A Global Perspective on Cardiovascular Risk Factors by Educational Level in CHD Patients: SURF CHD II
Marzà-Florensa A. Vaartjes I. Graham I. Klipstein-Grobusch K. Grobbee D.E. Joseph M. Costa Y.C. Enrique N.E. Gabulova R. Isaveva M. Alivev F. Rahimov U. Imanov G. Ibrahimov F. Naila Z. Abasov R. Dendale P. Jassen A. De Sutter J. Cuypers S. Precoma D. Ritt L. Sturzeneker M.C.S. Filho C.R.H. Lira M.T. Varablik M. Tumova E. Ozana J. Bovin A. Viigimaa M. Tsioufis K. Laina A. Achilles Z. Toulgaridis F. Sanidas E. Reiner Z. Gulin M. BejúiC A. Duplancic D. Šikic J. Szabados E. Tiksnadi B.B. McEvoy B. Reynolds A. Moore D. Spelman D. Puri R. Nanda R. Desai N. Dorairaj P. Iyengar S.S. Lakshmana S. Pandey A.K. Pradhan A. Mahajan K. Faggiano P. Zarcone P. Abrignani M.G. Daniyar M. Davletov K. Toleubekov K. Visternichan O. Mereke A. Dushpanova A. Zholdin B. Timirbayev Z. Derbissalina G. Aldyngurov D.K. Myssayev A. Nurtazina A. Romanova Z. Kalmakhanov S. Mintale I. Msalam O. Ehemmali E. Mohamed A. Mouine N. Amale T.M. Soufiani A. Agoumy Z. Bachri H. Massri I. Mitevska I. Haitjema S. De Groot M. Abreu A. Mosterou S. Gaita D. Pogosova N. Ezhov M.V. Kinsara A. Burazor I. Giga V. Bueno H. Dalmau R. García-Barrios A. Duque J.A.A. Mendinueta J.R. Kayikcioglu M. Tokgozoglu L. Aslanger E. Cabbar A.T. Kim S. Self C. Reynolds D. Rose S. Singh P.
2024Ubiquity Press
Global Heart
2024#19Issue 1
Background: Clinical guidelines recommend lifestyle modifications and medication use to control cardiovascular risk factors in coronary heart disease (CHD) patients. However, risk factor control remains challenging especially in patients with lower educational level. Objective: To assess inequalities by educational level in the secondary prevention of CHD in the Survey of Risk Factors in Coronary Heart Disease (SURF CHD II). Methods: SURF CHD II is a cross-sectional clinical audit on secondary prevention of CHD, conducted during routine clinical visits in 29 countries. The easy-to-perform design of the survey facilitates its implementation in settings with limited resources. We reported risk factor recording, attainment of guideline-defined risk factor targets, and treatment in CHD patients. Differences by educational level in target attainment and treatment were assessed with logistic regression stratified for high- (HIC), upper middle- (UMIC), and lower middle-income (LMIC) countries. Results: SURF CHD II included 13,884 patients from 2019 to 2022, of which 25.0% were female and 18.6% had achieved only primary school level. Risk factor recording ranged from 22.2% for waist circumference to 95.6% for smoking status, and target attainment from 15.9% for waist circumference to 78.7% for smoking. Most patients used cardioprotective medications and 50.5% attended cardiac rehabilitation. Patients with secondary or tertiary education were more likely to meet targets for smoking, LDL cholesterol and physical activity in HICs and LMICs; for physical activity and triglycerides in UMICs; but less likely to meet targets for blood pressure in HICs and LDL <1.4mmol/L in UMICs. Higher education was positively associated with medication use and cardiac rehabilitation participation. CONCLUSION: CHD patients generally have poor attainment of risk factor targets, but patients with a higher educational level are generally more likely to participate in cardiac rehabilitation, use medication, and meet targets.
cardiovascular risk factors , coronary heart disease , education , global health , health inequities , Secondary prevention
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Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
Trinity College, Dublin, Ireland
Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Socieded Argentina de Cardiología, Buenos Aires, Argentina
Counsel of Cardioecology and Healthy Habits Sociedad Argentina de Cardiología, Mar del Plata, Argentina
Azerbaijan Medical University, Educational Therapeutic Clinic, Baku, Azerbaijan
Scientific Research Institute for Cardiology, Baku, Azerbaijan
Baku Health Centre, Baku, Azerbaijan
Baku Medical Plaza, Baku, Azerbaijan
Azerbaijan Medical University, Educational Surgical Clinic, Baku, Azerbaijan
Central Clinic Hospital, Baku, Azerbaijan
Ganja City United Hospital, Ganja, Azerbaijan
ER Medical, Khachmaz, Azerbaijan
Jessa Hospital-Hartcentrum, Hasselt, Belgium
AZ Maria Middelares Cardiologie, Gent, Belgium
Hartcentrum OLV Ziekenhuis, Aalst, Belgium
Sociedade Hospitalar Angelina Caron, Campina Grande do Sul, Brazil
Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
Wallace Thadeu de Mello e Silva Regional University Hospital, Brazil
SC Street Blumenau, 294 Centro, Joinville, Brazil
Hospital Clínico Fuerza Aérea de Chile, Santiago, Chile
Centre of Preventive Cardiology, 3th Department of Internal Medicine, 1st Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic
Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc, Czech Republic
Danish Society of Cardiology, Copenhagen, Denmark
North Estonia Medical Centre, Tallinn University of Technology, Tallin, Estonia
Cardiology Department, Hippokration General Hospital, Athens, Greece
General Hospital of Athens Evangelismos, Athens, Greece
LAIKO General Hospital, Athens, Greece
Polish Mothers Memorial Hospital Research Institute, Lodz, Poland
University Hospital Center, Zagreb, Croatia
County Hospital Sibenik, Croatia
University Hospital, Split, Croatia
University Hospital Sveti Duh, Croatia
Ist Department of Medicine, Division of Preventive Cardiology and Rehabilitation, University of Pécs, Medical School, Pécs, Hungary
Hasan Sadikin General Hospital, West Java, Bandung, Indonesia
University Hospital Galway, Galway, Ireland
Tallaght University, Hospital Cardiology Clinic, Dublin, Ireland
South Tipperary General Hospital, Tipperary, Ireland
Cardiac Care Centre, New Delhi, India
Namana Medical Centre, Bengaluru, India
Ashwin Clinic, Anna Nagar, India
Manipal Hospital, Bangalore, India
Galaxy Hospital, Mahmoorganj, India
King Georges Medical University, Lucknow, India
Himachal Heart Institute, Chhanwari, India
Ospedali Riuniti, Brescia, Italy
Policlinico P. Giccone, Palermo, Italy
S Antonio Abate Hospital of Trapani, O.U. of Cardiology, Trapani, Italy
Central Clinical Hospital, Almaty, Kazakhstan
Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Cardiorehabilitation Center Tulpar, Karaganda Medical University, Karaganda, Kazakhstan
City Policlinic No. 32, Al Farabi Kazakh National University, Almaty, Kazakhstan
Scuola Superiore SantAnna, Pisa, Italy
Medical Center of West Kazakhstan Marat Ospanov Medical University, Zhanakonys, Kazakhstan
Astana Medical University, University Hospital, Astana, Kazakhstan
Department of Science and Human Resource, Ministry of Healthcare, Kazakhstan
Cardiological Center of Pavlodar Region, Department of Science and Human Resourse, Ministry of Healthcare, Kazakhstan
Cardiological Center of Pavlodar Region, Semey Medical University, Semey, Kazakhstan
City Polyclinic No. 5, Al Farabi Kazakh National University, Almaty, Kazakhstan
Latvian Center of Cardiology, Riga, Latvia
Libyan Cardiac Society, Tripoli, Libya
Misrata Heart & Cardiovascular Center, Misrata, Libya
Cabinet Cardiologie ALAMI, Casablanca, Morocco
Cardiology Centre, Mohammed v Military Hospital, Rabat, Morocco
Hopital Universitaire Cheikh Zaid, Rabat, Morocco
Ligue Nationale de Cardiologie, Rabat, Morocco
University Cardiology Clinic, Skopje, North Macedonia
Utrecht Patient Oriented Database (UPOD), Central Diagnostic Laboratory, Division of Laboratory, Pharmacy, and Biogenetics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
Hospital Universitário Santa Maria, IMPSP, ISAMB, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
Institute for Cardiovascular Diseases, Timisoara, Romania
National Medical Research Center of Cardiology, Preventive Cardiology Laboratory, Moscow, Russian Federation
Federal State Budget Institution, National Cardiology Research Centre of Ministry of Healthcare of Russian Federation, Moscow, Russian Federation
Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Research Center, Jeddah, Saudi Arabia
Institute for Rehabilitation, University of Belgrade, Faculty of Medicine, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia
Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
Hospital 12 de Octubre, Madrid, Spain
Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
University Hospital la Paz, Madrid, Spain
Hospital General Universitario Dr. Balmis, Alicante, Spain
Hospital Universitario Donostia/OSI Donostialdea, Donostia, Spain
Ege University Medical School, Cardiology Department, Ege University Tip Fak Kardivoloii AD Bornova, Izmir, Turkey
Hacettepe University, Department of Cardiology, Ankara, Turkey
Basaksehir Pine and Sakura City Hospital, Istanbul, Turkey
Yeditepe Univerisity Hospital, Istanbul, Turkey
Weil Cornell Medicine, New York, United States
Julius Global Health
Trinity College
Division of Epidemiology and Biostatistics
Socieded Argentina de Cardiología
Counsel of Cardioecology and Healthy Habits Sociedad Argentina de Cardiología
Azerbaijan Medical University
Scientific Research Institute for Cardiology
Baku Health Centre
Baku Medical Plaza
Azerbaijan Medical University
Central Clinic Hospital
Ganja City United Hospital
ER Medical
Jessa Hospital-Hartcentrum
AZ Maria Middelares Cardiologie
Hartcentrum OLV Ziekenhuis
Sociedade Hospitalar Angelina Caron
Escola Bahiana de Medicina e Saúde Pública
Wallace Thadeu de Mello e Silva Regional University Hospital
SC Street Blumenau
Hospital Clínico Fuerza Aérea de Chile
Centre of Preventive Cardiology
Department of Exercise Medicine and Cardiovascular Rehabilitation
Danish Society of Cardiology
North Estonia Medical Centre
Cardiology Department
General Hospital of Athens Evangelismos
LAIKO General Hospital
Polish Mothers Memorial Hospital Research Institute
University Hospital Center
County Hospital Sibenik
University Hospital
University Hospital Sveti Duh
Ist Department of Medicine
Hasan Sadikin General Hospital
University Hospital Galway
Tallaght University
South Tipperary General Hospital
Cardiac Care Centre
Namana Medical Centre
Ashwin Clinic
Manipal Hospital
Galaxy Hospital
King Georges Medical University
Himachal Heart Institute
Ospedali Riuniti
Policlinico P. Giccone
S Antonio Abate Hospital of Trapani
Central Clinical Hospital
Asfendiyarov Kazakh National Medical University
Cardiorehabilitation Center Tulpar
City Policlinic No. 32
Scuola Superiore SantAnna
Medical Center of West Kazakhstan Marat Ospanov Medical University
Astana Medical University
Department of Science and Human Resource
Cardiological Center of Pavlodar Region
Cardiological Center of Pavlodar Region
City Polyclinic No. 5
Latvian Center of Cardiology
Libyan Cardiac Society
Misrata Heart & Cardiovascular Center
Cabinet Cardiologie ALAMI
Cardiology Centre
Hopital Universitaire Cheikh Zaid
Ligue Nationale de Cardiologie
University Cardiology Clinic
Utrecht Patient Oriented Database (UPOD)
Hospital Universitário Santa Maria
Institute for Cardiovascular Diseases
National Medical Research Center of Cardiology
Federal State Budget Institution
Ministry of National Guard Health Affairs
Institute for Rehabilitation
Cardiology Clinic
Hospital 12 de Octubre
Centro Nacional de Investigaciones Cardiovasculares
University Hospital la Paz
Hospital General Universitario Dr. Balmis
Hospital Universitario Donostia/OSI Donostialdea
Ege University Medical School
Hacettepe University
Basaksehir Pine and Sakura City Hospital
Yeditepe Univerisity Hospital
Weil Cornell Medicine
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