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Heightened efforts for screening, interventions may decrease global CVD burden
The National Academies of Sciences, Engineering, and Medicine recommended that improvements of detection and treatment methods and decreasing the effects of risk factors may reduce global CVD burden, according to a report published in the Journal of the American College of Cardiology.
The report also stated CVD burden could be reduced by an emphasis on CVD management in global health infrastructure and increased research and development opportunities.
“All countries are vulnerable to threats from [infectious diseases] and to the chronic negative economic and health impacts of [noncommunicable diseases] such as CVD,” Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, and colleagues wrote. “There are opportunities for shared innovation and universal purpose as countries strive to develop best practices and strong health care systems.”
Health care costs
The highest health care expenditures are due to CVD in most countries, which is now the leading cause of mortality worldwide, according to the report. Most low- and middle-income countries lack appropriate health care infrastructure, trained health care providers and regulations. As there is no U.S. funding or presidential initiatives dedicated to reducing the global CVD burden, shared innovative approaches such as mobile health solutions may be necessary, the authors wrote.
Implementing cost-effective global interventions that are suitable to a country’s population can save money compared with a full suite of recommendations. Cost-effective interventions include patient care delivery, policies and regulations for preventive and treatment measures. This can help save $120 billion and lead to a 10% decrease in CVD mortality, according to the authors.
Risk factor interventions such as tax increases on cigarettes and sugar-sweetened beverages, screening programs in high-traffic areas and the integration of additional services into health care visits, may also contribute to reducing CVD burden, Fuster and colleagues wrote.
Early CVD intervention with the help of BP screening and other strategies can be integrated to prolong life and improve quality of life. This strategy can be successfully implemented with trained staff, a supply chain of treatment regimens and appropriate physical infrastructure, according to the report.
“Early detection can prompt behavioral changes, promote regular health visits and improve medical management,” Fuster and colleagues wrote.
Door-to-door, home-based screen services provide easy access for patients to receive the preventive measures and treatment they need.
“In addition to leveraging existing programs, redesigning health systems to be more holistic and integrated in nature, and decentralizing services in communities can improve efficiency and sustainability,” Fuster and colleagues wrote.
Services can be integrated through sharing locations, staff, tools, systems and strategies. Task-shifting can also broaden health care roles by utilizing the existing workforce for new purposes, such as screening and patient identification roles.
Drug development
Advances in drug development can contribute to better health care, according to the report. Many challenges face this area, including costs, approval processes and uncertain commercial potential. New trial approaches can potentially make them more efficient: pragmatic clinical trials, adaptive clinical trials and surrogate biomarkers or endpoints.
Adaptive clinical trials can shorten trial and development time, whereas pragmatic trials may help relax the controls. Using biomarkers as surrogate endpoints can accelerate the drug development process by providing short-term evidence on safety and effectiveness, according to the report.
The FDA now has different mechanisms to expedite the review of new drug applications: breakthrough therapy, fast track, accelerated approval and priority review.
“Though these options are designs to help share the burden of costs and ‘push’ a product through the development pipeline, they have not sufficiently incentivized private sector engagement and should be re-evaluated for expansion to further streamline the approval process for critical global health products,” Fuster and colleagues wrote.
Telecommunication and wireless multimedia can help advance medication adherence and chronic disease management through patient tracking, disease surveillance and telemedicine.
“These [National Academies of Sciences, Engineering, and Medicine] recommendations and this manuscript are among the most important efforts of my career because if they are adopted by the U.S. government, they have the potential to enact true change for global health,” Fuster said in a press release. “The next step for the committee is to present these recommendations to the U.S. Senate and to President Donald J. Trump.” – by Darlene Dobkowski
Disclosure: Fuster reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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The NHLBI is prepared to contribute leadership, in partnership with other federal agencies and appropriate non-governmental organizations, to reduce the global burden of CVD through efforts to turn discovery into global CV health. Our efforts will include support of research across the translational spectrum from basic discovery science to implementation science and support of research workforce development. We anticipate that other U.S. or international partners may focus on other aspects of this complex challenge, including, for example, development of the clinical and public health workforce.
A recently published report of an NHLBI-supported trial that demonstrated the valuable role of community health workers in controlling hypertension in a low-income population is an example of our ongoing efforts in this area (He J, et al. JAMA. 2017;doi:10.1001/jama.2017.11358). This work, conducted in Argentina, is clearly of great relevance in low- and middle-income countries; furthermore, the results are likely generalizable to low-income regions of the U.S. This interpretation of the results underscores the value of supporting global CV health research in a strategic manner.