Introduction to the ‘Partnerships to tackle Cardiovascular Disorders” article collection
By Prof Takao Kato
Cardiovascular diseases are among the most common non-communicable diseases and this creates a challenge for treatment and prevention. Establishing and maintaining an effective and successful collaboration to tackle cardiovascular diseases is one solution, but can be difficult; in this collection of articles from 2017 to the present, each paper focuses on some aspect of ’partnership‘ to address some aspect of cardiovascular disease. These include interdisciplinary, multidisciplinary, and international approaches, which may be combined with clinical activities using new technologies, psychology, education, and community-based or patient-centered methods.
The effectiveness of team-based approaches for secondary prevention of coronary artery disease, hypertension and heart failure is being assessed in two study protocols and an observational cohort study, in [1], [2] and [3] respectively. The team managing hypertension among outpatients consists of nurses and community pharmacists working in collaboration with physicians to improve blood pressure control [2]. The team-based treatment program for heart failure involved cardiac rehabilitation provided by a physical therapist, patient education delivered by the lead nurse, dietary consultation, and psychological consultation [3]. Another retrospective observational study concluded that nurse-led rehabilitation can better manage risk factors in patients with acute myocardial infarction [4].
A cardio-oncology medical team reported on their experience with a 10-year collaborative program in Brazil that involved an interdisciplinary partnership between clinical and surgical oncology medical teams, as well as Nutritionists, Geneticists and Psychiatrists [5]. Two studies on prediabetes and type-2 diabetes after coronary events [6] and health-related quality of life in Italian children and adolescents with congenital heart disease [7] revealed the need for individualized and multidisciplinary standardized care for patients. In the first study, sociodemographic, medical, and psychosocial factors were associated with risk factors in patients with coronary heart disease [6]. The second study concluded that lifestyle intervention using patient-centered cognitive behavioral therapy may be necessary to improve the physical and mental health in patients with congenital heart disease [7].
Further studies from international frameworks of authors involving low-income countries that focus on primary care, patient risk factors and public health policies, reveal geographic differences and contribute to expanding knowledge on each topic [8,9,10]. A study by the COVID-19 Critical Care International Consortium, made up of 19 researchers, determined the impact of inhibition of the renin-angiotensin-aldosterone system on mortality in COVID-19 critical care patients with pre-existing hypertension [11]. New technologies are helping us identify the risks to our health and prevent the progression of disease. Two study protocols describe approaches of systems biology, the first using metabolomics to investigate the correlation between metabolic profile and complexity of coronary disease [12], the second using combined analysis of genetic, clinical, and angiographic information, expected to enable detailed personalized risk assessment of patients with atherosclerosis [13]. A systematic review of 9 mobile health (mHealth) intervention studies showed that smartphones may help in the secondary prevention of cardiac disease through cardiac rehabilitation and heart failure management [14].
A cross-sectional study by psychiatrists and behavioral science specialists found that patients with peripheral arterial disease are at higher risk for depression, and assessment of depressive symptoms would be warranted in these patients [15]. Furthermore, educational approaches to improve self-care [16] and lifestyle interventions as behavioral therapy [17] are among the promising approaches to cardiovascular disease and will be accelerated by a team approach. Patient-centered approaches described in two studies, such as holistic approaches that take into consideration the emotional and social burden of the disease [18] and interactive-decision-aids for patients [19], may require collaboration between an integrative team and the patient. A review of heart failure systems of care reported good examples of community-based and primary care-professional interactions [20], which may help to achieve community-based partnerships.
The above cutting-edge, collaborative, multidisciplinary and interdisciplinary studies highlight the importance of partnerships to overcome the burden of cardiovascular disorders. However, partnerships are difficult to achieve without promoting understanding and mutual benefit among the parties involved. The accumulation of cases and evidence, both at the international and national levels, is important to promote understanding among the parties involved.
