European Society of Cardiology: Cardiovascular Disease Statistics 2019

Aims The 2019 report from the European Society of Cardiology (ESC) Atlas provides a contemporary analysis of cardiovascular disease (CVD) statistics across 56 member countries, with particular emphasis on international inequalities in disease burden and healthcare delivery together with estimates of progress towards meeting 2025 World Health Organization (WHO) non-communicable disease targets. Methods and results In this report, contemporary CVD statistics are presented for member countries of the ESC. The statistics are drawn from the ESC Atlas which is a repository of CVD data from a variety of sources including the WHO, the Institute for Health Metrics and Evaluation, and the World Bank. The Atlas also includes novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery obtained by annual survey of the national societies of ESC member countries. Across ESC member countries, the prevalence of obesity (body mass index ≥30 kg/m2) and diabetes has increased two- to three-fold during the last 30 years making the WHO 2025 target to halt rises in these risk factors unlikely to be achieved. More encouraging have been variable declines in hypertension, smoking, and alcohol consumption but on current trends only the reduction in smoking from 28% to 21% during the last 20 years appears sufficient for the WHO target to be achieved. The median age-standardized prevalence of major risk factors was higher in middle-income compared with high-income ESC member countries for hypertension {23.8% [interquartile range (IQR) 22.5–23.1%] vs. 15.7% (IQR 14.5–21.1%)}, diabetes [7.7% (IQR 7.1–10.1%) vs. 5.6% (IQR 4.8–7.0%)], and among males smoking [43.8% (IQR 37.4–48.0%) vs. 26.0% (IQR 20.9–31.7%)] although among females smoking was less common in middle-income countries [8.7% (IQR 3.0–10.8) vs. 16.7% (IQR 13.9–19.7%)]. There were associated inequalities in disease burden with disability-adjusted life years per 100 000 people due to CVD over three times as high in middle-income [7160 (IQR 5655–8115)] compared with high-income [2235 (IQR 1896–3602)] countries. Cardiovascular disease mortality was also higher in middle-income countries where it accounted for a greater proportion of potential years of life lost compared with high-income countries in both females (43% vs. 28%) and males (39% vs. 28%). Despite the inequalities in disease burden across ESC member countries, survey data from the National Cardiac Societies of the ESC showed that middle-income member countries remain severely under-resourced compared with high-income countries in terms of cardiological person-power and technological infrastructure. Under-resourcing in middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, device implantation and cardiac surgical procedures. Conclusion A seemingly inexorable rise in the prevalence of obesity and diabetes currently provides the greatest challenge to achieving further reductions in CVD burden across ESC member countries. Additional challenges are provided by inequalities in disease burden that now require intensification of policy initiatives in order to reduce population risk and prioritize cardiovascular healthcare delivery, particularly in the middle-income countries of the ESC where need is greatest

Pocket-size ultrasound, a new diagnostic tool in clinical practice

PhD i medisinsk teknologiPhD in Medical Technolog

Feasibility and accuracy of point-of-care pocket-size ultrasonography performed by medical students

Background Point-of-care ultrasound performed by clinicians is a useful supplement in the treatment and assessment of patients. We aimed to investigate whether medical students with minimal training were able to successfully acquire and interpret ultrasound images using a pocket-size imaging device (PSID) as a supplement to their clinical practice. Methods Thirty 5th year (of six) medical students volunteered to participate. They were each given a personal PSID device to use as a supplement to their physical examination during their allocated hospital terms. Prior to clinical placement the students were given three evenings of hands-on training with PSID by a board certified radiologist/cardiologist, including three short lectures (<20 min). The students were shown basic ultrasound techniques and taught to assess for basic, clinically relevant pathology. They were specifically instructed to assess for the presence or absence of reduced left ventricular function (assessed as mitral annular excursion < 10 mm), pericardial effusion, pleural effusion, lung comets, hydronephrosis, bladder distension, gallstones, abdominal free-fluid, cholecystitis, and estimate the diameter of abdominal aorta and inferior vena cava. Results A total of 211 patients were examined creating 1151 ultrasound recordings. Acceptable organ presentation was 73.8% (95% CI 63.1-82.6) for cardiovascular and 88.4% (95% CI: 80.6-93.6) for radiological structures. Diagnostic accuracy was 93.5% (95% CI: 89.0-96.2) and 93.2% (95% CI: 87.4-96.5) respectively. Conclusion Medical students with minimal training were able to use PSID as a supplement to standard physical examination and successfully acquire acceptable relevant organ recordings for presentation and correctly interpret these with great accuracy

Implantasjon av hjertestartere ved St. Olavs hospital 2006–15

BAKGRUNN Implantasjon av hjertestarter (implantable cardioverter defibrillator, ICD) er etablert behandling hos pasienter med høy risiko for plutselig hjertedød. Studiens formål var å kartlegge pasientkarakteristika, indikasjoner, hyppigheten av ICD-støt, komplikasjoner, reoperasjoner samt endringer over tid i ICD-behandlingen ved St. Olavs hospital. MATERIALE OG METODE Alle pasienter som fikk implantert hjertestarter ved St. Olavs hospital i perioden 2006–15 ble inkludert. Pasientene ble identifisert i pacemakerregisteret. Data ble hentet fra pacemakerregisteret og elektronisk pasientjournal. RESULTATER Studien inkluderte 598 pasienter (82 % menn, medianalder 65 år). Tidligere hjertestans eller alvorlig arytmi forelå hos 401 (67 %) av dem som fikk implantert hjertestarter. Koronarsykdom (n = 383) var vanligste underliggende årsak. I oppfølgingstiden (median 3,6 år) fikk 203 (34 %) av pasientene ICD-støt, 154 (26 %) fikk berettigede og 65 (11 %) fikk uberettigede støt. Hos 139 (23 %) pasienter oppstod komplikasjoner. 101 (17 %) pasienter døde i oppfølgingsperioden. FORTOLKNING Studien gir et godt grunnlag for kvalitetssikring av implantasjonsvirksomheten ved St. Olavs hospital. Kjønns- og aldersfordeling, indikasjon og underliggende årsaker for implantasjon samt hyppighet av støt og komplikasjoner samsvarer godt med tidligere publiserte data

Implantasjon av hjertestartere ved St. Olavs hospital 2006–15

BAKGRUNN Implantasjon av hjertestarter (implantable cardioverter defibrillator, ICD) er etablert behandling hos pasienter med høy risiko for plutselig hjertedød. Studiens formål var å kartlegge pasientkarakteristika, indikasjoner, hyppigheten av ICD-støt, komplikasjoner, reoperasjoner samt endringer over tid i ICD-behandlingen ved St. Olavs hospital. MATERIALE OG METODE Alle pasienter som fikk implantert hjertestarter ved St. Olavs hospital i perioden 2006–15 ble inkludert. Pasientene ble identifisert i pacemakerregisteret. Data ble hentet fra pacemakerregisteret og elektronisk pasientjournal. RESULTATER Studien inkluderte 598 pasienter (82 % menn, medianalder 65 år). Tidligere hjertestans eller alvorlig arytmi forelå hos 401 (67 %) av dem som fikk implantert hjertestarter. Koronarsykdom (n = 383) var vanligste underliggende årsak. I oppfølgingstiden (median 3,6 år) fikk 203 (34 %) av pasientene ICD-støt, 154 (26 %) fikk berettigede og 65 (11 %) fikk uberettigede støt. Hos 139 (23 %) pasienter oppstod komplikasjoner. 101 (17 %) pasienter døde i oppfølgingsperioden. FORTOLKNING Studien gir et godt grunnlag for kvalitetssikring av implantasjonsvirksomheten ved St. Olavs hospital. Kjønns- og aldersfordeling, indikasjon og underliggende årsaker for implantasjon samt hyppighet av støt og komplikasjoner samsvarer godt med tidligere publiserte data

Automatic measurements of mitral annular plane systolic excursion and velocities to detect left ventricular dysfunction

The purpose of the study described here was to evaluate an automatic algorithm for detection of left ventricular dysfunction, based on measurements of mitral annular motion indices from color tissue Doppler apical four-chamber recordings. Two hundred twenty-one patients, among whom 49 had systolic and 11 had diastolic dysfunction, were included. Echocardiographic evaluation by cardiologists was the reference. Twenty patients were also examined by medical students. The ability of the indices to detect systolic and diastolic dysfunction were compared in receiver operating characteristic analyses, and the agreement between automatic and reference measurements was evaluated. Mitral annular plane systolic excursion ≤10 mm detected left ventricular dysfunction with 82% specificity, 76% specificity, 56% positive predictive value and 92% negative predictive value. The automatic measurements acquired from expert recordings better agreed better with the reference than those acquired from student recordings. We conclude that automatic measurements of systolic mitral annular motion indices can be helpful in detection of left ventricular dysfunction.publishedVersionCopyright © 2018 The Author(s). Published by Elsevier Inc. on behalf of World Federation for Ultrasound in Medicine & Biology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)