The Feasibility Of A Mobile Application To Improve Heart Failure Care In Suriname

Introduction The use of mobile applications has been shown to be beneficial in heart failure (HF) management. In high income countries, mobile app use has significantly increased during the COVID-19 pandemic. Limited information exists regarding the use and effectiveness of mobile apps for HF management in Low- and Middle-Income Countries such as Suriname. The Suriname Heart Failure study is designed to assess the effectiveness of a mobile app for HF management tailored to the country's culturally diverse community. To evaluate its effectiveness, we first examined factors influencing successful implementation. Specifically, we assessed the receptiveness of HF patients and their healthcare providers (HCP) and potential facilitators and barriers associated with the proposed HF management app. Methods We developed the "Mi Ati” (My Heart in local language) culturally tailored mobile app using previously validated HF mobile apps as a foundation. All HF patients admitted to the Academic Hospital Thorax Centrum Paramaribo (AZP-TCP) between September-December 2021 and their HCPs were invited to complete a feasibility survey after sharing the β-version of the Mi Ati app with them. The survey consisted of five-point Likert scale (disagree completely to agree completely) and open-ended questions to assess the confidence in using mobile apps, their perceptions about virtual/telemonitoring, and potential barriers, facilitators, benefits and challenges. In addition, we collected patients' socio-demographic information and their access to a mobile phone and the internet. Results Sixty nine (62.3%, mean age: 57.8± SD 14.8 years, 44 (63.8%) male) of the 111 HF patients hospitalized during our inclusion period completed the survey. Fifty six (81.2%) had mobile phone access, and 55 (98.2%) of those had internet access. Forty nine (71.1%) patients indicated they were confident using a mobile phone for health purposes once taught and would like to receive HF education (N=53, 76.8%) and information on diet, exercise, and weight management(N:67,97.1%). Approximately 85% (N= 59) of patients felt confident to self-monitor their symptoms but did not know how to respond to possible symptom changes. In total 16 HCPs (11 cardiologists, 4 ward doctors, and 1 HF nurse) completed the questionnaire of which 15 (93.8%) were comfortable in using a mobile app for patient telemonitoring and all (100%) agreed this could be done by a HF nurse. The majority of HCPs (N= 15, 93.8%) also perceived the app would reduce their workload and 12 (75%) agreed that app usage would not have a negative impact on the patient-HCP relationship. The qualitative analysis for the HCP surveys showed that perceived barriers for the app implementation are low digital and health literacy and the country's current financial economic crisis. Identified facilitators were HF care expertise and existing digital infrastructure at the TCP. Conclusion HF patients and HCPs in Suriname feel confident using a mobile app for monitoring and education purposes. The application must take into account digital and health literacy barriers.

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions.

PURPOSE OF REVIEW: Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence, and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the increased burden of cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension. RECENT FINDINGS: In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity. SUMMARY: In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.

Influence of neighborhood-level social determinants of health on a heart-healthy lifestyle among Black church members: A mixed-methods study

Background Few church-based health interventions have evaluated the influence of neighborhood-level social determinants of health (SDOH) on adopting heart-healthy lifestyles;none has occurred in Louisiana. We aimed to characterize neighborhood-level SDOH that may influence the ability to adopt a heart-healthy lifestyle among Black community church members in New Orleans, LA. Methods This mixed methods study used quantitative data (surveys) and qualitative data (focus groups) to explore SDOH at the neighborhood- and church-area- level, including factors related to the physical (e.g., walkability, accessibility to recreational facilities) and social (e.g., social cohesion, perceived safety) environments. Descriptive analyses were conducted for quantitative data. Qualitative data were coded and analyzed using grounded theory and thematic analysis. Results Among survey respondents (n = 302, 77 % female, 99 % Black), most reported having walkable neighborhood sidewalks and high neighborhood social cohesion. Two-thirds did not feel violence was a problem in their neighborhood and felt safe walking, day, or night. Focus group participants (n = 27, 74 % female, 100 % Black) reported facilitators to heart-healthy living, including social support promoting physical activity, intentionality in growing, buying, and preparing produce, and the neighborhood-built environment. Reported barriers included: crime, the COVID-19 pandemic, individual-level factors limiting physical activity, and city-wide disparities influencing health. Participants discussed strategies to promote healthy living, centered around the theme of establishing and rebuilding community relationships. Conclusions Future health interventions aimed at improving cardiovascular outcomes among church communities should continue to inquire about neighborhood-level SDOH and tailor interventions, as appropriate, to address barriers and leverage facilitators within these communities.

Working Agenda for Black Mothers: A Position Paper From the Association of Black Cardiologists on Solutions to Improving Black Maternal Health.

Following decades of decline, maternal mortality began to rise in the United States around 1990-a significant departure from the world's other affluent countries. By 2018, the same could be seen with the maternal mortality rate in the United States at 17.4 maternal deaths per 100 000 live births. When factoring in race/ethnicity, this number was more than double among non-Hispanic Black women who experienced 37.1 maternal deaths per 100 000 live births. More than half of these deaths and near deaths were from preventable causes, with cardiovascular disease being the leading one. In an effort to amplify the magnitude of this epidemic in the United States that disproportionately plagues Black women, on June 13, 2020, the Association of Black Cardiologists hosted the Black Maternal Heart Health Roundtable-a collaborative task force to tackle the maternal health crisis in the Black community. The roundtable brought together diverse stakeholders and champions of maternal health equity to discuss how innovative ideas, solutions and opportunities could be implemented, while exploring additional ways attendees could address maternal health concerns within the health care system. The discussions were intended to lead the charge in reducing maternal morbidity and mortality through advocacy, education, research, and collaborative efforts. The goal of this roundtable was to identify current barriers at the community, patient, and clinician level and expand on the efforts required to coordinate an effective approach to reducing these statistics in the highest risk populations. Collectively, preventable maternal mortality can result from or reflect violations of a variety of human rights-the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health. This is the first comprehensive statement on this important topic. This position paper will generate further research in disparities of care and promote the interest of others to pursue strategies to mitigate maternal mortality.

Disparities in the COVID-19 pandemic: A clarion call for preventive cardiology.

In 2020, COVID-19 was the third leading cause of death in the US, with increased hospitalizations and mortality linked to factors such as obesity, hypertension, diabetes, higher social vulnerability, and lower socioeconomic status. These multiple factors contribute to inequities in COVID-19 outcomes, including among older persons, members of racial/ethnic populations, and persons experiencing homelessness. Perhaps the best pathway to overcome the distressing high degree of death and disability due to COVID-19 has shown to be immunization with widespread acceptance, uptake, and vaccine access. Especially in racial/ethnic communities, it is important to utilize trusted leaders to overcome common vaccine misconceptions and barriers. This commentary summarizes the keynote lecture given to the Cardiometabolic Health Congress (CMHC) addressing the intersection of social injustice, cardiovascular and cardiometabolic disparities, and increased COVID-19 morbidity and mortality in racial/ethnic populations in the US.

Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID-19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID-19 Pandemic.

The COVID-19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID-19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID-19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID-19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID-19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence-based pharmacotherapy are essential. There is a need to improve the implementation of community-based interventions and blood pressure self-monitoring, which can help build patient trust and increase healthcare engagement.

Global interventions in hypertension: new and emerging concepts.

PURPOSE OF REVIEW: Hypertension (HTN) is the most prevalent risk factor for cardiovascular disease (CVD) worldwide, affecting 1.39 billion people. This review discusses recent literature regarding the global burden of HTN and emerging concepts in prevalence, treatment, and control in different regions around the globe. RECENT FINDINGS: Community-based interventions and telemedicine may be useful in increasing access to care and identifying/assisting patients with HTN, especially in populations with geographical and economic barriers to healthcare. Home blood pressure monitoring is beneficial for HTN control in diverse regions. Polypills have proven benefits to decrease HTN and CVD risk. Continuation of treatment with angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers in high risk COVID-19 patients appears appropriate. SUMMARY: Extensive research demonstrates that early screening/treatment, lifestyle modification, and pharmacotherapy are essential to control HTN worldwide. This review highlights recent research and novel concepts on effective interventions being used globally.

The COVID-19 and Influenza "Twindemic": Barriers to Influenza Vaccination and Potential Acceptance of SARS-CoV2 Vaccination in African Americans.

Influenza is a contagious respiratory virus that causes a significant annual health burden in the United States (US). In spite of effective yearly vaccinations to protect individuals against influenza-related health complications, especially with certain chronic co-morbid illnesses, persistent racial/ethnic disparities exist in influenza immunization. African Americans continue to experience low vaccination uptake, stemming, at least in part, from years of bias in and mistrust of orthodox medicine, safety concerns, and environmental barriers to vaccine access. The novel respiratory coronavirus, SARS-CoV2, causes COVID-19, leading to a pandemic that in the U.S. has exerted severe physical, psychological, and economic tolls on the African Americans and other disadvantaged communities. These two respiratory-borne virus' cause disparate effects in the black community, unmasking persistent disparities in healthcare. Unfortunately, suboptimal influenza immunization acceptance exacerbates flu-related adverse health outcomes, similar to difficulties from the effects of the COVID-19 pandemic. In consideration of the impending influenza-COVID-19 "twindemic", robust educational campaigns, policy initiatives, and novel approaches to influenza immunization must be considered for the African American community to build trust in the health benefits of the influenza vaccination and, ultimately, to trust in the health benefits of potential SARS-CoV2 vaccines, when available for the general public.

State-of-the-Art review: Hypertension practice guidelines in the era of COVID-19.

The global burden of hypertension (HTN) is immense and increasing. In fact, HTN is the leading risk factor for adverse cardiovascular disease outcomes. Due to the critical significance and increasing prevalence of the disease, several national and international societies have recently updated their guidelines for the diagnosis and treatment of HTN. In consideration of the COVID-19 pandemic, this report provides clinicians with the best strategies to prevent HTN, manage the acute and long-term cardiac complications of HTN, and provide the best evidence-based care to patients in an ever-changing healthcare environment. The overarching goal of the various HTN guidelines is to provide easily accessible information to healthcare providers and public health officials, which is key for optimal clinical practice. However, the COVID-19 pandemic has challenged the ability to provide safe care to the most vulnerable hypertensive populations throughout the world. Therefore, this review compares the most recent guidelines of the 2017 American College of Cardiology/American Heart Association and multiple U.S. societies, the 2018 European Society of Cardiology/European Society of Hypertension, the 2019 National Institute for Care and Health Excellence, and the 2020 International Society of Hypertension. While a partial emphasis is placed on the management of HTN in the midst of COVID-19, this review will summarize current concepts and emerging data from the listed HTN guidelines on the diagnosis, monitoring, management, and evidence-based treatments in adults.

Contemporary and Future Concepts on Hypertension in African Americans: COVID-19 and Beyond.

BACKGROUND: Cardiovascular disease related mortality is the leading cause of death in the United States, with hypertension being the most prevalent and potent risk factor. For decades hypertension has disproportionately affected African Americans, who also have a higher burden of associated comorbidities including diabetes and heart failure. METHODS: Current literature including guideline reports and newer studies on hypertension in African Americans in PubMed were reviewed. We also reviewed newer publications on the relationship between COVID-19 and cardiovascular disease. FINDINGS: While APOL1 has been theorized in the epidemiology of hypertension, the increased prevalence and associated risks are primarily due to environmental and lifestyle factors. These factors include poor diet, adverse lifestyle, and social determinants. Hypertension control can be achieved by lifestyle modifications such as low sodium diet, weight loss, and adequate physical activity. When lifestyle modifications alone do not adequately control hypertension, a common occurrence among African Americans who suffer with greater prevalence of resistant hypertension, pharmacological intervention is indicated. The efficacy of renal denervation, and the use of sodium-glucose cotransporter 2 and aminopeptidase A inhibitors, have been studied for treatment of resistant hypertension. Furthermore, the recent COVID-19 crisis has been particularly devastating among African Americans who demonstrate increased incidence and poorer health outcomes related to the disease. CONCLUSION: The disparities in outcomes, which are largely attributable to a greater prevalence of comorbidities such as hypertension and obesity, in addition to adverse environmental and socioeconomic factors, highlight the necessity of specialized clinical approaches and programs for African Americans to address longstanding barriers to equitable care.

Association of cardiac biomarkers and comorbidities with increased mortality, severity, and cardiac injury in COVID-19 patients: A meta-regression and decision tree analysis.

BACKGROUND: Coronavirus disease-2019 (COVID-19) has a deleterious effect on several systems, including the cardiovascular system. We aim to systematically explore the association of COVID-19 severity and mortality rate with the history of cardiovascular diseases and/or other comorbidities and cardiac injury laboratory markers. METHODS: The standardized mean difference (SMD) or odds ratio (OR) and 95% confidence intervals (CIs) were applied to estimate pooled results from the 56 studies. The prognostic performance of cardiac markers for predicting adverse outcomes and to select the best cutoff threshold was estimated by receiver operating characteristic curve analysis. Decision tree analysis by combining cardiac markers with demographic and clinical features was applied to predict mortality and severity in patients with COVID-19. RESULTS: A meta-analysis of 17 794 patients showed patients with high cardiac troponin I (OR = 5.22, 95% CI = 3.73-7.31, P < .001) and aspartate aminotransferase (AST) levels (OR = 3.64, 95% CI = 2.84-4.66, P < .001) were more likely to develop adverse outcomes. High troponin I more than 13.75 ng/L combined with either advanced age more than 60 years or elevated AST level more than 27.72 U/L was the best model to predict poor outcomes. CONCLUSIONS: COVID-19 severity and mortality are complicated by myocardial injury. Assessment of cardiac injury biomarkers may improve the identification of those patients at the highest risk and potentially lead to improved therapeutic approaches.