The COVID-19 Pandemic: A Massive Threat for Those Living With Cardiovascular Disease Among the Poorest Billion.
The COVID-19 Pandemic: A Massive Threat for Those Living With Cardiovascular Disease Among the Poorest Billion.
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DOI：
10.1161/circulationaha.120.047969
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发表时间：
2020-11-17
期刊：
影响因子：
37.8
通讯作者：
Bukhman G
中科院分区：
文献类型：
--
作者：
Klassen SL;Kwan GF;Bukhman G
在最贫穷的10亿人口中，心血管疾病使更多的人容易患上严重的疾病，许多低收入国家的医疗保健预算很少，限制了这些人获得医疗保健的机会。最后，大流行期间发生的失业和全球经济衰退的涟漪反应可能使最贫穷的10亿慢性心血管疾病患者在短期和长期内无法负担药物和医疗服务。1然而，全球心血管病界仍有创新的机会，可以在这一大流行期间作出反应，实现长期的卫生系统强化。其中一个应对措施是支持将心力衰竭护理等专业护理分散到更偏远的社区，并在农村地区医院安装心脏护理单元或其他高依赖性护理单元，减轻高密度中心医疗保健系统的负担。这些举措可以促进社会距离，同时改善农村穷人获得护理的机会，即使同时采取区域封锁措施。权力下放既需要投资以扩大现有的供应链，也需要转移任务：重组培训和护理模式，以便将通常由转诊医院接受过专门培训的保健工作者执行的任务转移给培训水平较低的工作者。马拉维农村地区的健康伙伴组织成功地改造了现有的人类免疫缺陷病毒基础设施，以提供心血管疾病护理，其他团体将其描述为一项有效的战略。5多年来，我们的小组一直使用PEN-Plus模式培训护士，在农村中低收入国家领导严重慢性病患者的门诊（NCD Synergies PEN-Plus Toolkit可在http：//ncdsynergies上找到。org/chronic-care-toolkit/）。数字疾病监测系统、通过移动的设备举行的电话会议和在线培训平台等新技术可以促进权力下放和任务转移。在疫情期间，我们的小组对马拉维农村地区的医疗保健提供者进行了虚拟培训，以支持心力衰竭患者的护理。我们正在卢旺达农村使用开源学习平台（Moodle Pty Ltd）开发和测试在线心力衰竭教学模块。我们的目标是将这些基于技术的工具传播给撒哈拉以南非洲的农村医疗保健提供者。通过我们分散的诊所，我们还能够协调向我们最贫穷的病人提供现金转移，以提供直接的经济支助。在过去几个月里，已经很清楚，强大的卫生系统有能力在严重危机中进行适应，而资源不足的卫生系统只是将不断减少的供应从一个护理环境转移到另一个护理环境。尽管在撰写本文时，高收入和中上收入国家在COVID-19病例数方面继续领先，但中低收入国家可能仍在等待经历自己的病例激增，并已经感受到了疫情的深刻涟漪反应。
CVD in poorest billion populations predisposes more individuals to severe illness, small health care budgets in many LMICs limit access to health care for these very individuals. Last, the ripple effects of job loss and a global economic recession taking place during the pandemic may make it impossible for poorest billion individuals living with chronic CVD to afford medications and medical care both in the short and long term. 1 However, there are innovative opportunities for the global cardiovascular community to respond to achieve long-lasting health system strengthening during this pandemic. One such response would be to support efforts to decentralize specialized care, such as heart failure care, to more remote communities and install cardiac care units or other high-dependency care units in rural district hospitals, easing the burden on health care systems in high-density centers. These initiatives can promote social distancing, while improving access to care among the rural poor even with concurrent regional lockdown measures. Decentralization requires both investment to extend existing supply chains and tasking shifting: reorganization of training and care models so that tasks usually performed by health care workers with specialized training at referral hospitals are shifted to workers with lower levels of training. Partners In Health in rural Malawi has been successful in adapting preexisting human immunodeficiency virus infrastructure to provide CVD care and this has been described as an effective strategy by other groups. 5 For many years, our group has used the PEN-Plus model of training nurses to lead outpatient clinics for patients with severe chronic disease in rural LMICs (The NCD Synergies PEN-Plus Toolkit can be found at http://ncdsynergies. org/chronic-care-toolkit/). New technology, such as digital disease surveillance systems, teleconferencing via mobile devices, and online training platforms, can facilitate decentralization and task shifting. During the pandemic, our group has conducted virtual training of health care providers to support care of patients with heart failure at several sites in rural Malawi. We are developing and testing an online heart failure teaching module using an open-source learning platform (Moodle Pty Ltd) in rural Rwanda. Our goal is to disseminate these technology-based tools to rural health care providers across sub-Saharan Africa. Through our decentralized clinics, we have also been able to coordinate the distribution of cash transfers to our patients in highest poverty to provide direct economic support. Over the past several months, it has become clear that strong health systems have the ability to adapt in acute crises, whereas underresourced health systems simply shift dwindling supplies from one care environment to another. While high-income and upper middle–income countries continue to lead in COVID-19 case counts at the time of this writing, LMICs may still be waiting to experience their own surge in cases and have already felt the profound ripple effects of the