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Chioncel O, Čelutkienė J, Bělohlávek J, Kamzola G, Lainscak M, Merkely B, Miličić D, Nessler J, Ristić AD, Sawiełajc L, Uchmanowicz I, Uuetoa T, Turgonyi E, Yotov Y, Ponikowski P. Heart failure care in the Central and Eastern Europe and Baltic region: status, barriers, and routes to improvement. ESC Heart Fail 2024. [PMID: 38520086 DOI: 10.1002/ehf2.14687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 03/25/2024] Open
Abstract
Despite improvements over recent years, morbidity and mortality associated with heart failure (HF) are higher in countries in the Central and Eastern Europe and Baltic region than in Western Europe. With the goal of improving the standard of HF care and patient outcomes in the Central and Eastern Europe and Baltic region, this review aimed to identify the main barriers to optimal HF care and potential areas for improvement. This information was used to suggest methods to improve HF management and decrease the burden of HF in the region that can be implemented at the national and regional levels. We performed a literature search to collect information about HF epidemiology in 11 countries in the region (Bulgaria, Croatia, Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Serbia, and Slovenia). The prevalence of HF in the region was 1.6-4.7%, and incidence was 3.1-6.0 per 1000 person-years. Owing to the scarcity of published data on HF management in these countries, we also collected insights on local HF care and management practices via two surveys of 11 HF experts representing the 11 countries. Based on the combined results of the literature review and surveys, we created national HF care and management profiles for each country and developed a common patient pathway for HF for the region. We identified five main barriers to optimal HF care: (i) lack of epidemiological data, (ii) low awareness of HF, (iii) lack of national HF strategies, (iv) infrastructure and system gaps, and (v) poor access to novel HF treatments. To overcome these barriers, we propose the following routes to improvement: (i) establish regional and national prospective HF registries for the systematic collection of epidemiological data; (ii) establish education campaigns for the public, patients, caregivers, and healthcare professionals; (iii) establish formal HF strategies to set clear and measurable policy goals and support budget planning; (iv) improve access to quality-of-care centres, multidisciplinary care teams, diagnostic tests, and telemedicine/telemonitoring; and (v) establish national treatment monitoring programmes to develop policies that ensure that adequate proportions of healthcare budgets are reserved for novel therapies. These routes to improvement represent a first step towards improving outcomes in patients with HF in the Central and Eastern Europe and Baltic region by decreasing disparities in HF care within the region and between the region and Western Europe.
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Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C.C. Iliescu', Bucharest, Romania
- Carol Davila University of Medicine, Bucharest, Romania
| | - Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University/State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Jan Bělohlávek
- Second Department of Medicine, Cardiovascular Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czechia
| | - Ginta Kamzola
- Latvian Centre of Cardiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | - Davor Miličić
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jadwiga Nessler
- Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wrocław Medical University, Wrocław, Poland
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| | | | | | - Yoto Yotov
- First Department of Internal Diseases, Faculty of Medicine, Medical University of Varna, Varna, Bulgaria
| | - Piotr Ponikowski
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
- Wrocław Medical University, Wrocław, Poland
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Zhu X, Luo Z, Tian G, Hu Z, Li S, Wang QM, Luo X, Chen L. Hypotension and cognitive impairment among the elderly: Evidence from the CLHLS. PLoS One 2023; 18:e0291775. [PMID: 37725634 PMCID: PMC10508618 DOI: 10.1371/journal.pone.0291775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND While high blood pressure has been linked to cognitive impairment, the relationship between low blood pressure, especially hypotension, and cognitive impairment has not been well studied. Therefore, this study aimed to assess the prevalence of hypotension and cognitive impairment in the seniors of China, and the association between hypotension and cognitive function impairment. METHODS The data was derived from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured by objective examination. The Chinese version of the Mini-Mental State Examination (CMMSE) was used to evaluate the cognitive impairment of the elderly. Generalized linear models were conducted to evaluate the association of hypotension with cognitive impairment. RESULTS The prevalence of hypotension and cognitive impairment in the Chinese elderly were 0.76% and 22.06%, respectively. Participants with hypotension, lower SBP, and lower DBP, had odds ratios of 1.62, 1.38, and 1.48 for cognitive impairment, respectively. Besides, the CMMSE scores decreased by 2.08, 0.86, and 1.08 in the elderly with hypotension, lower SBP, and DBP, compared with those with non-hypotension, higher SBP, and DBP, respectively. Subgroup analyses showed that the association of cognitive impairment with hypotension was stronger in Chinese elderly who had decreased activity of daily living. Moreover, there was statistical evidence of a nonlinear dose-response relationship of SBP and DBP with cognitive impairment (Pnonlinear < 0.05). CONCLUSION Hypotension was a potential risk factor for cognitive impairment of the Chinese elderly, especially for those having decreased activity of daily living. Blood pressure management should be conducted to prevent them from cognitive impairment.
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Affiliation(s)
- Xidi Zhu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, the Teaching Affiliate of Harvard Medical School, Boston, Massachusetts, United States of America
| | - Zhicheng Luo
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhao Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shaojie Li
- School of Public Health, Peking University, Beijing, China
| | - Qing Mei Wang
- Stroke Biological Recovery Laboratory, Spaulding Rehabilitation Hospital, the Teaching Affiliate of Harvard Medical School, Boston, Massachusetts, United States of America
| | - Xun Luo
- Kerry Rehabilitation Medicine Research Institute, Shenzhen, China
- School of Medicine, Shenzhen University, Shenzhen, China
| | - Lizhang Chen
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Momtaz YA, Hamid TA, Haron SA, Bagat MF, Mohammadi F. Prevalence of hypotension and its association with cognitive function among older adults. Aging Ment Health 2018; 22:447-452. [PMID: 28060530 DOI: 10.1080/13607863.2016.1268093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The negative effect of hypertension has overshadowed possible health problems associated with hypotension. The purposes of this study were to describe the prevalence of hypotension in older adults and to determine the association between hypotension and cognitive function, after adjusting for possible covariates. METHODOLOGY The data for the study consisting of 1067 community-dwelling older adults were obtained from a national survey entitled "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly", conducted in Malaysia. The hypotension was considered as blood pressure <120/75 mm Hg, measuring by standard mercury manometer. Data analysis was performed using the SPSS Version 22.0. RESULTS The mean age of the respondents was 68.27 (SD = 5.93). Mean score of cognitive function as measured by MMSE was 22.70 (SD = 4.95). The prevalence of hypotension was 29.3%. The prevalence of cognitive impairment for hypotension group was 25.6%. Results of multiple linear regression analysis revealed that hypotension is negatively associated with cognitive function (Beta = -0.11, p<.01), after adjusting for age, gender, education, marital status, employment status, diabetes, heart disease, stroke and gastritis. CONCLUSION The study showing hypotension is significantly associated with decreased cognitive function in later life, implies more attention to low blood pressure in old age.
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Affiliation(s)
- Yadollah Abolfathi Momtaz
- a Iranian Research Center on Aging , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Tengku Aizan Hamid
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Sharifah Azizah Haron
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Mohamad Fazdillah Bagat
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Fatemeh Mohammadi
- c School of Nursing & Midwifery , Qazvin University of Medical Sciences , Qazvin , Iran
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Zhu KF, Wang YM, Zhu JZ, Zhou QY, Wang NF. National prevalence of coronary heart disease and its relationship with human development index: A systematic review. Eur J Prev Cardiol 2015; 23:530-43. [PMID: 25976715 DOI: 10.1177/2047487315587402] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary heart disease has become a major health concern over the past several decades. Several reviews have assessed the effects of socioeconomic status on the coronary heart disease epidemic in communities and countries, but only a few reviews have been performed at a global level. This study was to explore the relationship between the prevalence of coronary heart disease and socioeconomic development worldwide using the Human Development Index. DESIGN Systematic review. METHODS The data in this study were collected from the MEDLINE database. Cross-sectional studies reporting the prevalence of coronary heart disease until November 2014 were collected. The Human Development Index was sourced from the United Nations Development Programme Database and was used to measure the socioeconomic achievements of countries. Each country was classified as a developing or developed country based on its level of development according to the Human Development Index value. RESULTS Based on the data analysis on the global level, coronary heart disease prevalence had no association with the national Human Development Index (rho = 0.07). However, there was a positive association between coronary heart disease prevalence and the national Human Development Index in developing countries, although a negative association existed in developed countries (rho = 0.47 and -0.34, respectively). In addition, the past decades have witnessed a growing coronary heart disease epidemic in developing countries, with reverse trends observed in developed countries (P = 0.021 and 0.002, respectively). CONCLUSIONS With the development of socioeconomic status, as measured by the Human Development Index, the prevalence of coronary heart disease is growing in developing countries, while declining in developed countries. Future research needs to pay more attention to the reasonable allocation of medical resources and control of coronary heart disease risk factors.
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Affiliation(s)
- Ke-Fu Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, China
| | | | | | - Qin-Yi Zhou
- Columbian College of Arts and Science, The George Washington University, USA
| | - Ning-Fu Wang
- Department of Cardiovasology, Hangzhou First People's Hospital, China
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Nilsson PM, Journath G, Palm K, Viigimaa M. Risk factor control in treated hypertensives from Estonia and Sweden. Why the difference? Blood Press 2007; 16:301-4. [PMID: 17934917 DOI: 10.1080/08037050701517224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is of importance to study the risk factor control in treated hypertensives (tHT), both longitudinally within one country and between neighbouring countries, as hypertensive patients still run an increased cardiovascular risk in spite of treatment. METHODS In sample of 1135 tHT from Estonia and a similar number of age- and sex-matched Swedish tHT, the control of blood pressure and other cardiovascular risk factors were assessed as part of national surveys in primary health care. Data were retrieved form consecutive patients visiting primary health care centres all over each country. RESULTS The mean age of male patients (n = 421) was 50 years and for female patients (n = 714) it was 52 years. tHT from Sweden were more likely to be in better control of blood pressure and risk factor levels than corresponding Estonian patients, matched for age and gender. However, there was a significantly (p = 0.0003) higher rate of smoking in Swedish female patients (22.4%) than in corresponding Estonian patients (16.0%). More Swedish women than men were prescribed thiazide diuretics, but fewer were prescribed angiotensin-converting enzyme (ACE) inhibitors. No similar Estonian data were available. CONCLUSION Most cardiovascular risk factors were better controlled in the Swedish hypertensives, except for a higher smoking prevalence in Swedish female patients. This could be related not only to differences in clinical practice, but also influenced by social and lifestyle factors.
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Affiliation(s)
- Peter M Nilsson
- Department of Clinical Sciences, University Hospital Malmö, Lund University, Sweden.
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