Secondary Prevention Programs Research Articles

Including patient perspectives in secondary prevention: one step closer to patients needs

Abstract Introduction Including patients in the decisions regarding their health is challenging. Patients’ understanding of their health conditions and lifestyle behaviors are strongly influenced by the interactions between patients and health care providers (1). Putting their needs up-front when you are designing projects for a global approach on Secondary Prevention is even more defiant. Following up to the person-centered care approach, the best way to tailor anything is to focus on the patients’ needs, by including the patient in the choices of the services they can have/need available. Having initiated the partnership, it is also necessary to implement it and safeguard it (2). Purpose To identify the patients’ needs, regarding the Prevention Program, in order to better shape the health care services provision. Methods A qualitative design approach was carried out. A focus group was conducted with patients enrolled in the Cardiovascular Risk Prevention Program (N=8), that have participated in more than two components of the program. The aim of this focus group was to obtain feedback from patients in order to improve and develop the services included in the Secondary Prevention Program. Content analysis was performed, results were assessed with dedicated software. Results There were tree specific topics that were evidenced: communication/access; education; time. Regarding the communication/access, patients mostly outlined the need for a close-up partnership, in order for them to have faster and easier communication channel with the health care professionals team. In the education topic, patients identified the need for increasing the number of educational sessions and repeating some contents, in order to have more discussion moments. The need for increase of the interactive component of certain sessions was also outlined. Patients also identified time as an issue, considering that the sessions are during lunch time, the multidisciplinary consultations take longer than the pre-established timings, and they’re only one day per week. Conclusion(s) The obtained results were used for Program improvement, by creating new communication and educational opportunities. They also served as fuelers for safeguarding this partnerships, as patients were involved in the update and further development of the Program, that they were and are still benefiting from. Patient involvement in the development of healthcare services is a great step towards improvement of health systems performance globally.

Cardiovascular risk reduction in type 2 diabetes: What the non-specialist needs to know about current guidelines.

In the US, approximately 11% of the population have diagnosed diabetes and nearly 40% have prediabetes. In addition, chronic kidney disease (CKD) affects 14% of the US population including up to 40% of those with diabetes. Cardiovascular disease (CVD) remains the leading cause of death worldwide where it affects approximately half of adults. The presence of CKD or diabetes doubles the risk of cardiovascular events. When both CKD and diabetes occur in the same patient the risks are further increased. The clinical problems of hypertension, hyperglycemia, and hyperlipidemia are all closely related with obesity, metabolic syndrome, Type 2 diabetes, CKD, atherosclerotic cardiovascular disease, heart failure and non-alcoholic fatty liver disease and metabolic dysfunction-associated steatohepatitis. The increasing frequency of obesity has driven increases in all of these medical comorbidities. These conditions frequently cluster together in the same patient exacerbating the risk of morbidity and mortality. They are also associated with cognitive dysfunction/dementia, pulmonary diseases, cancers, gastrointestinal diseases, immune system abnormalities, and inflammatory disorders. Only 6.8% of adults in US meet all targets for cardiovascular risk management with significant disparities based on race and ethnicity. Given the complexity of these multisystem problems in people with diabetes and obesity, it would seem reasonable to attempt to diagnose and treat many of the comorbidities earlier in the course of disease rather than wait for substantial end organ dysfunction to occur. The American Diabetes Association (ADA) has recently published a consensus statement recommending early screening for the diagnosis of heart failure, CKD and diabetes, recognizing both the frequency and gravity of this combination. Likewise, there are recommendations in the guidelines to facilitate screening for microalbuminuria, blood pressure, glycemic control and lipids earlier in patients at risk rather than wait and treat as a secondary prevention program. Thus, the general principle is to facilitate earlier recognition and diagnosis and provide treatment before downstream target organ complications occur. This review will focus on CVD and risk management based on newest recommendations and standards of care in people with diabetes by the ADA. The main considerations in the treatment of people with diabetes are glycemic control, blood pressure, lipids, and the use of medications with proven cardiorenal disease progression capability to prevent or delay.

Measurement properties of utility-based health-related quality of life measures in cardiac rehabilitation and secondary prevention programs: a systematic review.

To identify utility-based patient-reported outcome measures (PROMs) for assessing health-related quality of life (HRQoL) in cardiac rehabilitation and secondary prevention programs (CR) and appraise existing evidence on their measurement properties. Secondly, to link their items to the International Classification of Functioning Disability and Health (ICF) and the International Consortium of Health Outcome Measures (ICHOM) domains for cardiovascular disease (CVD). Eight databases were searched. The review followed the COSMIN and JBI guidelines for measurement properties systematic reviews and PRISMA 2020 reporting guidelines. Non-experimental and observational empirical studies of patients ≥ 18years of age with CVD undergoing CR and assessed quality of life (QoL) or HRQoL using utility-based PROMs or one accompanied by health state utilities were included. Nine PROMs were identified with evidence on measurement properties for three measures: the German translations of SF-12, EQ-5D-5L, and MacNew heart disease HRQoL questionnaire. There was moderate quality evidence for responsiveness and hypothesis testing of the SF-12 and EQ-5D-5L, and high-quality evidence for responsiveness and hypothesis testing for the MacNew. All items of SF-12 and EQ-5D were linked to ICF categories, but four items of the MacNew were not classified or defined. All the PROM domains were mapped onto similar constructs from the ICHOM global sets. Three utility-based PROMs validated in CR were identified: the German versions of the EQ-5D and SF-12 and the MacNew questionnaire. These PROMs are linked to a breadth of ICF categories and all ICHOM global sets. Additional validation studies of PROMs in CR are required.

Evaluations of countering violent extremism programs: Linking success to content, approach, setting, and participants

Since the September 11 attacks, prevention and countering violent extremism (P/CVE) programs have rapidly increased worldwide, garnering significant interest among researchers. This paper is a systematic review focusing on the evaluations of primary, secondary and tertiary prevention programs from 2001 until 2020. The review identified 74 program evaluations that included satisfactory measures and metrics. Only 32% of the studies deemed the intervention successful, 55% described limited success, and 8% deemed the program had failed. Many of the programs evaluated failed to reach their objectives; some generated negative outcomes such as community disdain and an increase in the likelihood of alienation and stigma. Success was largely a self-assessed measure by the facilitators or stakeholders of the programs or the evaluators of the study. Success indicators can be operationalized as the degree of enhanced sense of belonging (connectedness to the community, social connection), trust and willingness to engage in programs, development of critical thinking skills (integrative complexity theory), and a strong sense of worth (quest for significance). Without a generally accepted set of metrics and no cohesive framework for conducting evaluations, this review offers an important addition to the field on the evidence suitable for program evaluations. An important aim of this systematic review was to identify what makes an effective and successful countering violent extremism program. The key findings indicate that enhancing belonging, identity, trust and community engagement, acknowledging perceptions of injustice, religious mentoring, and the promotion of critical thinking/self-reflection are associated with successful programs. The findings press upon policymakers, funders, and researchers the need to consider and support high-quality evaluations of programs.

Comparison of plasma and neuroimaging biomarkers to predict cognitive decline in non-demented memory clinic patients.

Plasma biomarkers of Alzheimer's disease (AD) pathology, neurodegeneration, and neuroinflammation are ideally suited for secondary prevention programs in self-sufficient persons at-risk of dementia. Plasma biomarkers have been shown to be highly correlated with traditional imaging biomarkers. However, their comparative predictive value versus traditional AD biomarkers is still unclear in cognitively unimpaired (CU) subjects and with mild cognitive impairment (MCI). Plasma (Aβ42/40, p-tau181, p-tau231, NfL, and GFAP) and neuroimaging (hippocampal volume, centiloid of amyloid-PET, and tau-SUVR of tau-PET) biomarkers were assessed at baseline in 218 non-demented subjects (CU = 140; MCI = 78) from the Geneva Memory Center. Global cognition (MMSE) was evaluated at baseline and at follow-ups up to 5.7 years. We used linear mixed-effects models and Cox proportional-hazards regression to assess the association between biomarkers and cognitive decline. Lastly, sample size calculations using the linear mixed-effects models were performed on subjects positive for amyloid-PET combined with tau-PET and plasma biomarker positivity. Cognitive decline was significantly predicted in MCI by baseline plasma NfL (β=-0.55), GFAP (β=-0.36), hippocampal volume (β = 0.44), centiloid (β=-0.38), and tau-SUVR (β=-0.66) (all p < 0.05). Subgroup analysis with amyloid-positive MCI participants also showed that only NfL and GFAP were the only significant predictors of cognitive decline among plasma biomarkers. Overall, NfL and tau-SUVR showed the highest prognostic values (hazard ratios of 7.3 and 5.9). Lastly, we demonstrated that adding NfL to the inclusion criteria could reduce the sample sizes of future AD clinical trials by up to one-fourth in subjects with amyloid-PET positivity or by half in subjects with amyloid-PET and tau-PET positivity. Plasma NfL and GFAP predict cognitive decline in a similar manner to traditional imaging techniques in amyloid-positive MCI patients. Hence, even though they are non-specific biomarkers of AD, both can be implemented in memory clinic workups as important prognostic biomarkers. Likewise, future clinical trials might employ plasma biomarkers as additional inclusion criteria to stratify patients at higher risk of cognitive decline to reduce sample sizes and enhance effectiveness.

Examining treatment targets and equity in bone-active medication use within secondary fracture prevention: a systematic review and meta-analysis.

This systematicreview seeks to evaluate the proportion of fragility fracture patients screened in secondary fracture prevention programs who were indicated for pharmacological treatment, received prescriptions for bone-active medications, and initiated the prescribed medication. Additionally, the study aims to analyze equity in pharmacological treatment by examining equity-related variables including age, sex, gender, race, education, income, and geographic location. We conducted a systematic review to ascertain the proportion of fragility fracture patients indicated for treatment who received prescriptions and/or initiated bone-active medication through secondary fracture prevention programs. We also examined treatment indications reported in studies and eligibility criteria to confirm patients who were eligible for treatment. To compute the pooled proportions for medication prescription and initiation, we carried out asingle group proportional meta-analysis. We also extracted the proportions of patients who received aprescription and/or began treatment based on age, sex, race, education, socioeconomic status, location, and chronic conditions. This review included 122 studies covering 114 programs. The pooled prescription rate was 77%, and the estimated medication initiation rate was 71%. Subgroup analysis revealed no significant difference in treatment initiation between the Fracture Liaison Service and other programs. Across all studies, age, sex, and socioeconomic status were the only equity variables reported in relation to treatment outcomes. Our systematic review emphasizes the need for standardized reporting guidelines in post-fracture interventions. Moreover, considering equity stratifiers in the analysis of health outcomes will help address inequities and improve the overall quality and reach of secondary fracture prevention programs.

EVALUATING FEASIBILITY OF A SECONDARY STROKE PREVENTION PROGRAM

INTRODUCTION &amp; AIMS While 80% of strokes are preventable, stroke remains the second leading cause of disability and death worldwide. Recurrent stroke has an accumulative effect that increases the level of disability and demands on healthcare. Healthy lifestyles that include regular exercise can reduce stroke risk, but stroke survivors lack guidance to modify their lifestyle after hospital discharge. Models of community care may support secondary stroke prevention with guidelines recommending physical activity and cardiovascular exercise, and referrals to support behaviour change to address modifiable risk factors. Our aim was to evaluate the implementation of a secondary stroke prevention program provided within a community rehabilitation service to see if it was feasible to deliver and acceptable for participants. METHOD We evaluated the implementation of a secondary stroke prevention program involving supervised exercise, multidisciplinary education and health coaching to address modifiable risk factors. The group-based program involved face-to-face and telehealth sessions. The primary outcomes were feasibility, examined via service information (referrals, uptake, participant demographics, costs), and participant acceptability (satisfaction and attendance). Secondary outcomes examined self-reported change in lifestyle factors, and pre-post scores on standardised clinical tests, [e.g., waist-circumference, 6-Minute-Walk (6MWT)]. RESULTS We ran seven programs in 12-months, and 37 people participated. Attendance for education sessions was 79%, and 30/37 participants completed the full program. No adverse events occurred. Participant satisfaction was high for ‘relevance’ (100%), ‘felt safe to exercise’ (96%) and ‘intend to continue’ (96%). Most participants (88%) changed (on average) 2.5 lifestyle factors (diet, exercise, smoking, alcohol). Changes in clinical outcomes seemed promising, with some being statistically significant, e.g. 6MWT (MD 59m, 95%CI 38m to 80159m, p&amp;lt;0.001), and waist-circumference (MD –2.1cm, 95%CI -3.9cm to -1.4cm, p&amp;lt;0.001). CONCLUSION The program was feasible to deliver, acceptable to participants and seemed beneficial for health. Access to similar programs may assist in secondary stroke prevention.

Intramuscular versus Enteral Penicillin Prophylaxis to Prevent Progression of Rheumatic Heart Disease: Study protocol for a non-inferiority randomized trial (the GOALIE trial)

Rheumatic Heart Disease (RHD) persists as a major cardiovascular driver of mortality and morbidity among young people in low- and middle-income countries. Secondary antibiotic prophylaxis (SAP) with penicillin remains the cornerstone of RHD control, however, sub-optimal treatment adherence undermines most secondary prevention programs. Many of the barriers to optimal SAP adherence are specific to the intramuscular form of penicillin and may potentially be overcome by use of oral penicillin. This non-inferiority trial is comparing the efficacy of intramuscular to oral penicillin SAP to prevent progression of mild RHD at 2 years. The Intramuscular versus Enteral Penicillin Prophylaxis to Prevent Progression of Rheumatic Heart Disease (GOALIE) trial is randomizing Ugandan children aged 5-17 years identified by echocardiographic screening with mild RHD (Stage A or B as defined by 2023 World Heart Federation criteria) to Benzathine Benzyl Penicillin G (BPG arm, every-28-day intramuscular penicillin) or Phenoxymethyl Penicillin (Pen V arm, twice daily oral penicillin) for a period of 2 years. A blinded echocardiography adjudication panel of 3 RHD experts and 2 cardiologists is determining the echocardiographic stage of RHD at enrollment and will do the same at study completion by consensus review. Treatment adherence and study retention are supported through peer support groups and case management strategies. The primary outcome is the proportion of children in the Pen V arm who progress to more advanced RHD compared to those in the BPG arm. Secondary outcomes are patient-reported outcomes (treatment acceptance, satisfaction, and health related quality of life), costs, and cost-effectiveness of oral compared to intramuscular penicillin prophylaxis for RHD. A total sample size of 1004 participants will provide 90% power to demonstrate non-inferiority using a margin of 4% with allowance for 7% loss to follow-up. Participant enrollment commenced in October 2023 and final participant follow-up is expected in December 2026. The graphical abstract (Figure 1) summarizes the flow of echocardiographic screening, participant enrollment and follow-up. The GOALIE trial is critical in global efforts to refine a pragmatic approach to secondary prevention for RHD control. GOALIE insists that the inferiority of oral penicillin be proven contemporarily and against the most important near-term clinical outcome of progression of RHD severity. This work also considers other factors that could influence the adoption of oral prophylaxis and change the calculus for acceptable efficacy including patient-reported outcomes and costs. ClinicalTrials.gov: NCT05693545.

Primary Health Care Interventions for Potentially Preventable Ear, Nose, and Throat Conditions in Rural and Remote Areas: A Systematic Review.

Background:Primary and secondary level preventive primary health care programs providing early detection and timely management of ear, nose, and throat (ENT) conditions in rural and remote regions are fundamental to preventing downstream impacts on health, social, and educational outcomes. However, the range and quality of evidence is yet to be reviewed. Objectives: The study objectives were to identify and synthesize the evidence of primary health care interventions for detection and management of ENT conditions in rural and remote areas, and evaluate the quality of the research and effectiveness of interventions. Methods: A systematic literature search of 6 databases (February 2023). The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, and the quality appraisal of studies was evaluated using the Mixed Methods Appraisal Tool (initial screening questions: Are there clear research questions? Do the collected data allow to address the research questions?). Results: Ten studies met the inclusion criteria. The results describe interventions for detection and management of respiratory tract infections, otitis media, and ear disease in primary health care settings. No studies met the inclusion criteria for tonsillitis. The role of community-based programs and allied health workers in the detection and management of ENT conditions was found to be effective in rural and remote regions. Only 2 of the studies met the screening criteria for quality appraisal. Conclusions: The study findings may inform future programs and policy development to address detection and management of ENT conditions in rural and remote primary care settings, and supports the need for further research on innovative models of care targeting potentially preventable hospitalizations through primary and secondary level prevention.

The significance of recent fracture location for imminent risk of hip and vertebral fractures—a nationwide cohort study on older adults in Sweden

SummaryThe role of recent fracture site in predicting the most detrimental subsequent fractures, hip and vertebral, is unclear. This study found that most recent fracture sites were associated with an increased risk of both hip and vertebral fracture, a finding that may impact the design of secondary prevention programs.BackgroundHip and vertebral fractures are the most serious in terms of associated morbidity, mortality, and societal costs. There is limited evidence as to which fracture types are associated with the highest risk for subsequent hip and vertebral fractures. This study aims to explore the dependency of imminent hip and vertebral fracture risk on the site of the recent index fracture.MethodsConducted as a nationwide retrospective cohort study, we utilized Swedish national registers to assess the risk of hip and vertebral fractures based on the site of the recent (≤ 2 years) index fracture and an old (> 2 years) prevalent fracture. This risk was compared to that observed in individuals without any prevalent fractures. This study encompassed all Swedes aged 50 years and older between 2007 and 2010. Patients with a recent fracture were categorized into specific groups based on the type of their previous fracture and were followed until December 2017, with censoring for death and migration. The study assessed the risk of hip and vertebral fractures during the follow-up period.ResultsThe study included a total of 3,423,320 individuals, comprising 145,780 with a recent fracture, 293,051 with an old fracture, and 2,984,489 without a previous fracture. The median follow-up times for the three groups were 7.6 years (IQR 4.0–9.1), 7.9 years (5.8–9.2), and 8.5 years (7.4–9.7), respectively. Patients with a recent fracture at almost all sites exhibited a significantly increased risk of hip fracture and an elevated risk of vertebral fracture compared to controls.Patients with recent fractures had an increased risk of subsequent hip and vertebral fractures, regardless of the index fracture site. These results strengthen the notion that all patients with a recent fracture, regardless of fracture site, should be included in secondary prevention programs, to improve the prevention of the clinically most serious fractures.

Current Role and Future Perspectives of Cardiac Rehabilitation in Heart Disease.

As a comprehensive secondary prevention program, cardiac rehabilitation (CR) is a beneficial and cost-effective intervention for patients with heart disease, but the participation rate of patients in CR is low globally. In recent years, due to the COVID-19 pandemic and scientific and technological advances, an increasing number of alternative CR modes have been developed, such as remote CR, home-based CR, hybrid CR and virtual CR. These alternative CR modes represent changes and new opportunities for patients with heart disease. In this review, we will discuss in detail the impact of CR on patients with different types of heart disease, review the various alternative CR models, and explore some prospects for the future of CR in the field of heart disease.

The Association of Sexual Minority Status with the Prevalence, Diagnosis, and Treatment of Depression among NYC Adults.

Major depressive disorder (MDD) is a common mental health disorder with a lifetime prevalence of 20.6% among United States (US) adults. Multiple US surveys have shown a consistently higher burden of mental health struggles among lesbian, gay, bisexual, trans, and questioning (LGBTQ+) adults compared to non-LGBTQ+ adults. However, it is not known whether diagnosis and treatment for those adults who do report symptoms of MDD differ based on sexual orientation.We test for differences in prevalence, diagnosis, and treatment of MDD in sexual minorities using appropriate multivariable logistic regression using the New York City Health and Nutrition Examination Survey (NYC HANES).About 10% of NYC adults (≥ 20 years old) self-identify as a sexual minority and 8.5% of adults in NYC have MDD based on the Patient Health Questionnaire (PHQ-9) score. Significantly higher proportion of sexual minorities in NYC have depression compared to non-sexual minorities (17.7% vs. 7.6%, p = 0.01). In the multivariable model, sexual minorities were 2.33 (CI = [1.24-4.39], p = 0.009) times more likely to have depression compared to non-sexual minorities. Additionally, people with multimorbidity were more likely to be diagnosed for depression (OR = 3.78, CI = [1.33, 10.75], p = 0.013).Disparities exist in the prevalence, diagnosis, and treatment of MDD in NYC adults. Targeted outreach toward the LGBTQ + community should be considered by public health officials when designing primary and secondary prevention programs for depression.

How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program

BackgroundOver 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials.MethodsWe conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis.ResultsWe interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients.ConclusionThis study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.

Analysis of Demographic and Socioeconomic Factors Influencing Adherence to a Web-Based Intervention Among Patients After Acute Coronary Syndrome: Prospective Observational Cohort Study.

Although telemedicine has been proven to have significant potential for improving care for patients with cardiac problems, there remains a substantial risk of introducing disparities linked to the use of digital technology, especially for older or socially vulnerable subgroups. We investigated factors influencing adherence to a telemedicine-delivered health education intervention in patients with ischemia, emphasizing demographic and socioeconomic considerations. We conducted a descriptive, observational, prospective cohort study in consecutive patients referred to our cardiology center for acute coronary syndrome, from February 2022 to January 2023. Patients were invited to join a web-based health educational meeting (WHEM) after hospital discharge, as part of a secondary prevention program. The WHEM sessions were scheduled monthly and used a teleconference software program for remote synchronous videoconferencing, accessible through a standard computer, tablet, or smartphone based on patient preference or availability. Out of the 252 patients (median age 70, IQR 61.0-77.3 years; n=189, 75% male), 98 (38.8%) declined the invitation to participate in the WHEM. The reasons for nonacceptance were mainly challenges in handling digital technology (70/98, 71.4%), followed by a lack of confidence in telemedicine as an integrative tool for managing their medical condition (45/98, 45.9%), and a lack of internet-connected devices (43/98, 43.8%). Out of the 154 patients who agreed to participate in the WHEM, 40 (25.9%) were unable to attend. Univariable logistic regression analysis showed that the presence of a caregiver with digital proficiency and a higher education level was associated with an increased likelihood of attendance to the WHEM, while the converse was true for increasing age and female sex. After multivariable adjustment, higher education level (odds ratio [OR] 2.26, 95% CI 1.53-3.32; P<.001) and caregiver with digital proficiency (OR 12.83, 95% CI 5.93-27.75; P<.001) remained independently associated with the outcome. The model discrimination was good even when corrected for optimism (optimism-corrected C-index=0.812), as was the agreement between observed and predicted probability of participation (optimism-corrected calibration intercept=0.010 and slope=0.948). This study identifies a notable lack of suitability for a specific cohort of patients with ischemia to participate in our telemedicine intervention, emphasizing the risk of digital marginalization for a significant portion of the population. Addressing low digital literacy rates among patients or their informal caregivers and overcoming cultural bias against remote care were identified as critical issues in our study findings to facilitate the broader adoption of telemedicine as an inclusive tool in health care.

Preventive Cardiology 2024: State of Problem Perspectives of Development.

This article presents the current relevance of preventive cardiology, substantiates the increasing importance of the prevention of cardiovascular diseases (CVD) to reduce mortality and the burden of CVD, including in the era of widespread use of modern high-tech methods and effective drug therapy for treating CVD in clinical practice. The article also addresses effectiveness of secondary prevention of CVD and approaches to its improvement. Particular attention is paid to the high importance of introducing into practice comprehensive programs for secondary prevention of CVD and cardiac rehabilitation. The principles of organizing such programs and their most important components are presented in detail.

Age and Gender Difference among Elderly Stroke Patients in a Rehabilitation Center, Retrospective Study

Aims This study aims to report the patients’ associated factors related to the study cohort. Methods This is a retrospective hospital-based cohort study that recruited 503 elderly patients (>55 years) with stroke from a tertiary rehabilitation center. Data were collected through a pre-designed case report form, and stroke was classified according to Data on Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Results There was a female predominance at a rate of 52.9% and a significant co-morbidity related to diabetes, hyperlipidemia, and hypertension in addition to cardiac disease. The ischemic stroke affected 84.7% of the studied sample. The univariate analysis reported that male gender, diabetes, hypertension, and hyperlipidemia were not associated with an increased risk of non-ischemic stroke, while obesity showed a paradoxical reduction in the risk of stroke. Conclusion Stroke among old patients behaves differently and warrants initiating both primary and secondary prevention programs.

О генетическом тестировании лиц на предрасположенность к инфаркту миокарда в практической медицине: Международный опыт

In Kazakhstan, the main burden in the structure of the incidence of diseases of the circulatory system is made by myocardial infarction, the overall incidence of which tends to increase (from 71.9‰ in 2016 to 127.6‰ in 2020). Therefore, according to the national health project of the Republic of Kazakhstan, reducing mortality from diseases of the circulatory system in Kazakhstan is one of the main vectors of the national health policy. The article presents a literature review of scientific publications on genetic testing for predisposition to myocardial infarction in a number of countries, such as the USA, Great Britain, the Netherlands, Spain, Russia, Korea, Japan, France, Thailand, Ukraine, Belarus. The review of scientific publications was carried out by keywords in Russian and English in scientific databases such as PubMed, Google Scholar, Elsevier, Cochrane, Web of Science and Cyberleninka. Testing makes it possible to identify a priority group of patients at increased risk of developing myocardial infarction, and further develop personalized programs for primary and secondary prevention of cardiovascular diseases in practical healthcare.

A Lifestyle Modification Program for Secondary Prevention of Atrial Fibrillation: Introductory Findings.

A Lifestyle Modification Program for Secondary Prevention of Atrial Fibrillation: Introductory Findings.

Optimising the implementation of digital-supported interventions for the secondary prevention of heart disease: a systematic review using the RE-AIM planning and evaluation framework

BackgroundmHealth technologies are now widely utilised to support the delivery of secondary prevention programs in heart disease. Interventions with mHealth included have shown a similar efficacy and safety to conventional programs with improvements in access and adherence. However, questions remain regarding the successful wider implementation of digital-supported programs. By applying the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to a systematic review and meta-analysis, this review aims to evaluate the extent to which these programs report on RE-AIM dimensions and associated indicators.MethodsThis review extends our previous systematic review and meta-analysis that investigated the effectiveness of digital-supported programs for patients with coronary artery disease. Citation searches were performed on the 27 studies of the systematic review to identify linked publications that reported data for RE-AIM dimensions. All included studies and, where relevant, any additional publications, were coded using an adapted RE-AIM extraction tool. Discrepant codes were discussed amongst reviewers to gain consensus. Data were analysed to assess reporting on indicators related to each of the RE-AIM dimensions, and average overall reporting rates for each dimension were calculated.ResultsSearches found an additional nine publications. Across 36 publications that were linked to the 27 studies, 24 (89%) of the studies were interventions solely delivered at home. The average reporting rates for RE-AIM dimensions were highest for effectiveness (75%) and reach (67%), followed by adoption (54%), implementation (36%) and maintenance (11%). Eleven (46%) studies did not describe relevant characteristics of their participants or of staff involved in the intervention; most studies did not describe unanticipated consequences of the intervention; the ongoing cost of intervention implementation and maintenance; information on intervention fidelity; long-term follow-up outcomes, or program adaptation in other settings.ConclusionsThrough the application of the RE-AIM framework to a systematic review we found most studies failed to report on key indicators. Failing to report these indicators inhibits the ability to address the enablers and barriers required to achieve optimal intervention implementation in wider settings and populations. Future studies should consider alternative hybrid trial designs to enable reporting of implementation indicators to improve the translation of research evidence into routine practice, with special consideration given to the long-term sustainability of program effects as well as corresponding ongoing costs.RegistrationPROSPERO—CRD42022343030.

A Portrait of Gambling Behaviors and Associated Cognitive Beliefs Among Young Adolescents in Italy

AbstractGambling disorder is a highly prevalent behavioral addiction in young adults. Accordingly, data on the prevalence of gambling as experience and problem gambling as at-risk behavior among adolescents are necessary, due to the increase in gambling behavior and its implications in recent years. This study aimed to assess the prevalence and characteristics (i.e., cognitive beliefs and knowledge of risk) of gambling among Italian adolescents.A cross-sectional survey analyzed gambling behavior, related cognitive beliefs, and knowledge of the gambling context in a large sample of Italian adolescents, differentiating gambling activities per se and problem gambling as a risk for addiction. Data from 4825 Italian 15-year-olds showed that the prevalence of regular gamblers (i.e., experiencing frequent gambling experience in the last 12 months) was 6.4%, and that of adolescents who played at least once in the last 12 months was 52%. The regular and at-risk gamblers who reported critical scores in the Gambling Related Cognitions Scale declared higher knowledge of gambling and worse cognitive beliefs than both non-gamblers and occasional gamblers.Prevalence data and descriptive outcomes of this study suggest the importance of further analyzing the gambling phenomenon among adolescents. The increasing intensity of gambling engagement and compulsive gambling highlights the clinical need to address youth addiction through structured primary and secondary prevention programs.