Low- and middle-income nations ill-prepared to combat CVD

Most healthcare facilities in many low- and middle-income countries (LMICs) are unprepared to treat patients with cardiovascular diseases (CVD), despite these conditions leading to millions of people dying prematurely every year, a new study reveals.

Experts analysed health survey data from eight LMICs across four World Health Organisation world regions to discover that most facilities are unprepared to deliver services to treat or manage cardiovascular disease risk factors (CVDRF) such as diabetes and hypertension.

However, the increased investment in facilities to treat HIV—received as part of the drive to meet UN Millennium Development Goal (MDG) targets—may form part of a solution to tackle CVDRFs, which have been relatively neglected in terms of receiving global funding and attention. The study authors found that if facilities can provide HIV care, they are much more able to supply care for CVDRFs.

Publishing their findings  in PLOS Global Public Health, an international team of researchers led by the University of Birmingham looked at readiness to provide care for HIV or CVD in Afghanistan, Bangladesh, the Democratic Republic of the Congo (DRC), Haiti, Malawi, Nepal, Senegal, and Tanzania.

They found that despite UN targets to reduce CVDRF, facilities were significantly less ready to provide CVDRF care than HIV care, even though, despite years of investment in HIV, facilities were often not ready to fully provide care for HIV.

The researchers found that in individual countries, readiness across all healthcare facilities to handle CVDRF was generally lower than for HIV. There were consistently weaknesses in information, staffing, and medicines. Lack of readiness of facilities to provide CVDRF care in rural and primary care facilities threatens SDG 3.8 to provide high-quality universal healthcare for all.

However, with increased focus on non-communicable diseases as part of the SDG agenda and the World Health Organisation's (WHO) vision of reducing the risk of diabetes, there may be greater opportunities for policymakers to improve CVDRF care.

Globally, nearly 18 million premature deaths in 2019 were due to CVD, of which 75% were in LMICs, where they are the leading causes of death and disability-adjusted life years (DALYs) in adults. Diabetes and hypertension are key risk factors for CVD and among the top three risk factors for deaths and disability globally.

Starting in 2015, the SDGs included goal 3.4, aiming to reduce premature mortality by 1/3 due to non-communicable diseases. This requires managing CVD and, importantly, managing CVDRF for the primary prevention of CVD.