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1.
J Epidemiol Community Health ; 2022 Jan 19.
Article in English | MEDLINE | ID: covidwho-1629386

ABSTRACT

BACKGROUND: Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. METHODS: We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. RESULTS: Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. CONCLUSIONS: Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.

2.
Glob Heart ; 16(1): 22, 2021 04 19.
Article in English | MEDLINE | ID: covidwho-1557646

ABSTRACT

Background: The emergence of novel coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase, and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions facilitated by international travel, leading to a pandemic. To guide effective control and interventions, primary data is required urgently, globally, including from low- and middle-income countries where documentation of cardiovascular manifestations and risk factors in people hospitalized with COVID-19 is limited. Objectives: This study aims to describe the cardiovascular manifestations and cardiovascular risk factors in patients hospitalized with COVID-19. Methods: We propose to conduct an observational cohort study involving 5000 patients recruited from hospitals in low-, middle- and high-income countries. Eligible adult COVID-19 patients will be recruited from the participating hospitals and followed-up until 30 days post admission. The outcomes will be reported at discharge and includes the need of ICU admission, need of ventilator, death (with cause), major adverse cardiovascular events, neurological outcomes, acute renal failure, and pulmonary outcomes. Conclusion: Given the enormous burden posed by COVID-19 and the associated severe prognostic implication of CVD involvement, this study will provide useful insights on the risk factors for severe disease, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients particularly from low and middle income countries from where the data remain scant.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/virology , Global Health , Observational Studies as Topic/methods , Cohort Studies , Hospitalization , Humans , Multicenter Studies as Topic , Pandemics , Prognosis , Risk Factors
3.
Glob Heart ; 16(1): 33, 2021 05 03.
Article in English | MEDLINE | ID: covidwho-1369874

ABSTRACT

The current and immediate past Presidents of the World Heart Federation are pleased to publish this invited editorial to demonstrate the organization's strong, ongoing commitment to addressing the impacts of air pollution on cardiovascular health and outline its strategy for action.


Subject(s)
Air Pollution , Air Pollution/adverse effects , Global Health , Humans
4.
Eur J Cardiothorac Surg ; 59(6): 1139-1143, 2021 06 14.
Article in English | MEDLINE | ID: covidwho-1301348

ABSTRACT

OBJECTIVES: Rheumatic heart disease (RHD) affects >33 000 000 individuals, mostly from low- and middle-income countries. The Cape Town Declaration on Access to Cardiac Surgery in the Developing World was published in August 2018, signalling the commitment of the global cardiac surgery and cardiology communities to improving care for patients with RHD. METHODS: As the Cape Town Declaration formed the basis for which the Cardiac Surgery Intersociety Alliance (CSIA) was formed, the purpose of this article is to describe the history of the CSIA, its formation, ongoing activities and future directions, including the announcement of selected pilot sites. RESULTS: The CSIA is an international alliance consisting of representatives from major cardiothoracic surgical societies and the World Heart Federation. Activities have included meetings at annual conferences, exhibit hall participation for advertisement and recruitment and publication of selection criteria for cardiac surgery centres to apply for CSIA support. Criteria focused on local operating capacity, local championing, governmental and facility support, appropriate identification of a specific gap in care and desire to engage in future research. Eleven applications were received for which 3 finalist sites were selected and site visits conducted. The 2 selected sites were Hospital Central Maputo (Mozambique) and King Faisal Hospital Kigali (Rwanda). CONCLUSIONS: Substantial progress has been made since the passing of the Cape Town Declaration and the formation of the CSIA, but ongoing efforts with collaboration of all committed parties-cardiac surgery, cardiology, industry and government-will be necessary to improve access to life-saving cardiac surgery for patients with RHD.


Subject(s)
Cardiac Surgical Procedures , Rheumatic Heart Disease , Health Services Accessibility , Humans , Rwanda , South Africa
5.
Glob Heart ; 16(1): 8, 2021 01 28.
Article in English | MEDLINE | ID: covidwho-1285507

ABSTRACT

Although the attention of the world and the global health community specifically is deservedly focused on the COVID-19 pandemic, other determinants of health continue to have large impacts and may also interact with COVID-19. Air pollution is one crucial example. Established evidence from other respiratory viruses and emerging evidence for COVID-19 specifically indicates that air pollution alters respiratory defense mechanisms leading to worsened infection severity. Air pollution also contributes to co-morbidities that are known to worsen outcomes amongst those infected with COVID-19, and air pollution may also enhance infection transmission due to its impact on more frequent coughing. Yet despite the massive disruption of the COVID-19 pandemic, there are reasons for optimism: broad societal lockdowns have shown us a glimpse of what a future with strong air pollution measures could yield. Thus, the urgency to combat air pollution is not diminished, but instead heightened in the context of the pandemic.


Subject(s)
Air Pollution/adverse effects , Cardiovascular Diseases/physiopathology , Global Health , Acute Disease , American Heart Association , COVID-19 , Cardiology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/metabolism , Chronic Disease , Environmental Health , Europe , Heart Disease Risk Factors , Humans , Inflammation , Oxidative Stress , SARS-CoV-2 , Societies, Medical , United States
6.
Glob Heart ; 16(1): 18, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-1175699

ABSTRACT

The current pandemic of SARS-COV 2 infection (Covid-19) is challenging health systems and communities worldwide. At the individual level, the main biological system involved in Covid-19 is the respiratory system. Respiratory complications range from mild flu-like illness symptoms to a fatal respiratory distress syndrome or a severe and fulminant pneumonia. Critically, the presence of a pre-existing cardiovascular disease or its risk factors, such as hypertension or type II diabetes mellitus, increases the chance of having severe complications (including death) if infected by the virus. In addition, the infection can worsen an existing cardiovascular disease or precipitate new ones. This paper presents a contemporary review of cardiovascular complications of Covid-19. It also specifically examines the impact of the disease on those already vulnerable and on the poorly resourced health systems of Africa as well as the potential broader consequences on the socio-economic health of this region.


Subject(s)
COVID-19/physiopathology , Cardiovascular Diseases/physiopathology , Acute Coronary Syndrome/economics , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/physiopathology , Africa , Antimalarials/adverse effects , Arrhythmias, Cardiac/economics , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , COVID-19/complications , COVID-19/economics , Cardiovascular Diseases/economics , Cardiovascular Diseases/etiology , Chloroquine/adverse effects , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Delivery of Health Care/economics , Economic Factors , Economic Recession , Gross Domestic Product , Health Resources/economics , Health Resources/supply & distribution , Heart Failure/economics , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Hydroxychloroquine/adverse effects , Inflammation , Myocardial Ischemia/economics , Myocardial Ischemia/etiology , Myocardial Ischemia/physiopathology , Myocarditis/economics , Myocarditis/etiology , Myocarditis/physiopathology , SARS-CoV-2 , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/physiopathology , Socioeconomic Factors , Takotsubo Cardiomyopathy/economics , Takotsubo Cardiomyopathy/etiology , Takotsubo Cardiomyopathy/physiopathology
7.
Eur Heart J ; 42(15): 1460-1463, 2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1052197

ABSTRACT

Although the attention of the world and the global health community specifically is deservedly focused on the COVID-19 pandemic, other determinants of health continue to have large impacts and may also interact with COVID-19. Air pollution is one crucial example. Established evidence from other respiratory viruses and emerging evidence for COVID-19 specifically indicates that air pollution alters respiratory defense mechanisms leading to worsened infection severity. Air pollution also contributes to co-morbidities that are known to worsen outcomes amongst those infected with COVID-19, and air pollution may also enhance infection transmission due to its impact on more frequent coughing. Yet despite the massive disruption of the COVID-19 pandemic, there are reasons for optimism: broad societal lockdowns have shown us a glimpse of what a future with strong air pollution measures could yield. Thus, the urgency to combat air pollution is not diminished, but instead heightened in the context of the pandemic.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Cardiovascular Diseases , Air Pollutants/analysis , Air Pollutants/toxicity , Air Pollution/adverse effects , Air Pollution/analysis , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Communicable Disease Control , Humans , Pandemics , Particulate Matter/adverse effects , Particulate Matter/analysis , SARS-CoV-2
9.
Glob Heart ; 15(1): 44, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-761019

ABSTRACT

In this paper, we provide recommendations on the management of cardiovascular disease (CVD) among patients with confirmed or suspected coronavirus disease (COVID-19) to facilitate the decision making of healthcare professionals in low resource settings. The emergence of novel coronavirus disease, also known as Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has presented an unprecedented global challenge for the healthcare community. The ability of SARS-CoV-2 to get transmitted during the asymptomatic phase and its high infectivity have led to the rapid transmission of COVID-19 beyond geographic regions, leading to a pandemic. There is concern that COVID-19 is cardiotropic, and it interacts with the cardiovascular system on multiple levels. Individuals with established CVD are more susceptible to severe COVID-19. Through a consensus approach involving an international group this WHF statement summarizes the links between cardiovascular disease and COVID-19 and present some practical recommendations for the management of hypertension and diabetes, acute coronary syndrome, heart failure, rheumatic heart disease, Chagas disease, and myocardial injury for patients with COVID-19 in low-resource settings. This document is not a clinical guideline and it is not intended to replace national clinical guidelines or recommendations. Given the rapidly growing burden posed by COVID-19 illness and the associated severe prognostic implication of CVD involvement, further research is required to understand the potential mechanisms linking COVID-19 and CVD, clinical presentation, and outcomes of various cardiovascular manifestations in COVID-19 patients.


Subject(s)
Cardiovascular Diseases/complications , Cardiovascular Diseases/therapy , Coronavirus Infections/complications , Pneumonia, Viral/complications , COVID-19 , Clinical Decision-Making , Decision Trees , Health Resources , Humans , Pandemics , Practice Guidelines as Topic
11.
Clin Res Cardiol ; 109(12): 1460-1468, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-718415

ABSTRACT

The COVID-19 pandemic, which started around December 2019 has, at present, resulted in over 450,000 deaths globally, and approximately 1% of these deaths have been reported in Africa. Despite the high prevalence of COVID-19 risk factors, namely: hypertension, diabetes, chronic pulmonary disease, cardiovascular diseases (CVDs) such as rheumatic heart disease, compromised immunity and obesity, low case fatality rates have been recorded in many parts of Africa so far. COVID-19 severity has previously been shown to be worse in patients with CVD and hypertension. We observed the severity of COVID-19 and mortality rates in Africa, and compared outcomes with prevalence of established risk factors (hypertension and CVD). We stratified data as per the United Nations' 5 African subregions. North African countries show a positive association between the risk factors and the mortality rates from COVID-19. However, we observed discordant patterns in the relationship between COVID-19, and either CVD or hypertension, in sub-Saharan African countries. In this paper, we also review the pathogenesis of SARS-CoV-2 infection and how it worsens CVD and postulate that the differences in modulation of the renin-angiotensin-aldosterone system (RAAS) axis which controls angiotensin-converting enzyme (ACE)/ACE2 balance may be an important determinant of COVID-19 outcomes in Africa.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Africa/epidemiology , COVID-19/mortality , COVID-19/physiopathology , COVID-19/virology , Cardiovascular Diseases/mortality , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/virology , Cardiovascular System/physiopathology , Cardiovascular System/virology , Host-Pathogen Interactions , Humans , Hypertension/epidemiology , Prevalence , Prognosis , Renin-Angiotensin System , Risk Assessment , Risk Factors , SARS-CoV-2/pathogenicity , Severity of Illness Index
12.
13.
Clin Res Cardiol ; 109(12): 1446-1459, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-381877

ABSTRACT

Coronavirus diseases 2019 (COVID-19) has become a worldwide pandemic affecting people at high risk and particularly at advanced age, cardiovascular and pulmonary disease. As cardiovascular patients are at high risk but also have dyspnea and fatigue as leading symptoms, prevention, diagnostics and treatment in these patients are important to provide adequate care for those with or without COVID-19 but most importantly when comorbid cardiovascular conditions are present. Severe COVID-19 with acute respiratory distress (ARDS) is challenging as patients with elevated myocardial markers such as troponin are at enhanced high risk for fatal outcomes. As angiotensin-converting enzyme 2 (ACE2) is regarded as the viral receptor for cell entry and as the Coronavirus is downregulating this enzyme, which provides cardiovascular and pulmonary protection, there is ongoing discussions on whether treatment with cardiovascular drugs, which upregulate the viral receptor ACE2 should be modified. As most of the COVID-19 patients have cardiovascular comorbidities like hypertension, diabetes, coronary artery disease and heart failure, which imposes a high risk on these patients, cardiovascular therapy should not be modified or even withdrawn. As cardiac injury is a common feature of COVID-19 associated ARDS and is linked with poor outcomes, swift diagnostic management and specialist care of cardiovascular patients in the area of COVID-19 is of particular importance and deserves special attention.


Subject(s)
COVID-19/therapy , Cardiology/standards , Cardiovascular Diseases/therapy , COVID-19/diagnosis , COVID-19/mortality , COVID-19/physiopathology , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/mortality , Cardiovascular Diseases/physiopathology , Comorbidity , Consensus , Humans , Prognosis , Risk Assessment , Risk Factors
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