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Heart failure with a reduced ejection fraction (HFrEF) is a condition frequently encountered by healthcare professionals and, in order to achieve the best outcomes for patients, needs to be managed optimally. This guideline document is based on the
...
European Society of Cardiology Guidelines for the treatment of acute and chronic heart failure published in 2016, and summarises what is considered the best current management of patients with the condition. It provides information on the definition, diagnosis and epidemiology of HFrEF in the African context. The best evidence-based treatments for HFrEF are discussed, including established therapies (beta-blockers, ACE-i/ARBs, mineralocorticoid receptor antagonists (MRAs), diuretics) that form the cornerstone of heart failure management as well as therapies that have only recently entered clinical use (angiotensin receptor-neprilysin inhibitor (ARNI), sodium/glucose cotransporter-2 (SGLT2) inhibitors). Guidance is offered in terms of more invasive therapies (revascularisation, implantable cardioverter defibrillators (ICDs) and cardiac resynchronisation therapy (CRT) by implantation of a biventricular pacemaker with (CRT-D) or without (CRT-P) an ICD, left ventricular assist device (LVAD) use and heart transplantation) in order to ensure efficient use of these expensive treatment modalities in a resourcelimited environment. Furthermore, additional therapies (digoxin, hydralazine and nitrates, ivabradine, iron supplementation) are discussed and advice is provided on general preventive strategies (vaccinations). Sections to discuss conditions that are particularly prevalent in sub-Saharan Africa (HIV-associated cardiomyopathy (CMO), peripartum CMO, rheumatic heart disease, atrial fibrillation) have been added to further improve clinical care for these commonly encountered disease processes.
more
Background
Chronic congestive heart failure is a common condition that, if untreated, markedly impairs the quality of life and is associated with a high risk of recurrent hospitalization and death.
Methods
This review is based on articles retriev
...
ed by a selective search in PubMed, as well as on relevant guidelines.
Results
Evidence-based treatment options are available only for congestive heart failure with a low ejection fraction. Pharmacotherapy is based on neurohumoral inhibition of the renin-angiotensin-aldosterone system and the adrenergic system. The prognosis of patients with this condition has been further improved recently through the introduction of combined angiotensin receptor antagonists and neprilysin inhibitors. Modern implantable devices are a further component of treatment. Implantable defibrillators and special pacemakers for cardiac resynchronization are well established; the utility of alternative devices (baroreflex modulation or cardiac contractility modulation) needs to be investigated in further studies. It was recently shown that the catheter-based treatment of secondary mitral regurgitation with a MitraClip improves the outcome of selected patients.
Conclusion
The treatment of chronic systolic heart failure as recommended in the relevant guidelines, with drugs and implanted devices if indicated, can significantly improve the clinical outcome.
more
Guidelines for Management of ST-Elevated Myocardial Infarction
Directorate General of Health Services
Ministry of Health & Family Welfare Government of India
(2022)
CC
Myocardial infarctions are generally clinically classified into ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI), based on changes in ECG. When blood flow to a part of the heart stops or the heart is injured and fails to receive enough oxyge
...
n required for its adequate functioning the condition is termed as STEMI or the ‘heart-attack’ in laymen language. Patients with elevated cardiac troponin levels but negative CK-MB who were formerly diagnosed with unstable angina or minor myocardial injury are now reclassified as non-ST-segment elevation Myocardial Infarction (non-STEMI) even in the absence of diagnostic changes.
more
Heart failure is an important global health problem, and the associated public health and economic effect is increasing across all societies and geographies.
Epidemiological studies have estimated that there are more than 25 million patients with heart failure globally, and population-
...
based studies from North America and Europe have estimated that 1–2% of people are living with heart failure. Factors such as ageing and expanding populations have contributed to increasing hospital admissions for heart failure.
more
The Guidelines for drinking-water quality: small water supplies have been developed to address the needs and opportunities associated with small supplies to facilitate progressive improvement towards safe and sustainable drinking-water services for all. These Guidelines are
...
based on the principal recommendation in the World Health Organization’s Guidelines for drinking-water quality, and they provide guidance on applying that recommendation to small water supplies in particular. These Guidelines aim to help governments and practitioners improve the safety of drinking-water delivered through small supplies.
more
Objective: To conduct a landscape assessment of public knowledge of cardiovascular disease risk factors and acute myocardial infarction symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) awareness and training in three underserved communities in Brazil.
Metho
...
ds: A cross-sectional, population-based survey of non-institutionalised adults age 30 or greater was conducted in three municipalities in Eastern Brazil. Data were analysed as survey-weighted percentages of the sampled populations.
Results: 3035 surveys were completed. Overall, one-third of respondents was unable to identify at least one cardiovascular disease risk factor and 25% unable to identify at least one myocardial infarction symptom. A minority of respondents had received training in CPR or were able to identify an AED. Low levels of education and low socioeconomic status were consistent predictors of lower knowledge levels of cardiovascular disease risk factors, acute coronary syndrome symptoms and CPR and AED use.
Conclusions: In three municipalities in Eastern Brazil, overall public knowledge of cardiovascular disease risk factors and symptoms, as well as knowledge of appropriate CPR and AED use was low. Our findings indicate the need for interventions to improve public knowledge and response to acute cardiovascular events in Brazil as a first step towards improving health outcomes in this population. Significant heterogeneity in knowledge seen across sites and socioeconomic strata indicates a need to appropriately target such interventions.
more
Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nat
...
ionally representative data on the current patterns of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment.
more
Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nat
...
ionally representative data on the current patterns of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment.
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The Infection Prevention and Control (IPC) Guidelines aim to support healthcare workers improve quality and safety health care. The Guidelines further aim to promote and facilitate the overall goal of IPC by providing evidence-based recommendations
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on the critical aspects of IPC, focusing on the fundamental principles and priority action areas. All health service organizations should consider the risk of healthcare-associated infection(s) (HAI) and antimicrobial resistance (AMR) transmission to implement these recommendations. The IPC Guidelines also set national standards for the prevention and control of HAIs and to ensure compliance to the National Quality Standards.
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The state of diabetes treatment coverage in 55 low-income and middle-income countries: a cross-sectional study of nationally representative, individual-level data in 680 102 adults 2021
Flood, D.; Seiglie, J.A.; Dunn, M.; et al.
The Lancet Healthy Longevity Volume 2, Issue 6e340-e351June 2021
(2021)
CC2
Approximately 80% of the 463 million adults worldwide with diabetes live in low-income and middle-income countries (LMICs). A major obstacle to designing evidence-based policies to improve diabetes outcomes in LMICs is the scarce availability of nat
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ionally representative data on the current patterns of treatment coverage. The objectives of this study were to estimate the proportion of adults with diabetes in LMICs who receive coverage of recommended pharmacological and non-pharmacological diabetes treatment; and to describe country-level and individual-level characteristics that are associated with treatment.
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This document provides an updated list of “best buys” and other recommended interventions to address noncommunicable diseases (NCDs). It is based on Appendix 3 of the Global action plan for the prevention and control of noncommunicable diseases
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2013–2020, which was first approved in 2013 and last updated in 2017. The global action plan, which was extended to 2030 by a World Health Assembly decision in 2019 has 6 objectives, the implementation of which at country level supports the attainment of the 9 voluntary NCD targets, and facilitates the realization of Sustainable Development Goal (SDG) 3 on good health and well-being.
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This Guidance was developed in response to the increase in HIV-related human rights crises and the shrinking civic space for rights-related responses to HIV in recent years across the world. This document builds upon existing guidance documents, offering updated guidance for country-
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based United Nations staff (United Nations Country Teams) and partners to use their respective mandates to coordinate effective responses to human rights-related crises within the framework of the Resident Coordinator system, the 2030 Agenda for Sustainable Development, global HIV and human rights strategies and frameworks.
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These are one pagers for the NCD staff to refer as check points during measuring blood pressure for 18 year & above or 30 years & above patients based on the state's requirement
These are one pagers for the NCD staff to refer as check points during measuring blood pressure for 18 year & above or 30 years & above patients based on the state's requirement.
Type 2 diabetes in adults
National Institute for Communicable Disease (NICE)
National Institute for Communicable Disease (NICE)
(2023)
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The document provides the NICE Quality Standard for managing Type 2 diabetes in adults (QS209). It outlines evidence-based recommendations for preventing Type 2 diabetes, structured education, continuous glucose monitoring (CGM), medication such as
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SGLT2 inhibitors, and regular care processes to monitor complications. The guidelines emphasize individualized care, addressing health inequalities, and improving patient outcomes. They are intended to support healthcare professionals and services in delivering high-quality, equitable diabetes care.
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The pamphlet "ADHD Medications" provides an overview of medications commonly used to treat ADHD, such as Adderall, Vyvanse, and Ritalin. It explains that these medications do not enhance intelligence and affect individuals differently based on dosag
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e and medical history. Potential dangers of misuse include insomnia, appetite changes, increased heart rate, and reliance on the drugs for studying. Combining ADHD medications with alcohol or sleeping pills is particularly dangerous. The pamphlet emphasizes the importance of proper medical supervision and provides resources for addiction support.
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Due to the heterogeneous distribution of malaria transmission and its determinants, subnational tailoring (SNT) provides an analytical framework to facilitate the targeting of each population with appropriate intervention packages for maximum impact to inform national strategic planning and prioriti
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zation based on resources available. The WHO Global Malaria Programme recommends the use of subnational data on disease epidemiology and other relevant local contextual factors to facilitate the process of SNT. Once the strategies and intervention mixes have been defined, programmes can proceed to the prioritization of
interventions for effective programming, based on available resources
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Prediabetes Risk Test
adapted from Bang et al., Ann Intern Med (2009)
American Diabetes Association in collaboration with the Centers for Disease Control and Prevention (CDC)
(2024)
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The "Prediabetes Risk Test" is a tool designed to help individuals assess their risk for prediabetes and type 2 diabetes. The test uses a point-based system with questions about age, gender, family history of diabetes, history of high blood pressure
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, physical activity level, and weight category. Based on the total score, individuals with a score of 5 or higher are at an increased risk of prediabetes, meaning their blood sugar levels may be elevated but not yet high enough to be classified as type 2 diabetes. The test encourages individuals with a high score to consult a doctor for further testing and suggests lifestyle changes as a preventive measure. Special risk considerations are provided for certain ethnic groups, such as African American, Hispanic/Latino, American Indian, Alaska Native, Asian American, and Pacific Islander populations.
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Action Plan for Implementation of Recommendations from the Evaluation of PAHO's Response to COVID-19
An external team evaluated PAHO’s response to COVID-19 to provide an independent assessment of the Pan American Sanitary Bureau’s (PASB) performance regarding preparedness for and response to the COVID-19 pandemic. The evaluations’ final report culminates with eight recommendations for actions
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to future response to health emergencies. The final report of EPRC culminates with eight evidence-based recommendations of actions to strengthen future pandemic responses, while building a resilient recovery in the Region. The recommendations by the external team focus on PAHO’s governance and management, on specialized regional mechanisms, diversified funding models, and use of new technologies, among others.
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