Challenges and Special Aspects of Pulmonary Hypertension in Middle- to Low-Income Regions: JACC State-of-the-Art Review

Challenges and special aspects related to the management and prognosis of pulmonary hypertension (PH) in middle- to low-income regions (MLIRs) range from late presentation to comorbidities, lack of resources and expertise, cost, and rare options of lung transplantation. Expert consensus recommendations addressing the specific challenges for prevention and therapy of PH in MLIRs with limited resources have been lacking. To date, 6 MLIR-PH registries containing mostly adult patients with PH exist. Importantly, the global prevalence of PH is much higher in MLIRs compared with high-income regions: group 2 PH (left heart disease), pulmonary arterial hypertension associated with unrepaired congenital heart disease, human immunodeficiency virus, or schistosomiasis are highly prevalent. This consensus statement provides selective, tailored modifications to the current PH guidelines to address the specific challenges faced in MLIRs, resulting in the first pragmatic and cost-effective consensus recommendations for PH care providers, patients, and their families.     

The relevance of heart failure severity for treatment with evidence-based pharmacotherapy in general practice

AIMS: Internationally, research indicates that pharmacotherapy for chronic heart failure (CHF) is sub-optimal. Traditionally, assessment of drug use in heart failure has focused on the use of individual agents irrespective of CHF severity. This study investigates drug use for CHF patients in general practice with respect to the available evidence, incorporating both disease severity and the use of combination drug regimes. METHODS AND RESULTS: A cross-sectional survey of 769 Dutch CHF patients was performed as part of IMPROVEMENT of HF study. For each New York Heart Association severity classification the minimum treatment appropriate for the heart failure severity according to the scientific evidence available at the time of the study (1999) was defined. The proportion of patients treated with each drug increased with increasing severity, with the exception of the beta-blockers. Patients with less severe heart failure were approximately four to eight times more likely to receive evidence-based treatment than those with more severe heart failure. DISCUSSION: To assess pharmacological treatment of heart failure, in relation to the available evidence, it is important to take severity into account. While the number of drugs prescribed increased with increasing severity, the use of evidence-based regimes was lower in patients with more severe heart failure.     

US evidence‐based dietary guidelines: The history and the process

Since 1980, the US Department of Health and Human Services and the Department of Agriculture have published the Dietary Guidelines for Americans (DGA) for the purpose of promoting the health of the American public. Based on the scientific findings from a select group of scientists known as the Dietary Guidelines Advisory Committee (DGAC), as well as public input, the DGA are the cornerstone of federal food and nutrition policy and education in the United States. The DGAC is formed and their work is governed by a transparent, consistent, systematic process. Topic formation influences expertise solicited for the DGAC, and the DGAC expertise and perspectives influence the interpretation of the best available evidence. The evidence considered by the DGAC can be submitted by the public, but must be published in peer‐reviewed journals, and is systematically reviewed for quality before inclusion in the Nutrition Evidence Library. The DGAC report informs the formation of the DGA, which is the US nutrition policy document. The 2010 DGA influence remains apparent through high‐profile initiatives such as ‘Let's Move!’ and ‘MyPlate’. The effects of the DGA are pervasive in American life, even if not well recognised, through both federal and non‐profit food and nutrition programmes, as well as a broad range of nutrition education initiatives.