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Diagnosis and Management of Acute Ischemic Stroke
DOI: http://dx.doi.org/10.5772/.106389
they can be monitored closely by stroke specialists and an interdisciplinary team of
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nurses, physiotherapists, speech and language pathologists, and dieticians to ensure
favorable functional outcome. Evidence suggests that patients that are cared for at an
acute stroke unit have less likelihood of disability and mortality compared to those
that are admitted to a general ward [81]. Early rehabilitation is crucial in preventing
long-term disability and early management of blood pressure, diabetes, cholesterol,
and antiplatelet/anticoagulant therapy is crucial in the secondary prevention of stroke.
. Conclusion
Gone are the days in which AIS was thought to be a terminal disease. Since The
National Institutes of Neurological Disorders and Stroke rt-PA Stroke Study Group
(NINDS) trial in 1995 there have been numerous advances which have prevented
patients from long-term disability. Both thrombolysis and EVT are potential treatments for carefully selected patients presenting with AIS and each has its benefits
as well as disadvantages. However, there still exist a major proportion of the stroke
population that does not qualify for either therapy, either because they have presented
out of the window or because there is no LVO. There are numerous trials underway
and show promise to cover a wider population. For example, the trial TEMPO II
is examining the use of thrombolysis in patients presenting with minor stroke,
NIHSS<6. The TIMELESS trial is investigating the use of thrombolysis in patients
presenting outside of the 4.5hour window who would still be a candidate for EVT.
Finally, better catheters and stent-retrievers are being developed to reach more distal
clots without increasing complications. There are also trials underway investigating
methods of improving neuroprotection and reducing cell death after AIS. Nerinetide,
a drug that showed promise in pre-clinical models of ischemia and reperfusion was
recently investigated and humans [82]. The drug did not seem to improve functioning
in those patients who had received tPA but did show a mild treatment effect in those
who did not, opening doors for future possibilities for the use of neuroprotection.
While stroke creates a tremendous healthcare burden across the world, the plethora
of trials currently underway provide hope that this burden will continue to decrease
over the next decade.
Novel Pathogenesis and Treatments for Cardiovascular Disease
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References
[1] Roth GA etal. Global burden of
cardiovascular diseases and risk factors,
1990-2019: Update from the GBD 2019
study. Journal of the American College of
Cardiology. 2020;(25):2982-3021
[2] Campbell BCV, Khatri P. Stroke.
Lancet. 2020;(10244):129-142
[3] Wardlaw JM. What causes lacunar
stroke? Journal of Neurology, Neurosurgery
& Psychiatry. 2005;(5):617
[4] Saini V, Guada L, Yavagal DR. Global
epidemiology of stroke and access to acute
ischemic stroke interventions. Neurology.
2021;(20 Supplement 2):S6-S16
[5] Moulin S, Leys D. Stroke mimics
and chameleons. Current Opinion in
Neurology. 2019;(1):54-59
[6] Caplan LR. Caplan's Stroke. Cambridge:
Cambridge University Press; 2016
[7] Powers WJ etal. Guidelines for the
early Management of Patients with
Acute Ischemic Stroke: 2019 update
to the 2018 guidelines for the early
Management of Acute Ischemic Stroke:
A guideline for healthcare professionals
from the American Heart Association/
American Stroke Association. Stroke.
2019;(12):e344-e418
[8] Adams HP Jr etal. Classification
of subtype of acute ischemic stroke.
Definitions for use in a multicenter clinical
stroke treatment. Stroke. 1993;(1):35-41
[9] Chen PH etal. Classifying ischemic
stroke, from TOAST to CISS. CNS
Neuroscience & Therapeutics.
2012;(6):452-456
[10] Mastriana J etal. Todd Paresis,
in StatPearls. Treasure Island (FL):
StatPearls Publishing LLC.; 2022,
StatPearls Publishing Copyright © 2022
[11] Mokin M et al, editors. Acute Stroke
Management in the First 24 Hours: A
Practical Guide for Clinicians. Online ed.
New York: Oxford Academic; June 1, 2018.
DOI:10.1093/med/9780190856519.
001.0001 [Accessed: August 3, 2022]
[12] Davis SM, Donnan GA. 4.5 hours:
The new time window for tissue
plasminogen activator in stroke. Stroke.
2009;(6):2266-2267
[13] Mackey J etal. Population-based
study of wake-up strokes. Neurology.
2011;(19):1662-1667
[14] Arboix A. Cardiovascular risk
factors for acute stroke: Risk profiles
in the different subtypes of ischemic
stroke. World Journal of Clinical Cases.
2015;(5):418-429
[15] The National Institute of
Neurological Disorders and Stroke rt-PA
Stroke Study Group. Tissue plasminogen
activator for acute ischemic stroke.
The New England Journal of Medicine.
1995;(24):1581-1587
[16] Brott T etal. Measurements of acute
cerebral infarction: A clinical examination
scale. Stroke. 1989;(7):864-870
[17] Rost NS etal. Stroke severity is
a crucial predictor of outcome: An
international prospective validation
study. Journal of the American Heart
Association. 2016;(1):1-7
[18] Wilson JT etal. Improving the
assessment of outcomes in stroke: Use of
a structured interview to assign grades
on the modified Rankin scale. Stroke.
2002;(9):2243-2246
Diagnosis and Management of Acute Ischemic Stroke
DOI: http://dx.doi.org/10.5772/.106389
[19] Sablot D etal. Predicting acute
493
https://t.me/medicina_free
ischaemic stroke outcome using
clinical and temporal thresholds. ISRN
Neurology. 2011;:354642
[20] Fischer U etal. NIHSS score and
arteriographic findings in acute ischemic
stroke. Stroke. 2005;(10):2121-2125
[21] Meyer BC, Lyden PD. The modified
National Institutes of Health stroke scale:
Its time has come. International Journal
of Stroke. 2009;(4):267-273
[22] Southerland AM. Clinical evaluation
of the patient with acute stroke.
Continuum (Minneap Minn). 2017;
(1, Cerebrovascular Disease):40-61
[23] Perry JJ etal. Sensitivity of computed
tomography performed within six hours
of onset of headache for diagnosis of
subarachnoid haemorrhage: Prospective
cohort study. BMJ. 2011;:d4277
[24] Menon BK. Neuroimaging in acute
stroke. Continuum (Minneap Minn).
2020;(2):287-309
[25] Sohn C-H. Radiological assessment
of ischemic stroke. In: Park J, editor.
Acute Ischemic Stroke: Medical,
Endovascular, and Surgical Techniques.
Singapore: Springer Singapore; 2017.
pp. 35-58
[26] Jensen-Kondering U, Riedel C,
Jansen O. Hyperdense artery sign on
computed tomography in acute ischemic
stroke. World Journal of Radiology.
2010;(9):354-357
[27] Barber PA etal. Validity
and reliability of a quantitative
computed tomography score in
predicting outcome of hyperacute
stroke before thrombolytic therapy.
ASPECTS study group. Alberta stroke
programme early CT score. Lancet.
2000;(9216):1670-1674
[28] Schröder J, Thomalla G. A critical
review of Alberta stroke program
early CT score for evaluation of acute
stroke imaging. Frontiers in Neurology.
2016;:245
[29] Rabinstein AA. Treatment of acute
ischemic stroke. Continuum (Minneap
Minn). 2017;(1, Cerebrovascular
Disease):62-81
[30] Potter CA etal. CT for treatment
selection in acute ischemic stroke: A
code stroke primer. Radiographics.
2019;(6):1717-1738
[31] Ehrlich ME etal. Safety of computed
tomographic angiography in the
evaluation of patients with acute stroke:
A single-Center experience. Stroke.
2016;(8):2045-2050
[32] Mayer SA etal. CTA-for-all: Impact
of emergency computed tomographic
angiography for all patients with stroke
presenting within 24 hours of onset.
Stroke. 2020;(1):331-334
[33] Menon BK etal. Multiphase
CT angiography: A new tool for
the imaging triage of patients with
acute ischemic stroke. Radiology.
2015;(2):510-520
[34] Dundamadappa S etal. Multiphase
CT angiography: A useful technique
in acute stroke imaging—Collaterals
and beyond. American Journal of
Neuroradiology. 2020;(2):221-227
[35] Maas MB etal. Collateral vessels
on CT angiography predict outcome
in acute ischemic stroke. Stroke.
2009;(9):3001-3005
[36] Yu AY etal. Multiphase
CT angiography increases
detection of anterior circulation
intracranial occlusion. Neurology.
2016;(6):609-616
Novel Pathogenesis and Treatments for Cardiovascular Disease
494
https://t.me/medicina_free
[37] Liu S, Levine SR, Winn HR.
Targeting ischemic penumbra: Part
I - from pathophysiology to therapeutic
strategy. Journal of Experimental
Stroke & Translational Medicine.
2010;(1):47-55
[38] Ramos-Cabrer P etal. Targeting the
ischemic penumbra. Stroke. 2011;
(1 Suppl):S7-S11
[39] Vagal A etal. Automated CT
perfusion imaging for acute ischemic
stroke: Pearls and pitfalls for real-world
use. Neurology. 2019;(20):888-898
[40] Demeestere J etal. Review of
perfusion imaging in acute ischemic
stroke: From time to tissue. Stroke.
2020;(3):1017-1024
[41] Lansberg MG etal. MRI profile and
response to endovascular reperfusion
after stroke (DEFUSE 2): A prospective
cohort study. Lancet Neurology.
2012;(10):860-867
[42] Sotoudeh H etal. Luxury perfusion:
A paradoxical finding and pitfall of CT
perfusion in subacute infarction of brain.
Radiology Case Reports. 2019;(1):6-9
[43] Lin SF etal. Predicting functional
outcomes of posterior circulation
acute ischemic stroke in first 36 h of
stroke onset. Journal of Neurology.
2018;(4):926-932
[44] Srinivasan A etal. State-of-the-art
imaging of acute stroke. Radiographics.
2006;(Suppl. 1):S75-S95
[45] Lansberg MG etal. Evolution
of apparent diffusion coefficient,
diffusion-weighted, and T2-weighted
signal intensity of acute stroke. AJNR.
American Journal of Neuroradiology.
2001;(4):637-644
[46] Thomalla G etal. DWI-FLAIR
mismatch for the identification
of patients with acute ischaemic
stroke within 4·5 h of symptom
onset (PRE-FLAIR): A multicentre
observational study. Lancet Neurology.
2011;(11):978-986
[47] Thomalla G etal. MRI-guided
thrombolysis for stroke with unknown
time of onset. The New England Journal
of Medicine. 2018;(7):611-622
[48] Allen LM etal. Sequence-specific
MR imaging findings that are useful in
dating ischemic stroke. Radiographics.
2012;(5):1285-1297 discussion 1297-9
[49] Nael K etal. Imaging-based selection
for endovascular treatment in stroke.
Radiographics. 2019;(6):1696-1713
[50] Boulanger JM etal. Canadian stroke
best practice recommendations for
acute stroke management: Prehospital,
emergency department, and acute
inpatient stroke care, 6th edition, update
2018. International Journal of Stroke.
2018;(9):949-984
[51] Alakbarzade V, O'Kane D, Pereira AC.
Hypersensitivity reactions to recombinant
tissue plasminogen activator. Practical
Neurology. 2020;(1):75-79
[52] Hacke W etal. Thrombolysis
with alteplase 3 to 4.5 hours after
acute ischemic stroke. The New
England Journal of Medicine.
2008;(13):1317-1329
[53] Wahlgren N etal. Thrombolysis with
alteplase for acute ischaemic stroke in
the safe implementation of thrombolysis
in stroke-monitoring study (SITSMOST): An observational study. Lancet.
2007;(9558):275-282
[54] von Kummer R etal. The Heidelberg
bleeding classification: Classification
of bleeding events after ischemic
stroke and reperfusion therapy. Stroke.
2015;(10):2981-2986
Diagnosis and Management of Acute Ischemic Stroke
DOI: http://dx.doi.org/10.5772/.106389
[55] Lees KR etal. Time to treatment
495
https://t.me/medicina_free
with intravenous alteplase and
outcome in stroke: An updated pooled
analysis of ECASS, ATLANTIS,
NINDS, and EPITHET trials. Lancet.
2010;(9727):1695-1703
[56] Whiteley WN etal. Risk of
intracerebral haemorrhage with alteplase
after acute ischaemic stroke: A secondary
analysis of an individual patient data
meta-analysis. Lancet Neurology.
2016;(9):925-933
[63] Hill MD etal. Hemi-orolingual
angioedema and ACE inhibition after
alteplase treatment of stroke. Neurology.
2003;(9):1525-1527
[64] O'Carroll CB, Aguilar MI.
Management of Postthrombolysis
Hemorrhagic and Orolingual
Angioedema Complications.
Neurohospitalist. 2015;(3):133-141
[65] Flick MJ. Mechanism of ICH with
tPA thrombolysis. Blood. 2021;(1):8-9
[57] Hacke W etal. The Desmoteplase
in acute ischemic stroke trial (DIAS):
A phase II MRI-based 9-hour window
acute stroke thrombolysis trial with
intravenous desmoteplase. Stroke.
2005;(1):66-73
[58] Khatri P etal. Effect of Alteplase
vs aspirin on functional outcome for
patients with acute ischemic stroke and
minor nondisabling neurologic deficits:
The PRISMS randomized clinical trial.
JAMA. 2018;(2):156-166
[59] Anderson CS etal. Low-dose
versus standard-dose intravenous
Alteplase in acute ischemic stroke. The
New England Journal of Medicine.
2016; (24):2313-2323
[60] Zhong CS etal. Routine use
of Tenecteplase for thrombolysis
in acute ischemic stroke. Stroke.
2021;(3):1087-1090
[61] Campbell BCV etal.Tenecteplase
versus Alteplase before Thrombectomy
for ischemic stroke. The New
England Journal of Medicine.
2018;(17):1573-1582
[62] Logallo N etal. Tenecteplase versus
alteplase for management of acute
ischaemic stroke (NOR-TEST): A phase
3, randomised, open-label, blinded
endpoint trial. Lancet Neurology.
2017;(10):781-788
[66] Lansberg MG etal. Risk factors of
symptomatic intracerebral hemorrhage
after tPA therapy for acute stroke. Stroke.
2007;(8):2275-2278
[67] Sweid A etal. Acute ischaemic stroke
interventions: Large vessel occlusion and
beyond. Stroke and Vascular Neurology.
2019;(1):80-85
[68] Berkhemer OA etal. A randomized
trial of intraarterial treatment for acute
ischemic stroke. The New England
Journal of Medicine. 2015;(1):11-20
[69] Jovin TG etal. Thrombectomy for
anterior circulation stroke beyond 6 h
from time last known well (AURORA):
A systematic review and individual
patient data meta-analysis. Lancet.
2022;(10321):249-258
[70] Nogueira RG etal. Thrombectomy
6 to 24 hours after stroke with a
mismatch between deficit and infarct.
The New England Journal of Medicine.
2018;(1):11-21
[71] Albers GW etal. Thrombectomy for
stroke at 6 to 16 hours with selection by
perfusion imaging. The New England
Journal of Medicine. 2018;(8):708-718
[72] Goyal M etal. Endovascular
thrombectomy after large-vessel
ischaemic stroke: A meta-analysis
Novel Pathogenesis and Treatments for Cardiovascular Disease
496
https://t.me/medicina_free
of individual patient data from
five randomised trials. Lancet.
2016;(10029):1723-1731
[73] Krishnan R, Mays W,Elijovich L.
Complications of mechanical
Thrombectomy in acute ischemic stroke.
Neurology. 2021;(20 Suppl. 2):
S115-s125
[74] LeCouffe NE etal. A randomized
trial of intravenous Alteplase before
endovascular treatment for stroke.
The New England Journal of Medicine.
2021;(20):1833-1844
[75] Suzuki K etal. Effect of mechanical
Thrombectomy without vs with
intravenous thrombolysis on functional
outcome among patients with acute
ischemic stroke: The SKIP randomized
clinical trial. JAMA. 2021;(3):244-253
[76] Yang P etal. Endovascular
Thrombectomy with or without
intravenous Alteplase in acute stroke.
The New England Journal of Medicine.
2020;(21):1981-1993
tissue plasminogen activator for ischemic
stroke. Stroke. 2004;(10):2326-2330
[81] Indredavik B etal. Benefit of a stroke
unit: A randomized controlled trial.
Stroke. 1991;(8):1026-1031
[82] Hill MD etal. Efficacy and safety
of nerinetide for the treatment of acute
ischaemic stroke (ESCAPE-NA1):
A multicentre, double-blind,
randomised controlled trial. Lancet.
2020;(10227):878-887
[77] Zi W etal. Effect of endovascular
treatment alone vs intravenous Alteplase
plus endovascular treatment on
functional Independence in patients
with acute ischemic stroke: The DEVT
randomized clinical trial. JAMA.
2021;(3):234-243
[78] Campbell BCV,Kappelhof M,
Fischer U. Role of intravenous
Thrombolytics prior to endovascular
Thrombectomy. Stroke. 2022;:2085-2092.
DOI:10.1161/STROKEAHA.122.036929
[79] Nogueira RG, Tsivgoulis G. Large
vessel occlusion strokes after the
DIRECT-MT and SKIP trials: Is the
Alteplase syringe half empty or half full?
Stroke. 2020;(10):3182-3186
[80] Aiyagari V etal. Hourly blood
pressure monitoring after intravenous
Chapter 25
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Cost-Effective Interventions to
Curb Cardiovascular Diseases in
Africa
M
abitsela Hezekiel ‘Pitso’Mphasha
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death globally and
in Africa, and the cost of care is expensive. Finances of the state may need to be
re-channeled to CVDs leading to delay in the development of the country and that
of the family since the cost of care also burdens the family. Cost-effective interventions to curb the prevalence and incidences of CVDs are required. A comprehensive
literature search was conducted. The risk factors include unhealthy diet, physical
inactivity, tobacco use, and harmful use of alcohol. On that background, the CVD can
be prevented through behavioral interventions aimed at addressing these risk factors. Moreover, behavioral interventions could be helpful in minimizing costs of care
and curb prevalence of cardiovascular diseases. Behavioral interventions have been
found to be cost-effective and assist in the management of cardiovascular diseases.
Therefore, healthcare providers must at each consultation sessions with patients
emphasize more on behavioural change. They must help patients visualize the do’s and
dont’s for the successful attainment of their health goals. In doing so, healthcare providers must collaborate among themselves and also collaborate with communities and
families of patients. At the same time, it is significant to alter false perceptions and
attitudes toward cardiovascular diseases to help individuals develop positive attitudes.
Keywords: cardiovascular diseases, cost-effectiveness, behavioral changes, factors,
healthcare providers
. Introduction
Cardiovascular diseases (CVDs) are regarded as a broader concept describing
diseases of the heart or blood vessels, including coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other conditions [1]. The development of
CVD is linked with build-up of fatty deposits in the arteries resulting in a condition
called atherosclerosis, increased risk of blood clots, and damage to arteries in organs
such as the brain, heart, kidneys, and eyes [2]. Detection of cardiovascular diseases
at an early age permits possible management before the development of adverse
effects, which may be costly to manage. The risk for the development of CVD includes
behaviors such as unhealthy diet, physical inactivity, tobacco use, and harmful use of
alcohol [3]. The effects of these behaviors may present in the form of increased blood
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pressure, glucose, and lipids, including overweight and obesity. On that background,
the CVD can be prevented through behavioral interventions aimed at addressing
these risk factors [3]. Moreover, behavioral interventions could be helpful in minimizing costs of care and also curb prevalence of cardiovascular diseases.
The care of cardiovascular disease is expensive and requires more state resources
leading to delay in the development of the country due to increased healthcare
expenditure and diminished productivity from disability, premature death, and
absenteeism [4]. It has been reported that patients diagnosed with cardiovascular
diseases incur more than double the medical costs as compared to a patient without
CVD of the same age and sex [5]. Patients living with cardiovascular diseases and
requiring medical treatment are unable to receive such due to financial constraints.
These financial implications manifest themselves in the form of physical barriers
(transportation to the healthcare facility), and system barriers (lack of medication at
the healthcare facilities) [6]. It has been discovered that patients experience financial
barriers related to payment of medical costs and visit to health care which may require
transportation costs [7]. In addition, in the event of long queues at the healthcare
facilities, patients may need lunch money. Furthermore, it has been found that there
are also indirect financial barriers, which may occur when a certain patient who has a
child may need to pay for someone to look after the child while visiting the healthcare
facilities [6]. Various studies have indicated that patients experiencing financial
barriers are likely not to adhere to medical therapies or health behavior change due to
direct or indirect financial costs [8, 9]. On that basis, patients’ outcomes are impacted
by financial barriers and cost-related non-adherence, leading to deterioration in the
quality of life, poor health status, and general well-being, and may also increase the
rates of hospitalization [6]. Moreover, CVDs do not only impact the health, quality
of life, and general well-being of patients, but also burden the individual and his/her
family financially [4]. These may also lead to the underdevelopment of the family and
consequently lead to financial burden and re-channeling of state resources. This may
result in financial toxicity. Financial toxicity can be described as healthcare-related
at the patient level and state expenditure related to provision of medical care and
improving quality of life of patients. State experiences more financial costs due to
rising medication costs [10]. The primary healthcare facilities which provide care to
outpatients must emphasize more on these behavioral interventions as cost-effective
strategy to curb cardiovascular diseases.
. Cardiovascular diseases as public health concern
World Health Organization (WHO) reported that CVDs are the leading cause
of death globally. In 2019 alone, approximately 17.9 million deaths associated with
CVDs were reported, which constitute 32% of all global deaths. Around 85% or four
in five CVDs deaths are due to heart attack and stroke [1]. However, in high-income
countries, 80% of cardiovascular deaths are due to myocardial infarctions and strokes
[11]. One-third of these deaths occur prematurely in patients diagnosed with CVDs
and are under the age of 70years. Many cases of cardiovascular diseases (about 80%)
are mainly reported in low- and middle-income countries with higher mortality [1].
The burden and prevalence of CVDs are expected to increase considering the lifestyle
and urbanization.
One million deaths due to CVDs were sub-Saharan Africa alone, resulting in 5.5% of all global and 11.3% of all CVDs deaths in the world and Africa,
Cost-Effective Interventions to Curb Cardiovascular Diseases in Africa
DOI: http://dx.doi.org/10.5772/.105464
respectively [12]. Cardiovascular diseases are the leading cause of death among
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non-communicable diseases, with about 38% of all non-communicable diseaserelated deaths in Africa due to CVDs. These are approximately twofold increase
of CVD deaths since 1990, with over 10% difference in mortality among women
compared with men [13]. Moreover, in South Africa, 215 persons die daily due to
heart diseases or strokes, while every hour 5 and 10 persons die due to heart attacks
and stroke, respectively [14].
. Urbanization
Urbanization involves the mass migration of persons from rural to urban
area and/or urbanization. Historically, urbanization was associated with human
development and progress; however, recently it is associated with significant
inequalities and health problems [15]. Some of the major health problems resulting
from urbanization include poor nutrition, pollution-related health conditions and
communicable diseases, poor sanitation and housing conditions, and related health
conditions. All these challenges have an impact on quality of life, health status,
and overall well-being resulting in the necessity for more cost of care burdening
the public purse [15, 16]. Conversely, rural areas have been progressively urbanized and realizing similar health challenges. In Africa, the rural people have due to
urbanization abandoned the traditional way of living including healthy eating and
physical activity [17]. Reports show that incidences of cardiovascular diseases began
to increase with increasing urbanization in Africa [17]. As such, there is a need to
encourage communities to embrace urbanization, emulate good things it brings, and
at the same time restore the way of life which was more beneficial to their health.
Obesity is most prevalent in urban areas and has become public health problem,
particularly because obesity is associated with CVDs [18]. However, obesity is also
increasing in rural areas due to urbanization, hence the increase of prevalence of
CVDs and its death rates. Obesity threat is increasing because of unhealthy behaviors
such as increased physical inactivity, and consumption of fatty food, and sugar
intake [15].
. Primary healthcare facilities
The Primary Health Care (PHC) facilities as the first health service visited by
patients/public with a health concern and serves mainly outpatients [19]. The PHC
intends to promote attainment by all people of a level of health that will permit them
to live socially and economically productive lives. Accordingly, PHC is essential,
scientifically sound, ethical, accessible, equitable, affordable, and accountable to the
community [20]. Therefore, it is important that a clear collaboration with communities and family of patients is established for improved health outcomes and curbing
of cardiovascular diseases. Healthcare providers at primary healthcare facilities are
therefore expected to provide cardiovascular diseases awareness, treatment, and preventative care [20]. Preventative healthcare is cost-effective; therefore, it is necessary
for PHC providers to be well-equipped through in-service training with preventative
healthcare to minimize the cost of care and improve health outcomes of patients
[21]. Moreover, healthcare providers must at each consultation sessions with patients
emphasize more on behavioural change in relation to physical activity, healthy eating,
Novel Pathogenesis and Treatments for Cardiovascular Disease
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and alcohol and tobacco use [22]. These interventions have been found to be costeffective and assist in the management of cardiovascular diseases.
. Collaborations with family and communities
Collaboration is about working together to achieve a particular purpose; in this
context working together to achieve improved health outcomes using cost-effective
interventions. The components of collaborations include openness, focus, accountability, and knowledge sharing [23]. Collaboration in health care is defined as professionals assuming complementary roles and cooperatively working together, sharing
responsibility for problem-solving and making decisions to formulate and carry out
plans for patient care [23]. Collaboration is about teamwork, which when applied in
health care implies interdisciplinary approach. Unlike a multidisciplinary approach,
in which each team member is responsible only for the improved healthcare collaboration has been cited as a key strategy for healthcare reform [24]. So far, collaboration
in health care improved patient outcomes such as reducing preventable adverse drug
reactions, decreasing morbidity and mortality rates, and optimizing medication
dosages [23]. In addition, teamwork is beneficial to healthcare providers by reducing extra work and increasing job satisfaction [23]. Most of the care of outpatients
takes place where they reside; therefore, there is a need for health care to collaborate
with family members and communities for improved outcomes using cost-effective
strategies.
Figure shows the collaboration of communities and families of patients in
providing an appropriate care.
. Collaboration with families
Family is regarded as the most important source of social support and is tightly
related with self-care activities and improved health outcomes [25]. Since most of the
patients with heart failure live with other family members at home, participation and
support of family members can play a key role in self-care behaviors and efficiency
of disease control, as shown in Figure . Therefore, family can influence a patient’s
Figure 1.
Collaborating in the care of patient.
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