Beyond Sharing and Shifting: Raising the Bar for Global Rheumatic Heart
                        Disease Control

Lee, Scott S.; Vedanthan, Rajesh

doi:10.1016/j.gheart.2019.04.004

Cited by 4 publications

(1 citation statement)

References 21 publications

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“…The study types and populations are highly heterogeneous, making it difficult to draw a definitive conclusion on AF prevalence [5] in Africa. Scott S. Lee and Rajesh Vedanthan discuss the reasons why too little progress is made in combatting RHD and state that "the continuing challenge of RHD is not one of understanding how to prevent and treat it-but rather, a failure of widespread implementation of effective prevention and treatment" [6]. Task-shared RHD care models are needed that should be designed with implementation in mind.…”

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confidence: 99%

Raising Cardiovascular Health in Low Resource Settings: Challenges and Road Maps Ahead

Grobbee

2019

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In this issue of Global Heart Dominque Vervoort discusses cardiac surgery as a neglected component of cardiovascular care in low and middle income countries (LMIC) [1]. Every year, 1 million babies are born with congenital heart defects in LMICs, of which 70% will require medical or surgical care within a year. Many LMICs, even larger ones, lack cardiac centers and surgeons, completely impeding any efforts to provide cardiac surgical care. Centers that do exist are subject to dysfunctional equipment or lack of disposables. Without, surgery cannot take place, calling for effective supply chains to cover this rate-limiting factor. Health is a basic human right and its constituents should be no less. Having access to interventions able to save the lives of millions and prevent disability for millions more around the world, while being cost effective and having a dramatic socioeconomic potential, should not be reserved to those born in specific parts of the world. In the 21st century, everyone deserves to live their life to its fullest potential. And access to quality care not only remains an issue for surgery. Even affordable effective medical treatment is a challenge. Widespread access to good quality antihypertensive medicines is a critical component for reducing premature cardiovascular disease (CVD) mortality. Julie Redfern and colleagues show that more than a quarter of some commonly prescribed antihypertensive medicines available in Nigeria may be of substandard quality. Enhanced quality assurance processes in LMICs are needed to support optimum management [2]. Strategies are needed to improve access and use of effective risk reduction therapies. Polypills, fixed dose combinations of blood pressure lowering drug(s), statin, with or without aspirin, improve the use of these recommended drugs in patients with or at high risk of CVD. However, their effective use appears limited not only by availability but also lack of knowledge among those that prescribe. Abdul Salam Mohammad and his team demonstrate that in a market where polypill use is licensed, e.g., India, their availability and use is still very low [3]. Lack of prescription of polypills was the predominant barrier to polypill use, and therefore making polypills with drugs that are more acceptable and at different strengths available, in conjunction with broader prescriber education and training may improve their use. The number of subjects at high risk in LMIC's is on the increase with certain countries showing particularly alarming trends. Juan P. González

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