Ischemic Heart Disease Worldwide, 1990 to 2013

Shepard, Dawn; VanderZanden, Amelia; Moran, Andrew E.; Naghavi, Mohsen; Murray, Christopher J L; Roth, Gregory A.

doi:10.1161/circoutcomes.115.002007

Cited by 67 publications

(38 citation statements)

References 1 publication

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“…[1][2][3] Consequently, hospital emergency departments (EDs) are seeing increasing number of patients presenting with chest pain and other signs of acute coronary syndromes (ACS). The emergent nature of ACS renders it important to rapidly and accurately diagnose and risk stratify patients.…”

Section: Introductionmentioning

confidence: 99%

Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI

et al. 2017

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ObjectiveHigh-sensitivity troponin (hs-Tn) assays need to be applied appropriately to improve diagnosis and patient outcomes in acute coronary syndromes (ACS).MethodsExperts from Asia Pacific convened in 2015 to provide data-driven consensus-based, region-specific recommendations and develop an algorithm for the appropriate incorporation of this assay into the ACS assessment and treatment pathway.ResultsNine recommendations were developed by the expert panel: (1) troponin is the preferred cardiac biomarker for diagnostic assessment of ACS and is indicated for patients with symptoms of possible ACS; (2) hs-Tn assays are recommended; (3) serial testing is required for all patients; (4) testing should be performed at presentation and 3 hours later; (5) gender-specific cut-off values should be used for hs-Tn I assays; (6) hs-Tn I level >10 times the upper limit of normal should be considered to ‘rule in’ a diagnosis of ACS; (7) dynamic change >50% in hs-Tn I level from presentation to 3-hour retest identifies patients at high risk for ACS; (8) where only point-of-care testing is available, patients with elevated readings should be considered at high risk, while patients with low/undetectable readings should be retested after 6 hours or sent for laboratory testing and (9) regular education on the appropriate use of troponin tests is essential.ConclusionsWe propose an algorithm that will potentially reduce delays in discharge by the accurate ‘rule out’ of non-ACS patients within 3 hours. Appropriate research should be undertaken to ensure the efficacy and safety of the algorithm in clinical practice, with the long-term goal of improvement of care of patients with ACS in Asia Pacific.

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Section: Introductionmentioning

confidence: 99%

Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI

et al. 2017

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“…Overall mortality from these conditions in sub-Saharan Africa is low (ischemic heart disease 4.7%, stroke 5.0%) but South Africa’s are slightly higher (7.6% and 6.3%, respectively) 54, 55 . Our data shows that one of the reasons for these high levels of mortality from cardiovascular events may be due to the poor control of CVD risk factors.…”

Section: Discussionmentioning

confidence: 99%

Disparities in Management of Cardiovascular Disease in Rural South Africa

Jardim¹,

Reiger²,

Abrahams‐Gessel³

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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Background Optimal secondary prevention is critical for the reduction of repeated cardiovascular events and the control of cardiovascular risk factors in this context is essential. Data on secondary prevention of cardiovascular disease (CVD) in sub-Saharan Africa are needed to inform intervention strategies, with a particular focus on local disparities. The aim of this study was to assess CVD management in a rural community in northeast South Africa. Methods and Results We recruited adults aged ≥ 40 years residing in the Agincourt sub-district of Mpumalanga province. Data collection included socioeconomic and clinical data, anthropometric measures, blood pressure, HIV status and point-of-care glucose and lipid levels. CVD was defined as self-report of myocardial infarction and stroke, or angina diagnosed by Rose Criteria. A linear regression model was built to identify variables independently associated with the number of cardiovascular risk factors controlled. Out of 5,059 subjects, 592 (11.7%) met CVD diagnostic criteria. Angina was reported in 77.0% of these subjects, stroke in 25.2% and myocardial infarction in 3.7%. Percent controlled of the five individual risk factors assessed were as follows: tobacco 92.9%; blood pressure 51.2%; BMI 33.8%; LDL 31.4%; and waist-to-hip ratio 29.7%. Only 4.4% had all five risk factors controlled and 42.4% had three or more risk factors controlled. Male sex (β-coefficient=0.44; 95%CI 0.25–0.63; p<0.001), absence of physical disability (β-coefficient=0.40; 95%CI 0.16–0.65; p=0.001) and socioeconomic status (SES) (β-coefficient=0.10; 95%CI 0.01–0.19; p=0.035) were directly associated with the number of risk factors controlled. Conclusions Currently, CVD is not being optimally managed in this rural area of South Africa. There are significant disparities in control of CVD risk factors by sex, SES, and level of disability. Efforts to improve secondary prevention in this population should be focused on females, subjects from lower SES, and those with physical disabilities.

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“…We are just beginning this feature, but are already receiving submissions and have published the first one, an infographic. 2 We also had many special theme features including a series on shared decision making and another on statistical methods. In addition, we devoted special issues to women's health and stroke.…”

Section: Performancementioning

confidence: 99%

The Privilege of Editorship

Krumholz

2016

Circ: Cardiovascular Quality and Outcomes

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Ischemic Heart Disease Worldwide, 1990 to 2013

Cited by 67 publications

References 1 publication

Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI

Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI

Disparities in Management of Cardiovascular Disease in Rural South Africa

The Privilege of Editorship

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