Take Heart and Stop the Silent Killer

Cardiovascular disease (CVD) is the leading cause of deaths, including premature deaths, among both men and women. The World Health Organization (WHO) has reported that 17.9 million people died from CVD in 2019, translating to 31 percent of all deaths which is nearly every third death in that year. More than 75% of CVD deaths occur in low- and middle-incomes countries and 85% of deaths are caused by heart attack and stroke. The number of CVD deaths are expected to increase to over 23 million by 2030 and the resulting economic burden of the disease to also increase from an estimated USD 30.9bn in 2015 in Latin America alone. There is clearly an urgent call for action, given the prevalence and significant socio-economic impact of CVD.

Cardiovascular diseases (CVD) are a group of disorders of the heart and blood vessels. Atherosclerotic Cardiovascular Disease (ASCVD) specifically, is caused by the build-up of fats, cholesterol, and other substances on the inner walls of arteries, causing them to narrow or harden, and reducing or blocking the flow of blood to the heart or brain. This build up is called plaque and can lead to blood clots, heart attacks and strokes. ASCVD is a major cause of premature deaths and disability from CVD. Early diagnosis and treatment can stop atherosclerosis from worsening and ending in medical emergencies or death.

Former Secretary of Primary Health Care/ Ministry of Health Brazil, physician specialized in Preventive Medicine and Public Health

The number 1 cause of death worldwide

Disease -Annual global deaths

• CVDs-Over 17 million
• Cancers-8.2 million
• Respiratory diseases-4 million
• Diabetes-1.5 million
• 31% global deaths from CVDs
• Over 23 million predicted deaths from CVDs by 2030
• Many CVDs are preventable by addressing behavioural risk factors
• Low and middle income countries most affected by CVD death
• 25% by 2025 World Health Organization (WHO) target to reduce premature deaths from non-communicable diseases (NCDs) - of which CVDs make up the largest proportion.
• Heart disease and stroke cause a third of all deaths in women world

• Measure and build the current understanding of the socio-economic impact of CVD and the expanse of patient population diagnosed with CVD, in turn illustrating the impact of ASCVD on healthcare resources and on national productivity while also highlighting where the investments should be made to improve CVD related patient outcome across the population.
• Improve equitable access to CVD preventive healthcare across all types of health covers and especially amongst low-and-middle-income patients who reside in rural areas. Prioritise health care research into how CVD and other diseases affects women and accordingly customise the treatments to meet the needs of women, taking into consideration cultural and societal expectations 53 placed on women. Awareness programs should also be built specifically addressing the prevalent misconceptions about the seriousness of the disease amongst women.
• Leverage public and private health care partnerships to scale preventive treatment solutions to sufficiently meet the needs of CVD patients that are currently being underestimated and undertreated.
• mplement the needed infrastructure to collect, manage and store electronic patient records, including interoperability of existing systems, to improve diagnosis of CVD and accessibility to the most effective treatment based on individual patient needs and circumstances. The data collected could also be analysed for insight on how to sustainably support the health care system to better treat CVD and potentially scale the solution to address the needs of other disease burdens on the country.
• Leverage digital solutions to encourage adherence to treatment and awareness of CVD severity. Re-purposing successful solutions from other disease areas or those developed to address the COVID pandemic are all potential options to accelerate implementation and drive impactful improvements in CVD patient outcomes in the short to medium term.
• Measure the implementation of the CVD guidelines issued and introduce suitable financial and non-financial incentives to encourage implementation and in turn contribute to the overall goal of reducing the burden of CVD in line with global, regional, and country specific health goals.
• Build awareness by prioritising discussions and emotive messaging on the benefits of treating and caring for CVD patients to prevent premature mortality and co-morbidities, at heart health & noncommunicable disease expert forums, community events, and on various media platforms, to induce behavioural change to act on CVD secondary prevention care in both HCPs and Patients.

Challenges

The challenges in combating CVD differ in nature between countries, given the differing characteristics and maturity of their healthcare systems and socio-economic conditions. This report looks at the impact of CVD challenges, focused  on ASCVD and the silent killer of heart attacks and stroke. There is significant opportunity for improved CVD secondary prevention care in the Latin America region, specifically looking at five countries: Argentina, Brazil, Chile, Colombia, and Mexico, accelerating and enhancing existing initiatives, sharing best practices, and building new initiatives.

In Latin America, despite a trend in reducing CVD deaths in the 1990s, CVD now accounts for 38% of deaths from non-communicable diseases and is the leading cause of death with 1.6 million deaths per year. More specifically, coronary heart disease and stroke were seen to cause 42.5% and 28.8%, respectively of the CVD mortality in the region. The trend is now pointing upwards for cardiovascular disease deaths resulting from demographic, economic and social changes in recent years. The poorest population sectors are seen to be disproportionally affected by the disease due to unequal health care access to manage and treat CVD risk factors.

Solution

Improving heart health is clearly a priority that is already being acted upon across the Latin American region. However, there is still a long way to go in changing the behaviours of the patients, healthcare providers, health policy and guideline executers and in implementing effective solutions that create a sustainable health care system to reduce CVD mortality and co-morbidity rates. 

To summarise, below are the proposed short to medium term focus areas for key solutions that will both complement the ongoing work and initiate new actionable and impactful change, which will in turn help the countries achieve their heart health goals.