Global Heart最新文献

{"title":"Global Trends in Ischemic Heart Disease Mortality from 1990 to 2021 and 2036 Projections: Insights from GBD 2021 Data.","authors":"Xiaoqin Zhou, Weiqiang Ruan, Hui Jie, Huizhen Liu, Ting Wang, Jing Li, Ke Lin, Jing Lin","doi":"10.5334/gh.1486","DOIUrl":"https://doi.org/10.5334/gh.1486","url":null,"abstract":"<p><strong>Background: </strong>Ischemic heart disease (IHD) remains a significant global health challenge despite advancements in prevention and treatment. This study aims to comprehensively analyze global IHD mortality trends from 1990 to 2021 and projections for 2036, to support evidence-based decision-making for IHD prevention and management strategies across diverse contexts.</p><p><strong>Methods: </strong>Using data from the Global Burden of Disease Study 2021, we conducted multi-level analyses of IHD mortality trends: globally, across socio-demographic index (SDI) quintiles, 21 Global Burden of Disease (GBD) regions, and 204 countries. We performed age-period-cohort (APC), decomposition, risk factor, and frontier analysis. Bayesian APC modeling was used for projections to 2036.</p><p><strong>Results: </strong>The global age-standardized mortality rate (ASMR) for IHD decreased from 1990 to 2021 (EAPC: -1.301%, net drift: -1.1%) despite a 67.5% increase in total deaths. APC analysis revealed exponential growth in IHD mortality rates with age, with the inflection point at 62.5 years in low SDI regions and 77.5 years in high SDI regions. High SDI regions demonstrated significant period and cohort effects. Frontier analysis showed that Nauru and Ukraine were the countries with the highest effective differences. Decomposition analysis identified population growth and aging as primary factors increasing IHD mortality. High systolic blood pressure remained the leading global risk factor, with increasing contributions from high fasting plasma glucose and high body-mass index, especially in high SDI regions. Projections indicate continued global ASMR decrease by 2036, but with concerning increases in Eastern Europe and some African regions.</p><p><strong>Conclusions: </strong>This study reveals the complex global landscape of IHD, emphasizing that high SDI regions should focus on comprehensive care for older adults and managing metabolic risk factors such as diabetes and obesity, while low and middle SDI regions need to strengthen healthcare systems and implement early prevention strategies. Regions projecting mortality increases require urgent attention and interventions.</p><p><strong>Highlights: </strong><b>What is new?:</b> Global IHD age-standardized mortality rates decreased from 1990 to 2021 (EAPC: -1.301%, net drift: -1.1%), despite a 67.5% increase in total deaths, reflecting advancements in care and ongoing challenges of population aging and growth.APC analysis showed exponential growth in IHD mortality rates with age across all SDI regions, with low SDI regions' inflection point 15 years earlier than high SDI regions, suggesting prioritization of comprehensive care for the elderly in high SDI areas.Decomposition analysis showed South Asia and East Asia experienced the largest increases in IHD deaths, with epidemiological changes contributing to death increases rather than reductions, underscoring the need for effective policies to addres","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"92"},"PeriodicalIF":3.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Price and Affordability of Heart Failure Guideline Directed Medical Therapy in Venezuela: A Cross Sectional Observational Study.","authors":"Karim J Gebran-Chedid, Diana De Oliveira-Gomes, Gabriela Lombardo, Maria Carolina Bacci-Padron, David A Forero-Peña","doi":"10.5334/gh.1474","DOIUrl":"https://doi.org/10.5334/gh.1474","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) impacts over 56 million people worldwide, with significantly higher mortality rates in low and low-middle-income countries (LIC/LMICs). Despite the effectiveness of guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF), its use remains limited in LIC/LMICs due to limited availability and affordability. These barriers are particularly pressing in Venezuela's context, as the country faces an ongoing crisis.</p><p><strong>Objective: </strong>Describe price and affordability of HF Guideline Directed Medical Therapy at optimal dosages in Venezuela.</p><p><strong>Methods: </strong>We conducted a cross-sectional analysis from December 2023 to January 2024, surveying prices of HF GDMT medications across 13 major pharmacy networks in Venezuela. Medications analyzed included ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), and sodium-glucose co-transporter 2 inhibitors (SGLT2i). Affordability was defined and calculated using the World Health Organization/Health Action International (WHO/HAI) methodology, comparing the median costs of one month of HF GDMT at optimal dosages to the lowest-paid government worker's (LPGW) daily wages. Other comparisons of price affordability were made against the mean daily salary of managers, professional and non-professional workers in the country.</p><p><strong>Results: </strong>The most expensive medication regime for HF in Venezuela was ARNI-based GDMT with a median monthly cost of 393.81USD, followed by ARB-based GDMT and ACEi-based GDMT costing $100.88USD and $82.23USD respectively. meaning LPGW and elderly receiving retirement stipends would need between 506 to 2421 paid work days to cover one month of treatment at optimal dosages.</p><p><strong>Conclusion: </strong>Based on the WHO/HAI methodology all HF GDMT regimens were deemed unaffordable in Venezuela. Similar affordability challenges exist in other LIC/LMICs countries highlighting the need for global advocacy and policy action to address financial barriers to access guideline-based heart failure care.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"89"},"PeriodicalIF":3.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Knowledge, Attitudes and Preventive Behaviour Towards the Cardiovascular Benefits of Reduced Exposure to Air Pollution in Nigeria: Evidence from the CARDINAL Study.","authors":"Adekunle Gregory Fakunle, Temilade Bello, Akintayo Olamide Ogunwale, Oyewale Mayowa Morakinyo, Olubunmi Ayinde, Susan Motunrayo Kebu, Oluwapelumi Peter Arinola, Marvelous Adeoye, Bosede Adebayo, Iretioluwa Mary Bamtefa, Akinkunmi Paul Okekunle, Augustine Odili, Mark R Miller, Amam C Mbakwem, Abiodun Moshood Adeoye","doi":"10.5334/gh.1482","DOIUrl":"https://doi.org/10.5334/gh.1482","url":null,"abstract":"<p><strong>Background: </strong>Air pollution has emerged as a known risk factor for cardiovascular diseases (CVDs) globally. Raising public knowledge of the importance of air pollution exposure is crucial for implementing future interventions to improve cardiovascular health. This study aimed to explore the knowledge, attitude and behaviour (KAB) of vulnerable women and men towards the cardiovascular benefits of reducing air pollution exposure.</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 602 vulnerable men and women in Ibadan, Nigeria, using a multi-stage sampling technique. Using the KAB framework, emphasis was placed on the link between air pollution exposure reduction and the burden of CVDs such as stroke, heart failure, heart attack, congenital heart disease, cardiac arrest and atherosclerosis. Data were collected using a digitalised validated semi-structured questionnaire that included questions on knowledge of the link between air pollution and CVD, attitude towards reducing air pollution and behaviours related to reducing air pollution exposure. The median (interquartile range [IQR]) KAB scores were calculated and dichotomised using the median score. Data were analysed using descriptive statistics, chi-square, Spearman's correlation analysis and regression models at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Respondents' mean age was 44.1 ± 14.0 years, and 54.2% were females. The participants' median (IQR) knowledge score was 7.0 (2.0-8.0), with the majority, 66.9%, having poor knowledge. The median (IQR) pollution-reduction attitude score was 10.0 (3.0-16.0), with a majority (58.5%) having a negative attitude. Respondents' median preventive behaviour score was 6.0 (1.0-11.0), and 58.6% had unsatisfactory behaviour. Awareness about air pollution was found to be associated with knowledge (aOR [adjusted odds ratio] 0.82; 95%CI: 0.57-0.97) and behaviour (aOR 0.44; 95%CI: 0.31-0.64) towards air pollution reduction.</p><p><strong>Conclusion: </strong>The poor knowledge of the link between exposure to air pollution and CVD underscores the need for targeted educational initiatives, supported by regulatory interventions, to harness the cardiovascular health benefits of reduced exposure to air pollution in Africa.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"90"},"PeriodicalIF":3.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fifteen Years of Advancing Cardiovascular Rehabilitation in Low-Resource Settings through the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) and a Look Ahead.","authors":"Abraham Samuel Babu, Sherry L Grace, Dion Candelaria, Robyn Gallagher, Aashish Contractor, Carley O'Neill, John Buckley, Gabriela Lima de Melo Ghisi","doi":"10.5334/gh.1484","DOIUrl":"https://doi.org/10.5334/gh.1484","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, with a particular burden in middle-income countries (MICs). Cardiac rehabilitation (CR) is a secondary prevention model resulting in reduced CV mortality, morbidity, cost-effectively. However, CR is under-utilized globally, especially in MICs due to structural, social, and economic barriers. The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) is a World Heart Federation-affiliated umbrella association founded ~15 years ago, now comprised of 50 Associations and 30 champions in countries without CR societies. ICCPR addresses delivery challenges through: CR guidelines tailored for MICs, the Global CR Audit to support advocacy, the International CR Registry (ICRR), Program Certification to support service quality, multi-disciplinary provider training (CR Foundations Certification; CRFC), women-focused CR initiatives, and partnerships with the World Health Organization. ICCPR continues to foster global CR accessibility through collaboration, communication, as well as research and advocacy with their upcoming Global CR Audit Update.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"91"},"PeriodicalIF":3.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising Access to Care for Patients with Heart and Kidney Diseases: A World Heart Federation and International Society of Nephrology White Paper.","authors":"Jagat Narula, Javed Butler, Yazied Chothia, Debasish Bannerjee, Faical Jarraya, Ifeoma Ulasi, Valerie Luyckx","doi":"10.5334/gh.1460","DOIUrl":"https://doi.org/10.5334/gh.1460","url":null,"abstract":"<p><p>The clinical impact of diabetes medications including sodium-glucose cotransporter-2 (SGLT2) inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs) and glucagon-like peptide 1 receptor agonists (GLP-1 RAs) on cardiovascular (CV) and kidney disease outcomes has focused attention on the inter-relatedness of kidney and heart health, both within and outside the context of diabetes. These conditions often co-exist in one individual resulting in frequent hospitalisations and premature deaths. Herein, we provide an updated comprehensive state-of-the-art review, summarising the linkages between heart disease and kidney disease, the mechanisms connecting these conditions, common risk factors, management, implications for health systems, and the impact on patients, particularly in low-resource settings. As experts representing the World Heart Federation (WHF) and International Society of Nephrology (ISN), we highlight areas of opportunity and provide recommendations on improving access to care for the growing numbers of patients with heart and kidney diseases with a focus on low-income and middle-income countries (LMICs).</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"88"},"PeriodicalIF":3.1,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and Willingness of Cardiothoracic Group Physicians in the Cardiovascular and Radiology Departments toward the Adjuvant Use of CT-Derived Fractional Flow Reserve in the Diagnosis of Coronary Artery Disease.","authors":"Xi Tian, Bingzhen Jia, Xusheng Lou, Dong Li, Zhang Zhang","doi":"10.5334/gh.1477","DOIUrl":"https://doi.org/10.5334/gh.1477","url":null,"abstract":"<p><strong>Background: </strong>The diagnosis of coronary artery disease (CAD) has traditionally relied on invasive coronary angiography (ICA), a method with inherent risks. As a noninvasive technique, computed tomography-derived fractional flow reserve (CT-FFR) can integrate both anatomical and functional assessments of the coronary arteries, identifying hemodynamically significant stenosis and thereby reducing unnecessary invasive procedures. Although its clinical value has been demonstrated, its widespread clinical adoption is constrained by physician perception.</p><p><strong>Objective: </strong>To quantify the professional attitudes and willingness to adopt CT-FFR for clinical application among cardiologists and radiologists, and to identify the key determinants influencing their positivity.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted from May to June 2023 across five provinces and cities in China. Data were collected from 265 cardiothoracic physicians using a validated, structured questionnaire (Cronbach's α = 0.884). The questionnaire assessed two core dimensions using a five-point Likert scale: \"Attitude\" (15 questions) and \"Willingness\" (eight questions). Higher scores indicated more positive attitudes or willingness.</p><p><strong>Results: </strong>The survey was completed by 265 physicians, with overall attitudes being positive. The median scores for the attitude and willingness dimensions were 51 (interquartile range: 48, 55) and 31 (interquartile range: 29, 32), respectively, with a significant positive correlation between them (r = 0.571, p < 0.001). While over 60% of physicians acknowledged that CT-FFR could prevent unnecessary invasive procedures, 38.1% still expressed concerns about its diagnostic accuracy. Logistic regression analysis showed that physicians working in specialized cardiovascular hospitals held more positive attitudes (OR = 3.085, p = 0.017). Multivariable analysis further confirmed that a positive attitude was the strongest independent predictor driving willingness to adopt (OR = 6.280, p < 0.001).</p><p><strong>Conclusion: </strong>Participants' belief in the development potential of CT-FFR was positively associated with their willingness to learn, receive training, consider improvements, and participate in clinical research involving CT-FFR.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"87"},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12513361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Rehabilitation in Patients with Coronary Heart Disease-Challenges, Inequalities, and Opportunities for Global Health.","authors":"Vagner Madrini, Monica T A Albuquerque, Caio A M Tavares, Patricia O Guimarães","doi":"10.5334/gh.1480","DOIUrl":"10.5334/gh.1480","url":null,"abstract":"<p><p>Cardiac rehabilitation (CR) is a cornerstone of secondary prevention in coronary heart disease, supported by robust evidence and classified as a Class I recommendation in international guidelines. Despite its proven benefits in reducing morbidity, mortality, and improving quality of life, CR remains strikingly underutilized worldwide, revealing a paradox of high-level evidence with low-level implementation. The INTERASPIRE study highlights this global gap, showing that many patients are neither referred nor adhere to CR programs, and that profound inequities persist across regions and socioeconomic groups. These findings underscore systemic failures in translating guideline recommendations into practice, driven not only by structural limitations but also by physician referral patterns, patient awareness, and health system priorities. Addressing this gap requires investment in infrastructure, equitable referral strategies, standardization of program content, and innovative delivery models such as telehealth. Ensuring universal access to CR is both a clinical imperative and a matter of health equity, with the potential to transform outcomes for patients with cardiovascular disease worldwide.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"86"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Deaths Profile and Its Subtypes in Brazil: Analysis Using Machine Learning.","authors":"Alessandro Rocha Milan de Souza, Letícia Martins Raposo, Glenda Corrêa Borges de Lacerda, Paulo Henrique Godoy","doi":"10.5334/gh.1476","DOIUrl":"10.5334/gh.1476","url":null,"abstract":"<p><strong>Background: </strong>Brazil has one of the highest stroke rates in Latin America. It is important to understand the impact of other causes of death and sociodemographic factors, as this may contribute to a better comprehension of the stroke mortality process. Machine learning provides a means to explain this process.</p><p><strong>Objective: </strong>To investigate the stroke deaths profile and its subtype in Brazil using machine learning.</p><p><strong>Methods: </strong>This is a time series analysis where deaths mentioning stroke and other conditions were identified using individual death records from the country's mortality information system (SIM) between 2000 and 2019. Strokes were grouped into the following subtypes: ischemic stroke (IS), hemorrhagic stroke (HS), and unspecified stroke (US). A decision tree model was built to identify the strongest factors distinguishing IS from HS.</p><p><strong>Results: </strong>There were 2,459,742 deaths mentioning stroke. There was a progressive increase in the number of deaths mentioning stroke over the study period. The most common type of stroke was US, accounting for more than 62% of deaths. Among HS deaths, hypertensive diseases were the most frequent group of associated causes (40.6%), while the most frequent group in subtypes IS and US was diseases of the respiratory system (48.30% and 42.30%, respectively). The decision tree analysis revealed that IS was more likely to occur in patients aged 60 years and over and in cases where respiratory diseases, endocrine diseases, arrhythmias, ischemic heart disease and heart failure were present. However, HS was more frequent in younger patients without these conditions but with nervous system diseases.</p><p><strong>Conclusions: </strong>The decision tree analysis identified the strongest factors distinguishing IS from HS, highlighting variables involved in each subtype of stroke-related death that can be recognized in clinical practice. These variables may also support the redistribution of deaths initially classified as unspecified stroke.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"85"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12493032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and Verification of a Predictive Model for the Progression of Aortic Valve Calcification.","authors":"Zhen Guo, Zhenyu Xiong, Chaoguang Xu, Jingjing He, Shaozhao Zhang, Rihua Huang, Menghui Liu, Jiaying Li, Xinxue Liao, Xiaodong Zhuang","doi":"10.5334/gh.1473","DOIUrl":"10.5334/gh.1473","url":null,"abstract":"<p><strong>Background: </strong>The primary objective of this study is to develop and validate a predictive model assessing the likelihood of disease progression in individuals with aortic valve calcification (AVC).</p><p><strong>Methods: </strong>For the second and third visits, 2,533 patients were followed up. They were randomly assigned to a train set and a validation set at a ratio of 7:3. After employing the Least Absolute Shrinkage and Selection Operator (LASSO) and multiple Cox regression to filter predictors, the selected variables were input into the Cox proportional risk model for model construction. Calibration curve, Consistency Index (C-index), Receiver Operating Characteristic (ROC) curve, and Decision Curve Analysis (DCA) were employed to validate the model. Patients were categorized into low- and high-risk groups based on the model's predicted risk score, and survival analysis was conducted using Kaplan-Meier (K-M) plots. An online platform was used to enhance the clinical utility.</p><p><strong>Results: </strong>The incidence of AVC progression was 9.63%. LASSO-Cox regression analysis identified seven variables significantly correlated with AVC progression. In both the training and validation sets, the Area Under the Curve (AUC) and C-index of the prediction model exceeded 0.8. The calibration curve aligned closely with the diagonal line. Decision Curve Analysis (DCA) underscored the clinical application value of the model. Survival analysis demonstrated a significantly higher progression rate in the high-risk group compared to the low-risk group. The online platform visualized the probability of progression.</p><p><strong>Conclusion: </strong>The developed predictive model has proven reliability and accuracy in forecasting the 2-, 3-, and 4-year progression rates of patients with AVC. It offers a dependable framework for estimating progression and facilitating individualized comprehensive prevention strategies for individuals with AVC.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"84"},"PeriodicalIF":3.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12466327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Polypill (Acetyl Salicylic Acid, Atorvastatin, and Ramipril) Paradigm Shift in Secondary Prevention: Global Expert Delphi Consensus.","authors":"Daniel Piñeiro, José Ramón González-Juanatey, Ana Abreu, Enrique Gómez Alvarez, Carlos Ponte-Negretti, Burkhard Weisser, Alexander Parkhomenko, Francisco Araújo, Alvaro Sosa-Liprandi","doi":"10.5334/gh.1466","DOIUrl":"10.5334/gh.1466","url":null,"abstract":"<p><strong>Background: </strong>The SECURE trial demonstrated that the cardiovascular (CV)-polypill (acetylsalicylic acid [ASA] + atorvastatin + ramipril) reduces CV mortality by 33% in patients with acute myocardial infarction compared to standard care. The 2023 ACS ESC Guidelines recommend the polypill to improve outcomes and adherence.</p><p><strong>Objective: </strong>This study aims to establish a global consensus on the optimal use of the CV-polypill in secondary prevention.</p><p><strong>Methods: </strong>A two-round, modified Delphi method was used, featuring a 30-statement evidence-based questionnaire validated by eight renowned cardiologists. Fifty clinicians from 19 countries in Europe, Latin America, and Asia were invited to join the Delphi panel. Panelists ranked responses using a three-point Likert scale for agreement and importance. Consensus was defined as ≥80% agreement or rating statements 'very important' or 'important'. Statements without consensus after the first round were refined with evidence and feedback in the second round. Remaining disagreements were resolved in a face-to-face meeting. Descriptive statistics were applied.</p><p><strong>Results: </strong>Response rate was 76% (round 1) and 74% (round 2); 82% were cardiologists, with 74% frequently recommending the CV-polypill. Consensus was achieved on 93.3% of statements. Research showing a 24% relative risk reduction in major adverse CV events over a median of 3 years with the CV-polypill post-acute myocardial infarction, compared to usual care, reached 97.4% agreement for clinical implementation, and a 100% consensus supported polypill use at hospital discharge or first follow-up visits; 81.1% agreed on a prompt initiation after patient stabilization. There was agreement on algorithms for initiating (97.3%), considering patient preferences (97.4%) to the polypill and its cost savings over usual care (89.5%).</p><p><strong>Conclusion: </strong>The Delphi consensus on real-world use of a CV polypill (ASA, atorvastatin, and ramipril) for secondary prevention post-acute coronary syndrome supports early initiation (within 8 days or at discharge). The findings provide a foundation to inform practice and policy, identifying priorities for further research.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"83"},"PeriodicalIF":3.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12466114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}