Global Heart Feed

Heart Failure Care and Post-Hospital Outcomes in Northwestern Tanzania

Mon, 26 Oct 2026 00:00:00 GMT

Introduction: In Africa, heart failure (HF) mortality is the highest in the world; approximately 50% of patients die within one year of HF hospitalization. Little is known about the quality of inpatient and post-discharge care and its association with patient outcomes. The purpose of this study is to describe HF outcomes for patients admitted in Northwestern Tanzania and evaluate associations between gaps in quality care and post-hospital survival. Methods: We conducted a retrospective chart review of all adult patients admitted with HF at Bugando Medical Centre in 2023. We abstracted data from the index hospitalization and subsequent encounters until August 31, 2025. Vital status was ascertained by telephone. We characterized post-discharge outcomes and adherence to guideline recommendations for HF care. Cox proportional hazards models assessed associations between gaps in quality measures and mortality. Results: Among 177 patients admitted with HF, 23 (13%) died during the index hospitalization. Of the 154 patients alive at discharge, 63 (40.9%) died within six months and 86 (56%) within a year. Among patients alive at discharge, 79% received indicated testing, 50% were on guideline-directed medical therapy (GDMT) at discharge, 68% attended the first post-discharge appointment, 53% received ongoing care three months post-discharge, and 39% were on GDMT three months post-discharge. Attending the first post-discharge visit (aHR 0.32 [95% CI: 0.17, 0.63]) and remaining in care three months after discharge (aHR 0.36 [95% CI: 0.16, 0.81]) were both independently associated with improved survival. GDMT use was low across outpatient visits (47%), with frequent medication changes and de-escalation over time. Conclusions: Mortality following HF admission in Northwestern Tanzania remains high. Factors associated with post-hospital mortality may include poor linkage to post-discharge care and low sustained care engagement. Implementation research is needed to develop strategies to improve post-discharge HF outcomes in East Africa, focusing on optimizing GDMT before discharge and improving early post-hospital linkage to care. Lay Summary Heart failure (HF) mortality in sub-Saharan Africa is the highest in the world, yet little is known about the quality of HF care provided during and after HF hospitalization and its relationship to post-hospital outcomes. This study seeks to understand the quality of care provided to patients admitted with HF in Northwestern Tanzania and its association with post-hospital outcomes. This study took place at Bugando Medical Centre, a large academic regional referral hospital in Mwanza, Tanzania that serves a catchment population of ~22 million people. Among 177 patients admitted with HF in 2023, there was a trend of high, early mortality following hospital discharge. Among the 154 patients who survived and were discharged, we found significant gaps in linkage to care after hospitalization, sustained retention in care, and utilization of guideline-directed medical therapy at discharge and in the outpatient setting. Linkage to care and retention in care were each independently associated with significant improvements in survival. There is a pressing need for future studies focused on understanding and addressing factors associated with post-hospital care engagement and utilization of guideline-directed medical therapy after HF hospitalization in East Africa.

Race-Free Equations and Cardiovascular Risk Assessment: Much Ado About Something

Fri, 23 Oct 2026 00:00:00 GMT

Estimated glomerular filtration rate (eGFR) is central to kidney-function assessment and cardiovascular risk prediction. The equations long used to compute it incorporated a race coefficient that artificially raised values in people of African descent. Because race is a sociocultural construct rather than a biological variable, a 2021 consensus statement recommended adoption of race-free eGFR equations—paralleling cardiology’s move from the race-based 2013 Pooled Cohort Equations to the race-free PREVENT equations. Whether removing race meaningfully alters cardiovascular risk stratification has remained largely untested in diverse populations outside North America. The HELIUS study addresses this gap, examining 21,617 Amsterdam adults from six ethnic groups, collapsed into non-African descent, African Surinamese, and Ghanaian categories. Replacing the 2009 race-corrected equation with the 2021 race-free equation lowered eGFR by roughly 9–10 mL/min/1.73 m² in the African Surinamese and Ghanaian groups, while estimates changed little in the non-African descent group. Agreement for composite chronic kidney disease (CKD) classification was near-perfect (Cohen’s κ 0.94–0.99), though driven largely by albuminuria, which is unaffected by the eGFR equation; isolating the eGFR component showed the prevalence of eGFR <60 mL/min/1.73 m² roughly doubling in Ghanaian and rising about three-quarters in African Surinamese participants, while falling in those of non-African descent. Within the SCORE2 CKD add-on model, equation choice did not materially change median risk or categorization at the population level. These reassurances are bounded by the cohort’s youth (mean age 44 years) and low burden of impaired function (1.2% with eGFR <60). As a cross-sectional study without events, HELIUS demonstrates classificational concordance but cannot establish equal predictive performance, and may not generalize to older or higher-risk populations. HELIUS nonetheless indicates that race-free estimation preserves risk categories without altering management in this low-risk cohort, while underscoring the need for rigorous, longitudinal, event-based validation across diverse global populations.

Association Between the Chinese Visceral Adiposity Index-Frailty Index (CVAI-FI) and the Incidence of New-Onset Stroke in Individuals with Cardiovascular-Kidney-Metabolic Syndrome Stage 0–3: Evidence From a National Population-Based Study

Thu, 22 Oct 2026 00:00:00 GMT

Objective: Cardiovascular-Kidney-Metabolic (CKM) syndrome represents a multisystem disorder linking metabolic dysfunction with cardiovascular complications. While the Chinese Visceral Adiposity Index (CVAI) and Frailty Index (FI) independently predict adverse outcomes, their combined utility for stroke prediction across CKM syndrome stages 0–3 remains unexplored. Methods: We analyzed 6,772 participants aged ≥45 years from the China Health and Retirement Longitudinal Study (2011–2020). Participants were classified into CKM stages 0–3, excluding stage 4 or baseline stroke. CVAI was calculated using age, BMI, waist circumference, triglycerides, and HDL-C. FI incorporated 32 health deficits following standardized methodology. The CVAI-FI index was derived as the product of CVAI and FI. Cumulative exposure was assessed in 4,170 participants with measurements from Waves 1 (2011) and 3 (2015). Multivariable logistic regression evaluated associations with incident stroke, adjusting for sociodemographic, behavioral, and clinical confounders. Model performance was assessed using ROC curves, with incremental value determined through NRI and IDI. Restricted cubic splines characterized dose-response relationships. Results: During follow-up, 447 participants (6.6%) developed stroke. CVAI-FI demonstrated a significant dose-response association with stroke risk (P for nonlinearity <0.001). Each one-SD increment in CVAI-FI corresponded to 31% higher stroke risk (OR 1.31, 95% CI 1.20–1.43). Cumulative CVAI-FI achieved superior discrimination (AUC 0.675) compared to standalone CVAI (0.616), FI (0.609), and baseline CVAI-FI (0.641, all P < 0.001), with significant IDI (0.018–0.020) and NRI (0.032) improvements. Associations remained robust across subgroups, with stronger effects among individuals with secondary education or above (OR 1.83) and those without hypertension (OR 1.51). Conclusions: The CVAI-FI index provides enhanced stroke risk stratification across CKM syndrome stages 0–3, with quantifiable improvements in discrimination and reclassification. Cumulative exposure assessment further strengthens predictive accuracy. These findings support CVAI-FI’s clinical utility for identifying high-risk individuals requiring intensified preventive interventions within emerging CKM syndrome frameworks.

Bangladesh HEARTS: Lessons Learned from a National Hypertension Control Program, 2018–2026

Wed, 21 Oct 2026 00:00:00 GMT

To improve hypertension control and prevent cardiovascular disease in Bangladesh, the National Heart Foundation of Bangladesh and Resolve to Save Lives collaborated with the Ministry of Health and Family Welfare to launch the Bangladesh Hypertension Control Initiative (BHCI). The BHCI implemented the WHO-HEARTS hypertension control package in four primary health care facilities (Upazila Health Complexes or UHCs) in 2018, then scaled up to 51 UHCs in 2021, 172 UHCs by 2024, and 320 UHCs by May 2026, covering about 54 million of 108 million adults (~43% coverage). By May 2026, the BHCI had enrolled 739,057 hypertensive patients and achieved 59% blood pressure (BP) control (<140/90 mmHg based on BP measured in the prior three months among all enrolled patients). The BHCI is a scalable model for hypertension control programs in other low- and middle-income countries. For sustained high-quality national scale-up, uninterrupted supply of medicines by the government and accurate information systems are crucial.

Beyond the Earthquake: Cardiovascular Consequences and Lessons for Colombia

Fri, 16 Oct 2026 00:00:00 GMT

An earthquake is an event that affects populations across multiple dimensions, extending far beyond trauma and immediate mortality. Cardiovascular events are particularly important during the acute phase and in the first days after the disaster, when physiological stress, disruption of healthcare services, medication interruption, and barriers to timely medical attention may increase cardiovascular risk. Previous evidence has documented increases in myocardial infarction, stroke, arrhythmias, cardiovascular mortality, and decompensation of chronic cardiovascular disease following major earthquakes. In Colombia, the recent earthquake affecting Chocó and neighboring regions highlights the particular vulnerability of populations facing geographic isolation and unequal access to healthcare. Disaster preparedness should therefore extend beyond trauma care and include continuity of cardiovascular medications, preservation of emergency referral pathways, capacity to manage sudden increases in cardiovascular demand, and structured follow-up after the acute phase. This article reviews these cardiovascular consequences and discusses their implications for disaster preparedness in Colombia.

Are Current Lipid Guidelines Adequate for South Asian Patients? A Narrative Review

Thu, 08 Oct 2026 00:00:00 GMT

South Asians, who account for nearly one quarter of the world’s population, experience a disproportionately high burden of atherosclerotic cardiovascular disease (ASCVD), often presenting 5–10 years earlier than European populations. This review evaluates whether contemporary lipid-management frameworks adequately address cardiovascular risk in South Asians. South Asians exhibit a distinct lipid phenotype characterised by elevated apolipoprotein B (ApoB), hypertriglyceridaemia, reduced HDL-cholesterol (HDL-C), increased small dense LDL (sdLDL) particles, and a high prevalence of elevated lipoprotein(a) (Lp(a)), features that are incompletely captured by conventional LDL-cholesterol (LDL-C)-based approaches. Existing cardiovascular risk tools show variable performance in South Asian populations, while contemporary guidelines differ substantially in risk assessment, LDL-cholesterol targets, incorporation of risk enhancers, and use of coronary artery calcium (CAC) scoring. Although recent guideline updates increasingly acknowledge South Asian ethnicity as a risk modifier, important gaps in calibration and implementation remain. Greater harmonisation of recommendations and validation of South Asian-specific risk assessment strategies are needed to improve cardiovascular prevention.

Generating Implementation Research Knowledge for Scaling Lifestyle Modification Intervention to Control Hypertension and Diabetes: Lessons from the CoCo-HD Study in Kerala

Tue, 29 Sep 2026 00:00:00 GMT

This article describes how a structured lifestyle modification intervention for hypertension and diabetes was scaled within Kerala’s health system, focusing on how implementation knowledge was generated and embedded in routine practice. Grounded in an implementation research approach, the work documents how evidence-informed strategies were continuously adapted through stakeholder engagement, peer-led delivery, and supportive institutional processes. Drawing on qualitative data from stakeholder consultations, document review, and field observations in Janakeeya Arogya Kendrams (basic unit of primary health care centres in Kerala), the article shows how local context, social learning, and power dynamics shaped iterative learning cycles. The findings outline key facilitators and barriers to knowledge use in practice. It offers practical insights for strengthening sustainable non-communicable disease prevention and control programmes in similar settings.

Longitudinal Trajectories of Body Roundness Index and Risk of Incident Hypertension in Non-Diabetic Elderly Adults: A Prospective Nationwide Cohort Study Involving Two Cohorts

Fri, 25 Sep 2026 00:00:00 GMT

Background: Central adiposity is a key determinant of hypertension, yet most studies rely on single-time-point measures or include individuals with diabetes, potentially confounding associations. The relationship between long-term body roundness index (BRI) trajectories and incident hypertension in non-diabetic populations remains unclear. Methods: We conducted a longitudinal analysis of non-diabetic middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS), with external validation using the English Longitudinal Study of Ageing (ELSA). In CHARLS, BRI measurements from Waves 1–3 (2011–2016) were used to construct trajectories, and incident hypertension was assessed at Wave 4 (2018–2020). In ELSA, trajectories were constructed using BRI measurements from Waves 2, 4, and 6 (2004–2013), and incident hypertension was assessed at Wave 8 (2016–2017). Associations were examined using multivariable logistic regression, with subgroup and sensitivity analyses. Machine learning models were additionally developed for multivariable hypertension risk prediction. Results: Three BRI trajectories were identified in both cohorts: low-level inverted U-shaped, moderate-level inverted U-shaped, and high-level increasing trajectories. Higher BRI trajectories were associated with a graded increase in incident hypertension risk in CHARLS. Compared with the low-level inverted U-shaped trajectory, the adjusted odds ratios (95% confidence intervals) were 1.40 (1.13–1.73) for the moderate-level inverted U-shaped trajectory and 1.76 (1.21–2.56) for the high-level increasing trajectory. Directionally consistent findings were observed in ELSA, particularly for the high-level increasing trajectory. Findings remained robust in subgroup and sensitivity analyses. Machine learning analyses showed that BRI trajectory provided complementary predictive information when combined with clinical and biomarker variables. Conclusions: Longitudinal BRI patterns were associated with incident hypertension in non-diabetic adults. Repeated assessment of BRI may provide complementary information for identifying individuals at elevated hypertension risk, although its causal and clinical implications require further investigation.

Enhanced Facility-Based Hypertension Screening: A Quality Improvement Initiative at Primary Health Care Facilities in Ethiopia

Wed, 23 Sep 2026 00:00:00 GMT

Less than half of people with hypertension in Ethiopia are diagnosed, and only one-third of adults visiting primary care facilities have their blood pressure (BP) screened. We implemented a quality improvement (QI) initiative across six facilities in Ethiopia to increase facility-based BP screening. Process mapping identified barriers, and interventions were tested in iterative QI cycles: establishing BP screening desks at key service points, ensuring the availability of validated BP devices, training staff in accurate measurement, standardizing documentation, and reviewing screening indicators in performance meetings. Between April 2024 and February 2025, monthly BP screening of adults without a hypertension diagnosis increased from 41.0% of 13,707 eligible adults to 79.6% of 14,270 eligible adults. Monthly hypertension program enrollments rose from 40 in April 2024 to 125 in February 2025. Strengthening primary health care systems to systematically measure BP for all adults visiting health facilities can significantly improve hypertension detection and treatment.

Menopause Hormone Therapy in Women With Cardiovascular Risk Factors or Established Ischemic Heart Disease: A Joint FIGO and WHF Position Paper

Tue, 22 Sep 2026 00:00:00 GMT

Extending women’s health-span is a key challenge for the medical community. Although women live longer than men, they face a higher burden of chronic diseases, such as cardiovascular diseases (CVDs) and disabilities. Endogenous estrogens appear to benefit cardiovascular health, and their marked decline at menopause is associated with increased cardiovascular risk; conversely, poor cardiovascular health may hasten menopause onset. Systemic menopause hormone therapy (MHT) begun early—ideally soon after symptom onset and at most within 10 years of the final menstrual period—alleviates climacteric symptoms and is associated with long-term benefits. This joint position paper between the International Federation of Gynecology and Obstetrics (FIGO) and the World Heart Federation (WHF) aims at supporting both gynecologists and cardiologists in providing a tailored and evidence-based counseling on systemic MHT use to women with increased CVD risk or established ischemic heart disease (IHD). Women with CVD risk factors require thorough risk stratification to tailor MHT type, dose, and route. For those at high thromboembolic risk, transdermal estrogen, with micronized progesterone or dydrogesterone when needed, is considered the safest regimen. Women with established IHD may receive systemic MHT for symptom relief, provided risks and benefits are carefully reviewed. Transdermal low-dose estrogen, alone or with micronized progesterone or dydrogesterone, is the best choice. All primary and secondary prevention measures, including statins, should be continued. Managing the most complex cases warrants the adoption of a multidisciplinary approach between cardiologists, gynecologists, internists and primary care providers to offer the best possible care.

Sleep Phenotype, Shift-Related Occupation, and Coronary Plaque Complexity in Young Adults: Association with CT-Derived Functional Ischemia

Tue, 22 Sep 2026 00:00:00 GMT

Background: Sleep disruption and irregular work schedules are increasingly recognized as behavioral risk factors for premature cardiovascular disease. Their associations with coronary plaque complexity and CT-derived functional ischemia in young adults remain underexplored. Objective: To investigate the association of multidimensional sleep phenotype, shift-related occupation, and coronary plaque complexity as well as CT-derived functional ischemia in adults aged ≤40 years, adjusting for clinical confounders. Methods: This retrospective study included 3,983 young adults who underwent coronary CT angiography (CCTA). Sleep phenotype was assessed using a multidimensional score incorporating sleep duration, timing, regularity, quality, and sleep-related symptoms. Occupations were classified as shift-related or non-shift. Coronary plaque characteristics, including stenosis severity, minimum lumen area, lesion length, diffuse disease, occlusion, coronary artery calcium score, and CT-derived fractional flow reserve (CT-FFR), were analyzed. Multivariable logistic regression, adjusted for age, sex, BMI, smoking, hypertension, diabetes, dyslipidemia, and shift-related occupation, assessed associations with CT-FFR ≤ 0.80. Results: Poor sleep phenotype was associated with more severe stenosis, smaller lumen area, longer lesions, and higher prevalences of diffuse disease, occlusion, and CT-FFR ≤ 0.80. In multivariable analysis, sleep phenotype remained independently associated with CT-FFR ≤ 0.80 after adjusting for clinical covariates and shift-related occupation. Shift-related occupation further modified this association, with a stronger relationship observed among shift workers. Conclusions: In young adults, poorer sleep phenotype was accompanied by more complex coronary plaque features and was independently associated with a higher likelihood of CT-FFR-defined functional ischemia after adjustment for clinical covariates. Lay Summary Poor sleep and irregular working hours may affect heart health, but their relationship with early coronary artery disease in young adults is not well understood. We studied 3,983 adults aged 40 years or younger who underwent coronary CT scans. Participants with poorer sleep patterns were more likely to have longer and more severe coronary artery narrowing, more widespread plaque, and reduced blood flow to the heart. These associations remained after accounting for established cardiovascular risk factors. The relationship between poor sleep and impaired coronary blood flow was particularly strong among people working night shifts or other irregular schedules. Although this observational study cannot prove that poor sleep directly causes coronary disease, the findings suggest that sleep habits and work schedules may help identify young adults who could benefit from earlier cardiovascular risk assessment and preventive support.

Correction: Association of Pre-PCI Blood Pressure and No-Reflow in Patients with Acute ST-Elevation Coronary Infarction

Wed, 09 Sep 2026 00:00:00 GMT

This article details a correction to: Li X, Yu C, Lei L, Liu X, Chen Y, Wang Y, Qiu S, Xiu J. Association of Pre-PCI Blood Pressure and No-Reflow in Patients with Acute ST-Elevation Coronary Infarction. Global Heart. 2024;19(1):28. DOI: https://doi.org/10.5334/gh.1309 (1).

Association of Sleep Duration, Metabolic Markers, and Risk of All-Cause and Cause-Specific Mortality in China and the UK

Tue, 01 Sep 2026 00:00:00 GMT

Background: Sleep duration is associated with various health outcomes like metabolic disturbances and mortality, but the underlying mechanisms remain unclear. Objectives: To investigate the link between sleep duration, metabolic markers, and mortality using data from the China Kadoorie Biobank (CKB) and the UK Biobank (UKB). Methods: Sleep duration was self-reported, and metabolic markers were quantified using nuclear magnetic resonance spectroscopy. The outcomes of interest were all-cause and cause-specific mortality. Linear regression was conducted to assess the association between sleep duration and metabolic markers, which were further compared with the association between metabolic markers and all-cause and cause-specific mortality using Cox models. Results: In both cohorts, sleep duration showed positive associations with all-cause and cause-specific mortality after adjustment. A total of 17 metabolic markers—encompassing lipoprotein subclasses in high-density lipoprotein cholesterol, relative lipoprotein lipid concentrations in very-low-density lipoproteins, cholesterol, and ketone bodies—were significantly associated with sleep duration and mortality. In general, the associations of sleep duration with metabolic markers and of these markers with mortality showed similar patterns for lipoprotein subclasses and relative lipoprotein lipid concentrations, whereas contrary patterns were observed for cholesterol and ketone bodies in the CKB. Furthermore, significant associations were also observed in the UKB cohort, with metabolic markers presenting generally consistent association patterns with sleep duration and mortality. Gender-specific analyses revealed significant links in females in the CKB and in both genders in the UKB. Sensitivity analyses confirmed the stability of these associations. Conclusions: Our findings suggest that lipid metabolism may partially explain the effect of sleep duration on mortality. These insights highlight the potential of targeted metabolic interventions to mitigate the risks associated with abnormal sleep patterns, especially when modifying sleep duration itself is challenging, and the projected health burden associated with sleep disorders could be reduced through metabolic-focused strategies. Lay Summary What question did this study address, and why does it matter? This study examined whether sleep duration is associated with metabolic markers and whether these markers, in turn, are associated with mortality risk, using data from two large population-based cohorts in China and the UK. Sleep problems are becoming increasingly common worldwide, and identifying metabolic pathways that may link sleep to health outcomes could inform future prevention strategies. Where was the study done and what were the main results? The study used data from the China Kadoorie Biobank (CKB) and the UK Biobank (UKB). In both cohorts, sleep duration was associated with changes in specific metabolic markers, including lipoprotein subclasses, cholesterol, and ketone bodies. These metabolic changes were further associated with all-cause and cause-specific mortality. While lipoprotein subclasses showed broadly consistent patterns across the two cohorts, cholesterol and ketone bodies exhibited contrary associations with mortality in the CKB compared to the UKB. Sex-specific differences were also observed, particularly in the CKB cohort, where significant associations were found only in women. What do these findings mean in practice? These findings suggest that lipid metabolism may play a role in the relationship between sleep duration and mortality. This raises the possibility that metabolic monitoring or targeted interventions—such as lifestyle or dietary modifications—could potentially help reduce the health risks associated with abnormal sleep duration, particularly in settings where sleep modification itself is challenging. However, further research is needed to determine whether these associations are causal and to explore their underlying mechanisms.

Fifth Universal Definition of Myocardial Infarction (2026)

Fri, 28 Aug 2026 00:00:00 GMT

On behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) Affirmation of Value by the Society for Cardiovascular Angiography and Interventions (SCAI)

Income, Geography, and Etiology as Factors Associated with Valve Replacement Outcomes: A Nationwide Cohort of 63,426 Patients in a Middle-Income Country

Tue, 25 Aug 2026 00:00:00 GMT

Background: Heart valve disease is a growing cause of mortality and disability worldwide, disproportionately burdening low- and middle-income countries (LMICs), where rheumatic heart disease remains a major etiology and cardiac surgical capacity covers less than 2% of the estimated need. Population-level outcome data after valve surgery in LMICs are virtually absent. We leveraged Brazil’s universal health system to quantify how income, geography, and disease etiology are associated with survival after valve replacement surgery. Methods: Five Brazilian public health databases covering outpatient care (SIA), hospital admissions (SIH), mortality records (SIM), the cancer registry (RHC), and a social vulnerability index (IVS Atlas) were linked to a single individual-level longitudinal record, with a proof-of-life algorithm correcting right-censoring bias. All patients undergoing valve replacement surgery between January 2015 and December 2024 were included. Results: Among 63,426 patients (mean age 56.9 ± 15.2 years; median follow-up 1,023 days), the in-hospital mortality rate was 8.6% and the five-year mortality was 30.1%. Income and geography were significantly associated with survival: the highest income quartile had significantly lower mortality than the lowest quartile in the adjusted Cox model (HR 0.82; 95% CI 0.76–0.89; p < 0.001), and in-hospital mortality exceeded 25% in low-volume municipalities in the North region. Valve lesion subtype predicted outcomes differentially across time horizons, and reoperation was associated with worse survival (HR 1.48; 95% CI 1.37–1.58; p < 0.001). Conclusion: Income, geography, and valve-specific risk factors are important factors associated with survival after valve surgery in Brazil’s public health system, reflecting structural conditions shared across LMICs. The linkage framework offers a scalable model for cardiovascular outcome surveillance in resource-constrained settings. Lay Summary Each year, thousands of Brazilians undergo heart valve surgery through the public health system. Using data from over 63,000 patients treated between 2015 and 2024, we found that survival after valve surgery in Brazil is substantially worse than in wealthier countries and that outcomes differ markedly depending on which valve is affected and why. Patients who required a second surgery fared worse, and those living in regions with fewer surgical centers faced higher mortality. These findings highlight critical gaps in cardiac surgical care, which can guide resource allocation and policy in Brazil and similar settings.

Impact of Adopting the Race/Ethnicity-Free 2021 CKD-EPI Equation on Cardiovascular Risk Stratification in a Multiethnic European Population: Results from the HELIUS Study

Fri, 21 Aug 2026 00:00:00 GMT

Aim: To assess the impact of the race-free 2021 CKD-EPI equation compared with the 2009 CKD-EPI equation (with/without race correction) on chronic kidney disease (CKD) detection and cardiovascular (CV) risk categorization in a multiethnic European population. Methods: This cross-sectional analysis included 21,617 participants of the Healthy Life in an Urban Setting (HELIUS) study in Amsterdam: Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, and Moroccan adults aged 18–70 years. Estimated glomerular filtration rate (eGFR) was calculated using the 2009 CKD-EPI equation (with/without race coefficient) and the race-free 2021 CKD-EPI equation. CKD was defined as eGFR <60 mL/min/1.73 m2 and/or urinary albumin-to-creatinine ratio ≥3 mg/mmol. CV risk was assessed using SCORE2 and SCORE2 CKD Add-on models. Results: Compared with the 2009 equation, the 2021 equation yielded lower eGFR values in African Surinamese and Ghanaian participants and marginally higher values in other groups. This led to a modest increase in CKD prevalence among those of African ancestry but did not affect overall CKD classification (Cohen’s κ = 0.94–0.99). Sensitivity, specificity, and C-statistics for CKD detection in risk groups were similar across equations. Integration of CKD modestly increased CV risk estimates, but results were virtually identical across the 2009 and 2021 equations. Conclusion: In this multiethnic European cohort, the race-free 2021 CKD-EPI equation produced different kidney function estimates, but both CKD and CV risk classifications were nearly identical to the 2009 equation. These findings support their clinical interchangeability and endorse adoption of the race-free equation as an equitable and reliable standard for kidney function assessment and CV risk prediction. Lay Summary In this large, multiethnic European cohort, adoption of the race-free 2021 CKD-EPI equation did not meaningfully alter chronic kidney disease (CKD) detection or cardiovascular (CV) risk stratification compared with the 2009 equation. The 2021 CKD-EPI equation lowered estimated glomerular filtration rate (eGFR) in individuals of African descent living in Europe but did not change CKD detection. Agreement between the 2009 and 2021 CKD-EPI equations for CKD classification was almost perfect, and CV risk categorization using SCORE2 and SCORE2 CKD Add-on tools was largely unaffected, indicating that adopting the race-free CKD-EPI equation is unlikely to alter CV risk management at the population level.

From Survival to Lifelong Care: The Global Burden of Congenital Heart Disease

Thu, 20 Aug 2026 00:00:00 GMT

Congenital heart disease (CHD) is the most common congenital anomaly and remains an under-recognised contributor to the global burden of cardiovascular disease. Once regarded as a paediatric condition, its burden now extends across the life course, as growing numbers of patients survive into adulthood and require lifelong, specialised care. Here we examine the global burden of CHD and propose actionable strategies. Data from the Global Burden of Disease (GBD) study, supplemented by peer-reviewed literature, global reports, and expert input, were used. We examined trends in CHD incidence, prevalence, mortality, and disability-adjusted life years (DALYs), from 1990 to 2023. In 2023, an estimated 2.3 million children were born with CHD, and 16 million people were living with the condition worldwide, up from 11.8 million in 1990, with the largest increase in lower-middle-income regions. CHD has remained the leading cause of neonatal and infant mortality among non-communicable diseases across all regions since 1990. Age-standardised mortality reached 4.7 deaths per 100,000 people globally in 2023, remaining four times higher in low-income (5.7) than in high-income (1.4) regions. Profound inequities persist across the accessibility, capacity, quality, and affordability of care, as high-income countries have 140–180 times as many cardiac surgeons as low-income countries. Coordinated initiatives such as Kerala’s Hridyam programme have shown that meaningful gains are achievable even in resource-limited settings. Persistent care disparities are driven less by an absence of clinical knowledge than by unequal access to timely diagnosis, treatment, and lifelong follow-up. Addressing the global CHD crisis will require coordinated efforts from policymakers, healthcare systems, and global health organisations, supported by the proposed 2027 World Health Assembly resolution on childhood-onset heart disease.

Development and Evaluation of a Clinical Prediction Model for Acute Kidney Injury Risk in Elderly Patients with Heart Failure with Reduced Ejection Fraction

Fri, 14 Aug 2026 00:00:00 GMT

Background: Acute kidney injury (AKI) is a significant complication among patients with heart failure with reduced ejection fraction (HFrEF). Once AKI occurs, therapeutic options are limited to supportive care, underscoring the clinical importance of early identification of patients at risk. This study sought to identify independent predictors of AKI development in geriatric HFrEF patients and subsequently establish a clinically applicable bedside risk quantification. Method: A total of 1,496 elderly patients (≥60 years) diagnosed with HFrEF at Guangdong Provincial People’s Hospital from January 2010 to December 2024 were enrolled according to predefined inclusion/exclusion criteria and stratified into an AKI group (n = 300) and a non-AKI group (n = 1196). Relevant parameters were screened using LASSO (Least Absolute Shrinkage and Selection Operator) regression, and risk factors for AKI in HFrEF patients were identified through univariate and multivariate logistic regression analyses. A nomogram was developed based on multivariate logistic regression results, accompanied by a corresponding heatmap. The predictive accuracy of the nomogram was evaluated using receiver operating characteristic (ROC) curves and calibration plots, while its clinical utility was demonstrated through decision curve analysis (DCA). Result: This study identified four independent predictors of AKI in patients with HFrEF, including N-terminal pro-B-type natriuretic peptide (NT-proBNP), uric acid (UA), CRP (C-reaction protein) and urea. A nomogram was developed based on these factors. The evaluation results demonstrated that the model exhibited good diagnostic accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.721 (95% CI: 0.658–0.785). The calibration curve and DCA further indicated that the model possesses favorable clinical applicability. Conclusion: This study developed and validated a nomogram model for predicting AKI in patients with HFrEF. Clinicians can utilize this model to optimize clinical decision-making based on individualized patient characteristics, enabling personalized risk stratification for therapeutic interventions and prognostic evaluations.

World Heart Day 2025 in Prasanthi Nilayam, India: A Silver Jubilee of the World Heart Federation Advocacy at the Centenary of a Humanitarian Legacy

Tue, 28 Jul 2026 00:00:00 GMT

An Unprecedented Confluence of Science, Selfless Service, and the World Heart Federation’s Mission of Cardiovascular Health for All On 29 September 2025, the World Heart Federation (WHF) marked the silver jubilee—25 years—of World Heart Day in what might seem an unlikely setting for a global cardiovascular organization: Prasanthi Nilayam in Puttaparthi, India, an internationally recognized epicenter of free, world-class medical care and humanistic service. The choice was deliberate. For an organization whose mission is ‘cardiovascular health for everyone, everywhere,’ it was most fitting to celebrate this milestone in a place where that principle has been quietly practiced, at scale and at no cost, for decades. For most of its history, the WHF has marked World Heart Day through campaigns centered initially only in its headquarters in Geneva, and subsequently in capitals and at multilateral fora, where global policy is debated and shaped. By contrast, Prasanthi Nilayam sits closer to village life than to ministries of health, and closer to patients’ daily realities than to conference halls. Precisely for that reason, it offered a real-life model of how values-driven policy translates into free, high-quality cardiovascular care, prevention, and community engagement on the ground. The timing was equally symbolic: the 25th anniversary of World Heart Day coincided with the centenary celebrations of Sri Sathya Sai Baba, whose guiding maxim—‘Love All, Serve All; Help Ever, Hurt Never’—has, for decades, animated an integrated, free-of-cost healthcare ecosystem that mirrors the WHF’s founding pledge that cardiovascular health should be a right, not a privilege, regardless of background, religion, caste, or means.

Hypertension Control in Bangladesh: Changes, Sociodemographic Variation, and Socioeconomic Inequality from the 2017–18 to 2022 Bangladesh Demographic and Health Surveys

Mon, 27 Jul 2026 00:00:00 GMT

Background: Hypertension is a major public health challenge in Bangladesh, yet population-level blood pressure control remains poorly characterized. This study estimated changes in population-level hypertension control between the Bangladesh Demographic and Health Survey (BDHS) 2017–18 and BDHS 2022 and examined sociodemographic variation and socioeconomic inequality in hypertension control. Methods: Nationally representative BDHS 2017–18 (n = 13,131) and BDHS 2022 (n = 14,296) data were analyzed using a cross-sectional design. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or antihypertensive medication use. Population-level control was defined as blood pressure <140/90 mmHg among hypertensive individuals in the population. Adjusted control rates and sociodemographic variation were estimated using pooled survey-weighted multivariable logistic regression with marginal standardization. Socioeconomic inequality was assessed using the concentration index (CnI), slope index of inequality (SII), and relative index of inequality (RII). Findings: Among individuals with hypertension, control increased from 12.5% (95% CI: 11.3–13.8) in 2017–18 to 19.3% (17.5–21.2) in 2022, alongside increases in awareness from 42.4% (40.5–44.4) to 54.3% (51.9–56.6) and treatment from 37.0% (35.2–38.9) to 44.6% (42.1–47.0). Hypertension prevalence was 27.5% (26.5–28.5) in 2017–18 and 20.5% (19.6–21.4) in 2022. Adjusted control improved across most sociodemographic groups, with the largest increases among older adults (+6.5%), females (+6.3%), urban residents (+6.8%), individuals with higher education (+7.3%), and residents of Sylhet (+7.9%) and Chattogram (+7.2%) divisions. Socioeconomic inequality also increased between 2017–18 and 2022, with a persistent pro-rich pattern (CnI: 0.11 to 0.13; SII: 8.5% to 15.1%; RII: 1.99 to 2.22). Conclusion: Population-level hypertension control in Bangladesh improved between survey rounds, although socioeconomic and geographic disparities persisted. Differences in survey implementation and measurement methods warrant cautious interpretation of changes over time. Strengthening equitable primary care and medication access may help sustain improvements and reduce disparities.