Global cardiovascular health (FS-03)

J Redfern1, R Adesoji Adedoyin2, L Nedkoff3, N Lowres4, J Jones5
1University of Sydney, Westmead Applied Research Centre, Sydney, Australia, 2Obafemi Awolowo University, Ile-Ife, Faculty of Basic Medical Sciences, Ile-Ife, Nigeria, 3University of Western Australia, School of Population and Global Health, Perth, Australia, 4University of Sydney, Heart Research Institute, Sydney, Australia, 5Brunel University, Physiotherapy Division, London, United Kingdom
Learning objectives:
  1. To showcase the need and potential for an expanding role in the prevention and management of cardiovascular disease across the globe.
  2. To explore and understand challenges associated with equity and access with a focus on language, culture and scale-up.
  3. To expand the role and understanding of physiotherapy across the spectrum of cardiovascular diseases.

Description: Cardiovascular disease (CVD) is responsible for most of the global burden of non-communicable diseases (NCD) accounting for over 17 million deaths globally in 2016.1 Internationally, guidelines place adherence to prevention medication and healthy lifestyle behaviors at the core of CVD risk management, primary and secondary prevention recommendations. 2-4 However, use of evidence-based medications and lifestyle change are typically suboptimal and with an aging and growing population the health burden is escalating.5-6 Thus, implementation of primary and secondary prevention strategies (such as healthy living, adherence to medicines) are an international priority requiring development and testing of innovative and scalable strategies that are evidence-based and better support patients.7 The potential role for physiotherapists in the clinical management of people with cardiac conditions is extensive and diverse. Interventions span acute and chronic care, involvement in primary and secondary prevention programs, and implementation of strategies aimed at reducing modifiable risk factors.8 Physiotherapists are skilled in the assessment of physical activity, activities of daily living, musculoskeletal integrity, and quality of life, but they can also assess other cardiovascular risk factors such as blood pressure and body mass index, as well as absolute cardiovascular risk. However, the value and potential of physiotherapy in the prevention and management of CVD remains underutilised.9 Whilst the role of physiotherapy in therapeutic exercise and assessment is widely accepted, the capacity of physiotherapists to participate in and coordinate other behavioural strategies for cardiac disease management is also of key importance.9 Therefore, the aim of this symposium is to highlight and showcase the potential need for an expanding role of physiotherapy in the prevention and management of CVD on a global scale and to explore current and future challenges associated with equity, access and cultural diversity. The symposium includes a case study from a lower middle-income country (Nigeria) and shares the perspectives of physiotherapists from the Asia Western Pacific, African and European Regions of WCPT. Overall, the symposium will explore, through a global lens, CVD clinical and prevention care needs for the future as well as opportunities for leadership across professional organisations and in research.

Implications/conclusions: Physiotherapists are highly trained health professionals, are comfortable working as part of a multidisciplinary team and have extensive training in behaviour modification. To meet the growing global health demands associated with health across the spectrum of CVD, physiotherapy is of great importance. In addition, physiotherapists' understanding of multiple body systems allows them to account for the impact of co-morbid conditions when developing cardiovascular management plans, eg, physical activity management plans for patients who have co-existing musculoskeletal conditions or breathlessness. With increasing population and increasing lifestyle related health conditions such as CVD, the role of physiotherapists can and should expand and broaden.

1. Organization WH. Cardiovascular diseases (CVDs) Fact Sheet (accessed 8th January 2020).
2. Chew DP, Scott IA, Cullen L, et al. National Heart Foundation of Australia and CSANZ: Australian clinical guidelines for the management of acute coronary syndromes 2016. The Medical journal of Australia 2016;205:128-133.
3. Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European heart journal 2012;33:2569-2619.
4. Anderson JL et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. Circulation 2011;123:e426-579.
5. Chow CK et al. Association of diet, exercise, and smoking modification with risk of early cardiovascular events after acute coronary syndromes. Circulation 2010;121:750-8.
6. Kotseva K et al. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009;373:929-40.
7. Perel P et al. Reducing Premature Cardiovascular Morbidity and Mortality in People With Atherosclerotic Vascular Disease: 
The World Heart Federation Roadmap for Secondary Prevention of Cardiovascular Disease. Global heart 2015; 10: 99-110.
8. Pryor JA, Prasad A (2008) Physiotherapy for Respiratory and Cardiac Problems (4th ed). London: Churchill Livingstone.
9. Redfern J, Nedkoff L. Engagement of physiotherapists in cardiology research. Physiotherapy J Aus 2011;57:209-211.
Key-words: 1. Cardiovascular disease 2. Diversity 3. Scale-up

Funding acknowledgements: Nil

All authors, affiliations and abstracts have been published as submitted.

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