present an investment case for interventions to prevent and manage RHD in the African Union (AU). Methods We created a cohort state-transition model to estimate key outcomes in the disease process, including cases of pharyngitis from group A streptococcus, episodes of acute rheumatic fever (ARF), cases of RHD, heart failure, and deaths. With this model, we estimated the impact of scaling up interventions using estimates of effect sizes from published studies. We estimated the cost to scale up coverage of interventions and summarised the benefits by monetising health gains estimated in the model using a full income approach. Costs and benefits were compared using the benefit-cost ratio and the net benefits with discounted costs and benefits. Findings Operationally achievable levels of scale-up of interventions along the disease spectrum, including primary prevention, secondary prevention, platforms for management of heart failure, and heart valve surgery could avert 74 000 (UI 50 000-104 000) deaths from RHD and ARF from 2021 to 2030 in the AU, reaching a 30.7% (21.6-39.0) reduction in the age-standardised death rate from RHD in 2030, compared with no increase in coverage of interventions. The estimated benefit-cost ratio for plausible scale-up of secondary prevention and secondary and tertiary care interventions was 4.7 (2.9-6.3) with a net benefit of $2.8 billion (1.6-3.9; 2019 US$) through 2030. The estimated benefit-cost ratio for primary prevention scale-up was low to 2030 (0.2, <0.1-0.4), increasing with delayed benefits accrued to 2090. The benefit-cost dynamics of primary prevention were sensitive to the costs of different delivery approaches, uncertain epidemiological parameters regarding group A streptococcal pharyngitis and ARF, assumptions about long-term demographic and economic trends, and discounting. Interpretation Increased coverage of interventions to control and manage RHD could accelerate progress towards eradication in AU member states. Gaps in local epidemiological data and particular components of the disease process create uncertainty around the level of benefits. In the short term, costs of secondary prevention and secondary and tertiary care for RHD are lower than for primary prevention, and benefits accrue earlier. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (NCDs). In addition to older age, people living with CVD, stroke, obesity, diabetes, kidney disease, and hypertension are at a particularly greater risk for severe forms of COVID-19 and its consequences. Meta-analysis indicates that hypertension, diabetes, chronic kidney disease, and thrombotic complications have been observed as both the most prevalent and most dangerous co-morbidities in COVID-19 patients. And despite the nearly incalculable physical, mental, emotional, and economic toll of this pandemic, forthcoming public health figures continue to place cardiovascular disease as the number one cause of death across the globe in the year 2020. The world simply cannot wait for the next pandemic to invest in NCDs. Social determinants of health cannot be addressed only through the healthcare system, but a more holistic multisectoral approach with at its basis the Sustainable Development Goals (SDGs) is needed to truly address social and economic inequalities and build more resilient systems. Yet there is reason for hope: the 2019 UN Political Declaration on UHC provides a strong framework for building more resilient health systems, with explicit calls for investment in NCDs and references to fiscal policies that put such investment firmly within reach. By further cementing the importance of addressing circulatory health in a future Framework Convention on Emergency Preparedness, WHO Member States can take concrete steps towards a pandemic-free future. As the chief representatives of the global circulatory health community and patients, the Global Coalition for Circulatory Health calls for increased support for the healthcare workforce, global vaccine equity, embracing new models of care and digital health solutions, as well as fiscal policies on unhealthy commodities to support these investments.

The current COVID-19 pandemic has challenged health systems and communities globally. As such, several countries have embarked on national COVID-19 vaccination programmes in order to curb spread of the disease. However, at present, there isn't yet enough dosages to enable vaccination of the general population. Different vaccine prioritization strategies are thus being implemented in different communities in order to permit for a systematic vaccination of individuals. Here, on behalf of the World Heart Federation, we emphasize the need for individuals with Cardiovascular disease to be prioritized in national vaccine prioritization programmes as these are high risk individuals.

The introduction of non-vitamin K antagonists oral anticoagulants, a class of medicines which includes dabigatran, apixaban, edoxaban and rivaroxaban, has resulted in improvements in the safety and efficacy of non valvular atrial fibrillation treatment for stroke prevention, with significant reductions in stroke, intracranial haemorrhage, and mortality. For these reasons, a team of World Heart Federation Emerging Leaders led efforts to add non-vitamin K antagonists oral anticoagulants to the World Health Organization's Model List of Essential Medicines in 2019. Following the inclusion of this class of medicines in the Essential Medicines List, this editorial proposes several recommendations to improve the accessibility, affordability and acceptability of non-vitamin K oral anticoagulants, especially in low- and middle-income settings, in order to successfully manage non-valvular atrial fibrillation and to lower the risk of stroke.

Cardiovascular diseases (CVDs) are the among the main causes of morbidity and mortality in Kenya. Although hypertension is the main CVD risk factor, more than half of Kenyans have never been screened for this condition and 92% are not on treatment. In 2015, the World Heart Federation (WHF)

Global Heart is the official and primary publication of the World Heart Federation, offering a platform for the dissemination of knowledge on research, developments, trends, solutions and public health programmes in the area of cardiovascular disease. Global Heart welcomes research results, points of view and educational material on the prevention, treatment and control of cardiovascular disease with a special focus on low and middle-income countries which are facing the brunt of epidemiological transition.Global Heart strongly encourages authors to adhere to CONSORT, STROBE, STARD, and PRISMA guidelines for reporting of clinical trials, observational studies, diagnostic test accuracy papers, and systematic reviews or meta-analyses. Authors are required for submission to download and complete the appropriate Equator Network checklist: http://www.equator-network.org/.

the-art research facilities of Fuwai Hospital and the NCCD, and with full support from their visionary director Professor Hu, this young group's scientific efforts are likely to shed more light into various unresolved issues related to this challenging heart disease.Moreover, the group members have research ambitions to cover all cardiomyopathies and ultimately provide better health care solutions for these patients and their relatives at risk.To this end, they intend to launch a nationwide screening program for cardiomyopathies and establish a comprehensive Chinese database, incorporating detailed clinical and pathological records, imaging data, genetic information, and a largescale biobank in the near future.'Learning is a treasure that will follow its owner everywhere', says a Chinese proverb.The young clinicians and researchers at Fuwai Hospital are putting tremendous effort to get more in-depth knowledge and experience in their fields of research.Without any doubt, their scientific work will follow them as a treasure and help them and others to understand mechanisms of cardiovascular diseases and improve management strategies.