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. 2024 Jan 22;19(1):8.
doi: 10.5334/gh.1278. eCollection 2024.

World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update

Liliana Laranjo  1 , Fernando Lanas  2 , Marie Chan Sun  3 , Deborah Anne Chen  4 , Lisa Hynes  5 , Tasnim F Imran  6 , Dhruv S Kazi  7 , Andre Pascal Kengne  8 , Maki Komiyama  9 , Masanari Kuwabara  10 , Jeremy Lim  11 , Pablo Perel  12 , Daniel José Piñeiro  13 , Carlos I Ponte-Negretti  14 , Tania Séverin  15 , David R Thompson  16   17 , Lale Tokgözoğlu  18 , Lijing L Yan  19 , Clara K Chow  20
Affiliations

World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease: 2023 Update

Liliana Laranjo et al. Glob Heart. .

Abstract

Background: Secondary prevention lifestyle and pharmacological treatment of atherosclerotic cardiovascular disease (ASCVD) reduce a high proportion of recurrent events and mortality. However, significant gaps exist between guideline recommendations and usual clinical practice.

Objectives: Describe the state of the art, the roadblocks, and successful strategies to overcome them in ASCVD secondary prevention management.

Methods: A writing group reviewed guidelines and research papers and received inputs from an international committee composed of cardiovascular prevention and health systems experts about the article's structure, content, and draft. Finally, an external expert group reviewed the paper.

Results: Smoking cessation, physical activity, diet and weight management, antiplatelets, statins, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and cardiac rehabilitation reduce events and mortality. Potential roadblocks may occur at the individual, healthcare provider, and health system levels and include lack of access to healthcare and medicines, clinical inertia, lack of primary care infrastructure or built environments that support preventive cardiovascular health behaviours. Possible solutions include improving health literacy, self-management strategies, national policies to improve lifestyle and access to secondary prevention medication (including fix-dose combination therapy), implementing rehabilitation programs, and incorporating digital health interventions. Digital tools are being examined in a range of settings from enhancing self-management, risk factor control, and cardiac rehab.

Conclusions: Effective strategies for secondary prevention management exist, but there are barriers to their implementation. WHF roadmaps can facilitate the development of a strategic plan to identify and implement local and national level approaches for improving secondary prevention.

Keywords: CVD; cardiac rehabilitation; fixed combination therapy; influenza vaccination; polypill; secondary prevention.

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Conflict of interest statement

Fernando Lanas has received speaker honoraria and has served as an advisory board member for Pfizer, Novartis, Bayer, BMS, Boehringer, Astrazeneca, Novo Nordisk. Lale Tokgözoğlu has received honoraria or has been part of advisory boards from Abbott, Amgen, AstraZeneca, Bayer, Daiichi Sankyo, Eli Lilly, MSD, Novartis, Novo Nordisk Pfizer, Recordati, and Sanofi.

Figures

Possible solutions to enable secondary prevention - Responses to the WHF survey
Figure 1
Possible solutions to enable secondary prevention - Responses to the WHF survey on which of the solutions was relevant to their setting.
Answers to the question: “Excise taxes in your country”
Figure 2
Answers to the question: “In Your country, do you have excise taxes for:…”.
Perceptions with respect to the availability and affordability of secondary prevention medicines
Figure 3
Perceptions with respect to availability and affordability of secondary prevention medicines.
See this image and copyright information in PMC

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References

    1. Perel P, Avezum A, Huffman M, et al. Reducing Premature Cardiovascular Morbidity and Mortality in People With Atherosclerotic Vascular Disease: The World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease. Glob Heart. 2015; 10(2): 99–110. DOI: 10.1016/j.gheart.2015.04.003 - DOI - PubMed
    1. Grainger Gasser A, Welch C, Arora M, et al. Reducing Cardiovascular Mortality Through Tobacco Control: A World Heart Federation Roadmap. Glob Heart. 2015; 10(2): 123–133. DOI: 10.1016/j.gheart.2015.04.007 - DOI - PubMed
    1. Jeemon P, Séverin T, Amodeo C, et al. World Heart Federation Roadmap for Hypertension—A 2021 Update. Glob Heart. 2021; 16(1): 63. DOI: 10.5334/gh.1066 - DOI - PMC - PubMed
    1. Ray KK, Ference BA, Séverin T, et al. World Heart Federation Cholesterol Roadmap 2022. Glob Heart. 2022; 17(1): 75. DOI: 10.5334/gh.1154 - DOI - PMC - PubMed
    1. Freedman B, Hindricks G, Banerjee A, et al. World Heart Federation Roadmap on Atrial Fibrillation—A 2020 Update. Glob Heart. 2021; 16(1): 41. DOI: 10.5334/gh.1023 - DOI - PMC - PubMed

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