Journal of the Saudi Heart Association最新文献

{"title":"Sex-based Differences in the Utility and Outcomes of Left Ventricular Assist Devices.","authors":"Mirvat Alasnag, Waleed AlHabeeb, Feras Khaliel","doi":"10.37616/2212-5043.1418","DOIUrl":"10.37616/2212-5043.1418","url":null,"abstract":"<p><p>The totality of evidence suggests that there remains a significant disparity in the use of left ventricular assist devices (LVADs) and heart transplantation (HT) in women. This disparity persists even after accounting for differences in baseline characteristics, comorbidities, and cardiovascular risk factors between men and women undergoing LVAD implantation as a bridge to HT. Generally, women are less likely to undergo HT, leading to a higher mortality rate in women on the HT waiting list. The differences in risk profiles and device-related complications may account for the sexrelated disparities in the assignment of device therapies. These findings warrant an urgent need to conduct prospective studies to better define this conundrum and establish guidelines to narrow the current gaps in care.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 1","pages":"6"},"PeriodicalIF":0.7,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemia and Anatomy in the New 2024 European Guidelines for Chronic Coronary Syndromes: Update and Comparison of Recommendations.","authors":"Christian A Caroli","doi":"10.37616/2212-5043.1416","DOIUrl":"10.37616/2212-5043.1416","url":null,"abstract":"<p><p>The new 2024 European guideline on chronic coronary syndromes (CCS) is a pivotal document for clinical practice, updating the evidence and indications after five years, incorporating insights from the paradigm-shifting ISCHEMIA trial. This article explores the evolving role of functional and anatomical testing in assessing coronary artery disease (CAD), highlighting the introduction of a new risk probability score based on clinical and risk factors. Additionally, it provides a detailed comparison between these European recommendations and those from the most influential American guidelines, emphasizing key differences in the approach to risk stratification and diagnostic strategies. This comprehensive analysis provides valuable insights for optimizing the management of a syndrome that, in light of new evidence, has proven to be clinically complex and, in many aspects, counterintuitive.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 1","pages":"8"},"PeriodicalIF":0.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Safety of Ramadan Fasting in Chronic Heart Failure Patients With Reduced Ejection Fraction.","authors":"Ahmed F Alaarag, Mahmoud A Elkhalek Abou-Omar, Osama A Amin","doi":"10.37616/2212-5043.1419","DOIUrl":"10.37616/2212-5043.1419","url":null,"abstract":"<p><strong>Objectives: </strong>Even though Islam excludes the sick from Ramadan Fasting (RF), countless Muslims choose to fast throughout this holy month. So, it is of paramount importance to review how RF influences patients with chronic Heart Failure with reduced Ejection Fraction (HFrEF). Our study intended to check the safety of RF in these patients.</p><p><strong>Methods: </strong>We selected patients under 75 years old with compensated chronic HFrEF. After applying all the exclusion conditions, those who insisted on fasting during the coming Ramadan were enrolled in fasting Group I (90 patients). Those who decided not to fast were listed as control Group II (68 patients) to ensure a comprehensive model.</p><p><strong>Results: </strong>Patients with prior revascularization, AF, lower e-GFR, and poor functional capacity (higher NYHA class) had higher AEs after RF with P values (0.013, 0.027, 0.001, and 0.038), respectively. The low e-GFR and prior revascularization were independent predictors of AEs with P-values (0.005 & 0.031), respectively. The e-GFR (50 ml/min/1.73 m²) was cut off at which the incidence of AEs increased, with a specificity and sensitivity of 65 % and 81 %, respectively.</p><p><strong>Conclusions: </strong>RF may be harmless in low-risk patients with chronic HFrEF under the supervision of a medical professional. However, HFrEF patients with prior coronary revascularization or CKD may have a higher incidence of AEs.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 1","pages":"3"},"PeriodicalIF":0.7,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Usefulness of 3D Heart Models as a Tool of Congenital Heart Disease Education: A Narrative Review.","authors":"Raghad A Alhojailan, Reghd H M Alkhalifah, Bana AlBani, Majed Wadi","doi":"10.37616/2212-5043.1417","DOIUrl":"10.37616/2212-5043.1417","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this review is to evaluate the effectiveness of three-dimensional (3D) heart models as teaching tools for congenital heart disease (CHD), addressing the limitations of traditional medical education methods.</p><p><strong>Methods: </strong>A thorough literature review was conducted using PubMed, Google Scholar, Scientific Direct and Scopus databases. Relevant articles were screened and selected based on their discussion of the application of 3D models in CHD education.</p><p><strong>Results: </strong>The comprehensive review of 19 studies revealed that 3D heart models provide students, healthcare professionals, and patients with meaningful experiences that significantly enhance understanding and learning outcomes. These models improve objective knowledge, structural conceptualization, and personal satisfaction in medical education, especially in complex CHD compared to traditional methods such as books and 2D images ( <i>p</i>< 0.001). Additionally, they enhance spatial orientation, surgical planning, simulation training, clinical reasoning, and critical thinking of healthcare providers. Patients and parents showed better comprehension and confidence in explaining their condition to others. Despite the cost and technical limitations, 3D models of CHD show promising potential.</p><p><strong>Conclusion: </strong>Integrating 3D heart models into CHD education has positively impacted knowledge acquisition, satisfaction, and confidence across various learner populations. The interactive and tangible nature of 3D models offers advantages over traditional teaching methods, fostering a deeper understanding of complex cardiac structures and pathology. However, further research is necessary to investigate long-term benefits and develop effective integration strategies in medical curricula and practice.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 1","pages":"1"},"PeriodicalIF":0.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological Characteristics of Patients With Supraventricular Tachycardias Who Were Inappropriately Diagnosed With Panic Attacks: Experience From a Large Saudi Tertiary Care Center.","authors":"Ghram Awlia, Ahmed T Mokhtar, Maha Alsaiari, Nagham Alsolaimani, Waddah Y Ashram, Alaa S Algazzar, Naeem Alshoaibi","doi":"10.37616/2212-5043.1413","DOIUrl":"10.37616/2212-5043.1413","url":null,"abstract":"<p><strong>Objectives: </strong>Supraventricular tachycardia (SVT) is a significant cause of morbidity in patients visiting cardiology clinics with a chief complaint of palpitations and notable signs of distress worldwide. SVTs and panic attacks have overlapping clinical presentations, beginning with rapid palpitations of the heart that start abruptly and can be accompanied by shortness of breath, chest pain or discomfort, and a feeling of lightheadedness. The diagnosis could be straightforward if an ECG is recorded precisely during the attack. The chances of misdiagnosing patients with panic attacks increase because of the self-terminating nature of SVTs. Given the diagnostic dilemma caused by these conditions and lack of corresponding literature, we aimed to determine the true incidence of patients who were misdiagnosed with anxiety disorder and were later appropriately diagnosed with SVT in a large tertiary care center.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of 105 patients, both male and female aged ≥18 years, from King Abdulaziz University Hospital Jeddah, Saudi Arabia. Patients who were diagnosed with SVT between January 2015 and January 2023 and had data regarding SVT subtype, date of SVT diagnosis, and comorbidities were included. Patients with a confirmed diagnosis of a psychiatric condition were excluded. Ninety patients were contacted to participate in a prospective phone survey involving a subjective assessment of SVT symptomatology. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, panic disorder criteria under the classification of anxiety disorders were applied.</p><p><strong>Results: </strong>Forty-seven patients responded, while 43 were lost to contact for reasons, such as out-of-service or switched off phones. In the final group, 20 patients (42.6%) were misdiagnosed with anxiety/panic attacks before being correctly diagnosed with SVT. The most prominent subtype was AVNRT (57.4%). The clinical presentations of both panic attacks and arrhythmia coincided; differentiation was performed based on the ECG results during the episode and appropriate further workup. SVT can be easily misdiagnosed as anxiety due to several factors, including lack of ECG and overlapping symptomatology.</p><p><strong>Conclusions: </strong>Further research is needed to better assess the relationship between the overlapping clinical presentations of SVTs and panic attacks. Overall, physician awareness must be increased to avoid misdiagnosis, which can delay appropriate management of the underlying medical arrhythmia.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 1","pages":"7"},"PeriodicalIF":0.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Avoid Arterial Access During Transcatheter Closure of Patent Ductus Arteriosus Using Anatomo-haemodynamic Landmark.","authors":"Mohit Sachan, Kumar Himanshu, Mukesh J Jha, Santosh K Sinha, Mahmodullah Razi, Awadhesh K Sharma, Puneet Aggarwal, Praveen Shukla, Umeshwar Pandey, Rakesh Verma","doi":"10.37616/2212-5043.1415","DOIUrl":"10.37616/2212-5043.1415","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility, safety, and efficacy of transcatheter closure (TCC) of patent ductus arteriosus (PDA) using anatomo-haemodynamic landmark without any arteriography.</p><p><strong>Method: </strong>In this prospective, non-randomized study, all consecutive patients with PDA undergoing transcatheter closure at LPS Institute of Cardiology, Kanpur, India between January 2019 and June 2024 were evaluated. TCC was performed using anatomical and haemodynamicl landmark without aortogram, and device was deployed through antegrade route only. Transthoracic echocardiography with colour-Doppler imaging was used to confirm position of the device before final deployment. Primary outcome was procedural and fluoroscopy time, and major complications (access site complications, device embolization, residual shunt ≥ grade 3, haemolysis, flow acceleration in left pulmonary artery and descending thoracic aorta, and death). Success was defined as complete closure of shunt without any major complications.</p><p><strong>Result: </strong>TCC was successfully performed through antegrade route in 250 patients (age: 2.3 ± 1.2 years; weight: 10.3 ± 9.8 kg) while 16 patients were excluded for various reasons. Mean diameter of duct was 6.7 ± 4.5 mm. Male and female comprised 176 (70.4%) and 74 (29.6%) respectively. PDA were type A (n = 195; 78%), B (n = 27; 10.8%), C (n = 20; 8%), and (n = 8; 3.2%). TCC was successful in all patients although dislodgement was noted in 1 (0.04%). Lifetech duct occluder and Konar MFO were most commonly used devices in 156 (62.4%) and 33 (13.2%) patients respectively. Immediate closure was achieved in 233 (93.2%) patients while remaining 17 (7.8%) with grade I or II shunt on echocardiogram had complete closure in 2 days. Device embolization was observed in 1 (0.4%) patient while flow acceleration in DTA were observed in 5 (2%) patients. Procedure was successful in 99.6% using antegrade while TCC using isolated venous route was successful in 94%.</p><p><strong>Conclusion: </strong>TCC of PDA using anatomo-haemodynamic landmark and avoiding arterial access is feasible, safe, and effective, with excellent results on short and medium-term follow-up.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 1","pages":"5"},"PeriodicalIF":0.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Diagnosing and Treating Fungal Endocarditis: A Case Report of Recurrent Candida Endocarditis in a Hemodialysis Patient.","authors":"Ghaidaa A Almuhammadi, Rawia A Alzughaibi, Lamar A Amer, Talal S Alzahrani","doi":"10.37616/2212-5043.1414","DOIUrl":"10.37616/2212-5043.1414","url":null,"abstract":"<p><p>Fungal endocarditis (FE) is a rare yet life-threatening condition, especially in hemodialysis (HD) patients with indwelling long-term catheters. Symptoms often overlap with non-fungal infective endocarditis, making diagnosis difficult. As FE incidence increases, healthcare providers face challenges in diagnosing and managing this severe condition. Early suspicion of FE is crucial for patients with long-term catheters. We reported a 23-year-old male with end-stage renal disease (ESRD) on HD that developed FE affecting the tricuspid valve, requiring valve replacement and anti-fungal medication. Despite these interventions, he had recurrent Candida prosthetic endocarditis (CPE). Currently, he is receiving anti-fungal medication, with plans for a third surgery.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"37 1","pages":"4"},"PeriodicalIF":0.7,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zilebesiran and Hypertension: A Systematic Review and Meta-analysis.","authors":"Mohamed Lemine, Saif Almuzainy, Rayan Aljubeh, Ahmad Alilo","doi":"10.37616/2212-5043.1408","DOIUrl":"https://doi.org/10.37616/2212-5043.1408","url":null,"abstract":"<p><strong>Objectives: </strong>Zilebesiran is an investigational RNA interference therapeutic designed to lower blood pressure by targeting the hepatic production of angiotensinogen, the most upstream precursor of the renin-angiotensin-aldosterone system. This approach aims to offer long-lasting blood pressure control with potentially fewer doses compared to traditional antihypertensive medications. The objective of this systematic review and meta-analysis was to assess the antihypertensive efficacy of zilebesiran in patients with hypertension.</p><p><strong>Methods: </strong>We conducted a search across PubMed, Cochrane Library, Ovid, EBSCO, up until July 2024. The eligible studies included randomized controlled trials that examined Zilebesiran versus placebo in hypertensive patients. These studies reported outcomes like reduction in 24-hour systolic blood pressure (SBP) from baseline, changes in plasma angiotensinogen (ATG) levels and office SBP at three months. Meta-analyses were carried out using RevMan.</p><p><strong>Results: </strong>Our search identified 138 records, of which three randomized controlled trials (RCTs) with 1145 patients met inclusion criteria, focusing on Zilebesiran versus placebo for primary hypertension. Quality assessment revealed two high-quality and one moderate-quality study. Pooled analysis showed Zilebesiran significantly reduced 24-hour systolic blood pressure (SBP) compared to placebo across all doses (MD -12.84, 95% CI -16.00 to -9.68, P < 0.00001), though heterogeneity was high for doses above 500 mg. Zilebesiran also significantly lowered plasma angiotensinogen and office SBP. Sensitivity analysis resolved some heterogeneity issues. Publication bias could not be assessed.</p><p><strong>Conclusion: </strong>Zilebesiran effectively reduces 24-hour and office systolic blood pressure and plasma angiotensinogen, demonstrating significant antihypertensive benefits. Optimal dosing appears between 250 and 500 mg. Further research should explore patient-specific responses to enhance therapeutic efficacy and minimize side effects.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"36 4","pages":"420-430"},"PeriodicalIF":0.7,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Saudi Heart Association Position Statement on Cardiovascular Diseases and Diabetes Mellitus.","authors":"Waleed Alhabeeb, Abdelfatah Elasfar, Abdulhalim J Kinsara, Ahmed Aljizeeri, Ibrahim Jelaidan, Kamal Alghalayini, Mohammed F AlKheraiji, Mousa Akbar, Sameh Lawand, Sarah M Alyousif, Saud Alsifri, Taher Hassan","doi":"10.37616/2212-5043.1407","DOIUrl":"10.37616/2212-5043.1407","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease (CVD) and diabetes mellitus are prominent public health concerns in Saudi Arabia owing to their increasingly high prevalence and burden. Based on this, the Saudi Heart Association (SHA) set out to develop an official position statement on CVD and diabetes mellitus, with a focus on the prevention and management of these conditions and relevant special populations in the context of Saudi Arabia.</p><p><strong>Methods: </strong>A multidisciplinary panel of experts met under the auspices of the SHA in a series of meetings to review and discuss available evidence on the prevention and management of comorbid CVD and diabetes mellitus. Specialized subcommittees reviewed the data and offered context-specific recommendations (taking into account Saudi population characteristics, local healthcare system, available resources and medical expertise), which were later approved by the full expert panel.</p><p><strong>Results and conclusions: </strong>The prevalence of diabetes mellitus and CVD is alarming in the Saudi Arabian population. Diabetes mellitus and CVD are interconnected on several levels, including cellular and molecular events as well as epigenetic and genetic mechanisms. Screening for CVD is a priority for patients with diabetes and concomitant risk factors. The expert panel also recommends aggressive management of high blood pressure and dyslipidemia in addition to lifestyle changes and achieving glycemic targets for the prevention of CVD in patients with diabetes. Some glucose-lowering drug classes, namely SGLT2-inhibitors and GLP-1 receptor agonists, offer significant benefits on the level of cardiovascular risk reduction and are thus a powerful addition to the clinical management armamentarium in CVD and diabetes. Special consideration is also advised for patient populations with distinct clinical presentation and needs, such as coronary artery disease, heart failure, and chronic kidney disease, among others.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"36 4","pages":"385-407"},"PeriodicalIF":0.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives of Policymakers on Barriers to and Enablers of the Uptake of Cardiac Rehabilitation in Saudi Arabia: A Qualitative Study.","authors":"Ahmed M Almoghairi, Jane O'Brien, Jed Duff","doi":"10.37616/2212-5043.1405","DOIUrl":"https://doi.org/10.37616/2212-5043.1405","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to identify the barriers to and enablers of secondary prevention care and cardiac rehabilitation (CR) utilization by patients with coronary heart disease (CHD) following percutaneous coronary intervention (PCI) from the perspective of policymakers.</p><p><strong>Methods: </strong>A qualitative study involving an interpretive descriptive design was conducted through recorded semistructured interviews with key decision-makers in cardiology care in Saudi Arabia. The analysis was guided by the updated Consolidated Framework for Implementation Research (CFIR), which informed the resulting themes.</p><p><strong>Results: </strong>Interviews were conducted with nine key decision-makers: four directors of major cardiac centers, four heads of cardiac rehabilitation units, and one president of a specialized cardiac society. Data coding identified 16 CFIR constructs as barriers, with seven prioritized by the participants. The most frequently cited barriers included lack of CR facilities, shortage of trained staff, and insufficient knowledge of CR among cardiologists. Seventeen constructs emerged as enablers to aid in overcoming these challenges, with nine receiving high consensus among policymakers. Key enablers included implementing alternative models, such as home-based programs; enhancing cardiologists' understanding of CR benefits; and involving higher authorities for support.</p><p><strong>Conclusions: </strong>This study highlights the significant barriers to CR utilization and proposes solutions to facilitate the implementation of these programs from the perspective of healthcare leaders. Successful implementation requires improved communication within institutions, collaboration with the broader healthcare system, and engagement with other stakeholders, such as the private sector, to expand access and ensure comprehensive service delivery.</p>","PeriodicalId":17319,"journal":{"name":"Journal of the Saudi Heart Association","volume":"36 4","pages":"371-380"},"PeriodicalIF":0.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}