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Dharmayat KI, Vallejo-Vaz AJ, Stevens CAT, et al., 2024, Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study, The Lancet, Vol: 403, Pages: 55-66, ISSN: 0140-6736
BackgroundApproximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies.MethodsFor this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia.FindingsOf 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8–13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetica
Ray K, Dharmayat K, Vallejo-Vaz A, 2023, Global Perspective of Familial Hypercholesterolaemia in Children and Adolescents: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), The Lancet, ISSN: 0140-6736
Lyons ARM, Stevens CAT, Dharmayat KI, et al., 2023, Overview of a collaborative global effort to address the burden of familial hypercholesterolaemia, Indian Heart Journal, ISSN: 0019-4832
This is an overview of the EAS Familial Hypercholesterolaemia (FH) Studies Collaboration (FHSC) global consortium and registry (established 2015), which broadly addresses the global burden of FH. Eighty-seven National Lead Investigators from 74 countries form this expanding global consortium, and this global registry currently includes pooled data on 70,000 participants from participating countries to facilitate FH surveillance. Published first results from this global registry concluded that FH is diagnosed late, and management of LDL-cholesterol falls below guideline recommendations, and therefore earlier detection of FH and wider use of combination therapy is required. Further FHSC studies will follow on updated data including new countries, participants and variables, and non-DNA genetic information, and on the remaining cohorts in the registry. FHSC cross-sectional collaborative global studies are expected to promote FH detection earlier in life to subsequently initiate early lipid lowering therapy to reduce lifelong exposure to cumulative LDL-cholesterol thus reducing cardiovascular disease risk.
Dharmayat K, Vallejo-Vaz A, Stevens C, et al., 2023, HOW ARE CHILDREN AND ADOLESCENTS WITH FAMILIAL HYPERCHOLESTEROLAEMIA DETECTED GLOBALLY? ANALYSIS FROM THE FHSC REGISTRY ON OVER 11,800 PARTICIPANTS FROM 48 COUNTRIES, 91st Annual Meeting of the European-Atherosclerosis-Society (EAS), Publisher: ELSEVIER IRELAND LTD, ISSN: 0021-9150
Lyons A, Elshorbagy A, Vallejo-Vaz A, et al., 2023, OBESITY AND STATIN USE MAY IMPACT THE PREVALENCE OF DIABETES IN FAMILIAL HYPERCHOLESTEROLAEMIA: A WORLDWIDE CROSS-SECTIONAL STUDY BY THE EAS FAMILIAL HYPERCHOLESTEROLAEMIA STUDIES COLLABORATION (FHSC), 91st Annual Meeting of the European-Atherosclerosis-Society (EAS), Publisher: ELSEVIER IRELAND LTD, ISSN: 0021-9150
Barkas F, Vallejo-Vaz A, Elshorbagy A, et al., 2023, LIPOPROTEIN (A) AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN ADULTS WITH HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLAEMIA: A CROSS-SECTIONAL STUDY FROM THE EAS FAMILIAL HYPERCHOLESTEROLAEMIA STUDIES COLLABORATION (FHSC), 91st Annual Meeting of the European-Atherosclerosis-Society (EAS), Publisher: ELSEVIER IRELAND LTD, ISSN: 0021-9150
Dharmayat K, Stevens C, Elshorbagy A, et al., 2023, APPROACHES TO LDL-C MANAGEMENT IN CHILDREN AND ADOLESCENTS WITH FAMILIAL HYPERCHOLESTEROLAEMIA: ANALYSIS ON OVER 3000 INDIVIDUALS RECEIVING LIPID-LOWERING MEDICATION IN THE FHSC REGISTRY, 91st Annual Meeting of the European-Atherosclerosis-Society (EAS), Publisher: ELSEVIER IRELAND LTD, ISSN: 0021-9150
Elshorbagy A, Vallejo-Vaz A, Barkas F, et al., 2023, GLOBAL PREVALENCE OF OVERWEIGHT AND OBESITY AMONG PAEDIATRIC AND ADULT PATIENTS WITH HOMOZYGOUS OR HETEROZYGOUS FAMILIAL HYPERCHOLESTEROLAEMIA, AND ASSOCIATION WITH CORONARY ARTERY DISEASE, 91st Annual Meeting of the European-Atherosclerosis-Society (EAS), Publisher: ELSEVIER IRELAND LTD, ISSN: 0021-9150
Vallejo-Vaz AJ, Dharmayat K, Nzeakor N, et al., 2023, DO COMORBIDITIES AND RESIDUAL RISK FACTORS INFLUENCE CHOICE OF ANTIPLATELET MONOTHERAPY IN PATIENTS WITH PERIPHERAL ARTERY DISEASE? RESULTS FROM THE CROSS-SECTIONAL RESRISK-PAD STUDY, 91st Annual Meeting of the European-Atherosclerosis-Society (EAS), Publisher: ELSEVIER IRELAND LTD, Pages: S194-S195, ISSN: 0021-9150
Stevens C, Lyons A, Dharmayat K, et al., 2023, Ensemble machine learning methods in screening electronic health records: a scoping review, Digital Health, Vol: 9, Pages: 1-17, ISSN: 2055-2076
Background:Electronic Health Records (EHRs) provide the opportunity to identify undiagnosed individuals likely to have a given disease using Machine Learning (ML) techniques, and who could then benefit from more medical screening and case finding, reducing the number needed to screen with convenience and healthcare cost savings. Ensemble Machine Learning Models (EMLs) combining multiple prediction estimates into one, are often said to provide better predictive performances than non-ensemble models. Yet, to our knowledge, no literature review summarises the use and performances of different types of EMLs in the context of medical pre-screening. Method:We aimed to conduct a scoping review of the literature reporting the derivation of EMLs for screening of EHRs. We searched EMBASE and MEDLINE databases across all years applying a formal search strategy using terms related to medical screening, EHR and ML. Data were collected, analysed, and reported in accordance with the PRISMA scoping review guideline. Results:A total of 3,355 articles were retrieved, of which 145 articles met our inclusion criteria and were included in this study. EMLs were increasingly employed across several medical specialities and often outperformed non-ensemble approaches. EMLs with complex combination strategies and heterogeneous classifiers often outperformed other types of EMLs but were also less used. EML methodologies, processing steps and data sources were often not clearly described. Conclusions:Our work highlights the importance of deriving and comparing the performances of different types of EMLs when screening EHRs and underscores the need for more comprehensive reporting of ML methodologies employed in clinical research.
Gidding SS, Wiegman A, Groselj U, et al., 2022, Paediatric familial hypercholesterolaemia screening in Europe: public policy background and recommendations, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, Vol: 29, Pages: 2301-2311, ISSN: 2047-4873
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Vallejo-Vaz A, Stevens C, Dharmayat K, et al., 2022, Identification, characteristics and management of adults with heterozygous Familial Hypercholesterolaemia in high and non-high income countries participating in the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), European Atherosclerosis Society Congress 2022, Publisher: Elsevier, Pages: 15-16, ISSN: 0021-9150
Vallejo-Vaz AJ, Dharmayat KI, Nzeakor N, et al., 2022, RESIDUAL RISK OF MAJOR ADVERSE CARDIOVASCULAR AND LIMB EVENTS AMONG DIFFERENT ATHEROSCLEROTIC CARDIOVASCULAR DISEASE PHENOTYPES RECEIVING GUIDELINE-RECOMMENDED ANTIPLATELET MONOTHERAPY: THE RESRISK STUDY, Publisher: ELSEVIER IRELAND LTD, Pages: E62-E63, ISSN: 0021-9150
Dharmayat KI, Vallejo-Vaz AJ, Stevens CA, et al., 2022, Global perspective of paediatric Familial Hypercholesterolaemia: Analysis from the EAS FHSC registry on over 11,200 children and adolescents with heterozygous Familial Hypercholesterolaemia from 44 countries, 90th European Atherosclerosis Society (EAS) Congress, Publisher: Elsevier, Pages: E13-E13, ISSN: 0021-9150
El Asmar ML, Dharmayat K, Vallejo-Vaz AJ, et al., 2021, Effect of computerised, knowledge-based, clinical decision support systems on patient-reported and clinical outcomes of patients with chronic disease managed in primary care settings: a systematic review, BMJ Open, Vol: 11, Pages: 1-14, ISSN: 2044-6055
Objectives: Chronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised Clinical Decision Support Systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care. Design and eligibility criteria: Systematic review including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series, and controlled before-and-after studies , assessing the effect of CDSS (vs. usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis, and osteoporosis) managed in primary care.Data sources: Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Health Management Information Consortium, and trial register clinicaltrials.gov, searched from inception to June 24, 2020.Data extraction and synthesis: Screening, data extraction, and quality assessment were performed by two reviewers independently. The Cochrane Risk of Bias tool was used for quality appraisal. Results: From 5,430 articles, eight studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components, and outcome measurements and focused on diabetes, asthma, hyperlipidaemia, and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies.Conclusions: There is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was
Vallejo-Vaz AJ, Stevens CAT, Lyons ARM, et al., 2021, Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC), The Lancet, Vol: 398, Pages: 1713-1725, ISSN: 0140-6736
BackgroundThe European Atherosclerosis Society Familial Hypercholesterolaemia Studies Collaboration (FHSC) global registry provides a platform for the global surveillance of familial hypercholesterolaemia through harmonisation and pooling of multinational data. In this study, we aimed to characterise the adult population with heterozygous familial hypercholesterolaemia and described how it is detected and managed globally.MethodsUsing FHSC global registry data, we did a cross-sectional assessment of adults (aged 18 years or older) with a clinical or genetic diagnosis of probable or definite heterozygous familial hypercholesterolaemia at the time they were entered into the registries. Data were assessed overall and by WHO regions, sex, and index versus non-index cases.FindingsOf the 61 612 individuals in the registry, 42 167 adults (21 999 [53·6%] women) from 56 countries were included in the study. Of these, 31 798 (75·4%) were diagnosed with the Dutch Lipid Clinic Network criteria, and 35 490 (84·2%) were from the WHO region of Europe. Median age of participants at entry in the registry was 46·2 years (IQR 34·3–58·0); median age at diagnosis of familial hypercholesterolaemia was 44·4 years (32·5–56·5), with 40·2% of participants younger than 40 years when diagnosed. Prevalence of cardiovascular risk factors increased progressively with age and varied by WHO region. Prevalence of coronary disease was 17·4% (2·1% for stroke and 5·2% for peripheral artery disease), increasing with concentrations of untreated LDL cholesterol, and was about two times lower in women than in men. Among patients receiving lipid-lowering medications, 16 803 (81·1%) were receiving statins and 3691 (21·2%) were on combination therapy, with greater use of more potent lipid-lowering medication in men than in women. Median LDL cholesterol
Chirambo GB, Thompson M, Hardy V, et al., 2021, Effectiveness of smartphone-based community case management on the urgent referral, reconsultation, and hospitalization of children aged under 5 years in Malawi: cluster-randomized, stepped-wedge trial, Journal of Medical Internet Research, Vol: 23, Pages: 1-11, ISSN: 1438-8871
Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi from illnesses such as malaria, pneumonia and diarrhoea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an electronic version of a smartphone-based CCM (eCCM) application on referral, re-consultation and hospitalization rates of children presenting to village clinics in Malawi. Methods: A stepped-wedge cluster-randomized trial compared paper-based CCM (control) with and without use of an eCCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from two districts in Northern Malawi were assigned to one of six clusters which were randomized to the sequencing of crossover from the control to the intervention phases, as well as the duration of exposure in each phase. Children ≥2 months to <5 years presenting with acute illness were enrolled consecutively by Health Surveillance Assistants (HSAs). The primary outcome of urgent referrals to higher-level facilities was evaluated using multi-level mixed effects models. A logistic regression model with random effect of cluster and fixed effect for each step was fitted. Adjustment for potential confounders included baseline factors, such as patient’s age, sex, and geographical location of village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited, 3421 in the control and 3544 in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility compared with children in the control phase (OR 2.02, 95% CI 1.27-3.23; p<0.01). Overall, children in the intervention arm had lower odds of attending a repeat HSA consultation (OR 0.45, 95% CI 0.34-0.59; p<0.01) or hospital admission (OR 0.75, 95% CI 0.62-0.90; p<
Vallejo-Vaz A, Dharmayat KI, Nzeakor N, et al., 2021, Atherothrombotic residual risk in coronary and peripheral artery disease patients on guideline-recommended antiplatelet monotherapy: baseline preliminary results from the RESRISK study, Publisher: OXFORD UNIV PRESS, Pages: 2546-2546, ISSN: 0195-668X
Brandts J, Dharmayat KI, Vallejo-Vaz AJ, et al., 2021, A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFICACY OF MEDICATIONS DIRECTED AGAINST PCSK9 IN FAMILIAL HYPERCHOLESTEROLEMIA., Publisher: ELSEVIER IRELAND LTD, Pages: E256-E257, ISSN: 0021-9150
Watkinson F, Dharmayat K, Mastellos N, 2021, A mixed-method service evaluation of health information exchange in England: technology acceptance and barriers and facilitators to adoption, BMC Health Services Research, Vol: 21, Pages: 1-13, ISSN: 1472-6963
Background The need for information exchange and integrated care has stimulated the development of interoperability solutions that bring together patient data across the health and care system to enable effective information sharing. Health Information Exchange (HIE) solutions have been shown to be effective in supporting patient care, however, user adoption often varies among users and care settings. This service evaluation aimed to measure user acceptance of HIE and explore barriers and facilitators to its wider uptake. Methods A mixed-method study design was used. A questionnaire was developed using the Unified Theory of Acceptance and Use of Technology and administered to HIE users to assess technology acceptance. Pearson Chi² tests were used to examine differences in acceptance between user groups and care settings. Web-based, semi-structured interviews were conducted drawing on the Normalisation Process Theory to explore barriers and facilitators to adoption. Interview data were analysed thematically using the Framework Approach. Results A total of 105 HIE users completed the survey and another 12 participated in the interviews. Significant differences were found in HIE acceptance between users groups and care settings, with high adopters demonstrating higher acceptance and social care users showing lower acceptance. Participants identified several drivers to adoption, including increased information accessibility, better care coordination, informed decision-making, improved patient care, reduced duplication of procedures, and time and cost savings. However, they also highlighted a number of barriers, such as lack of awareness about the solution and its value, suboptimal communication strategies, inadequate training and lack of resources for knowledge dissemination, absence of champions to support the implementation, lack of end-user involvement in the implementation and evaluation of HIE, unclear accountability and responsibility for the overall success
Brandts J, Dharmayat KI, Vallejo-Vaz AJ, et al., 2021, A meta-analysis of medications directed against PCSK9 in familial hypercholesterolemia, Atherosclerosis, Vol: 325, Pages: 46-56, ISSN: 0021-9150
BACKGROUND AND AIMS: Several medications targeting PCSK9 reduce LDL-cholesterol (LDL-C) in heterozygous familial hypercholesterolemia (HeFH). We aimed to assess in patients diagnosed clinically as HeFH, whether LDL-C reduction varied by different therapeutic approaches to PCSK9-targeting or by the underlying genetic variant. METHODS: We conducted a random-effects meta-analysis of randomised clinical trials assessing PCSK9-targeting therapies, namely alirocumab, evolocumab and inclisiran, in patients with clinically diagnosed HeFH and restricted analyses to those patients in whom genotypic data were available. A search of MEDLINE and Embase identified eligible trials published between inception and June 29, 2020. We included trials of sufficient duration to allow for a stable treatment effect: ~12 weeks for monoclonal antibodies (mAbs) (alirocumab, evolocumab) and ~1 year for small interfering RNA (siRNA) (inclisiran). Single-moderator meta-regression comparing mean percentage LDL-C reduction between mAbs and siRNA as well as PCSK9-targeting therapies between different genotypes was used to assess heterogeneity. RESULTS: Eight trials of HeFH met our inclusion criteria, including 1887 genotyped patients. Among monogenic HeFH cases (N = 1347) the LDL-C reduction from baseline was 46.12% (95%CI 48.4-43.9) for siRNA and 50.4% (59.3-41.4) for mAbs compared to control, without evidence of significant heterogeneity between treatment (QM = 0.32, df = 1, p = 0.57). Irrespective of therapeutic approach to PCSK9-targeting, reductions in LDL-C were generally consistent across genetic variants (LDL-Receptor variants, LDL-Receptor variants of unknown significance, Apolipoprotein B variants, two variants and no variant) (QM = 8.3, df = 4, p = 0.08). CONCLUSIONS: Among patients with HeFH, the LDL-C-lowering effect of PCSK9-targeting medications did not show statistical heterogeneity across different drug-classes a
Dharmayat K, Stevens C, Lyons A, et al., 2020, Heterozygous familial hypercholesterolaemia in children: preliminary analysis from the eas fhsc global registry on over 7,900 children with familial hypercholesterolaemia, European Atherosclerosis Society Congress, Publisher: Elsevier, Pages: e76-e76, ISSN: 0021-9150
Vallejo-Vaz AJ, Dharmayat K, Stevens C, et al., 2020, Characteristics of adults with heterozygous familial hypercholesterolaemia stratified by gender: preliminary analysis from the eas fhsc global registry on over 36,000 cases of familial hypercholesterolaemia, European Atherosclerosis Society Congress, Publisher: Elsevier, Pages: e13-e13, ISSN: 0021-9150
Dharmayat K, Woringer M, Mastellos N, et al., 2020, Investigation of cardiovascular health and risk factors among the diverse and contemporary population in London (the TOGETHER Study): protocol for linking longitudinal medical records, JMIR Research Protocols, Vol: 9, Pages: 1-10, ISSN: 1929-0748
Background:Global trends in cardiovascular disease (CVD) exhibit considerable interregional and interethnic differences, which in turn affect long-term CVD risk across diverse populations. An in-depth understanding of the interplay between ethnicity, socioeconomic status, and CVD risk factors and mortality in a contemporaneous population is crucial to informing health policy and resource allocation aimed at mitigating long-term CVD risk. Generating bespoke large-scale and reliable data with sufficient numbers of events is expensive and time-consuming but can be circumvented through utilization and linkage of data routinely collected in electronic health records (EHR).Objective:We aimed to characterize the burden of CVD risk factors across different ethnicities, age groups, and socioeconomic groups, and study CVD incidence and mortality by EHR linkage in London.Methods:The proposed study will initially be a cross-sectional observational study unfolding into prospective CVD ascertainment through longitudinal follow-up involving linked data. The government-funded National Health System (NHS) Health Check program provides an opportunity for the systematic collation of CVD risk factors on a large scale. NHS Health Check data on approximately 200,000 individuals will be extracted from consenting general practices across London that use the Egton Medical Information Systems (EMIS) EHR software. Data will be analyzed using appropriate statistical techniques to (1) determine the cross-sectional burden of CVD risk factors and their prospective association with CVD outcomes, (2) validate existing prediction tools in diverse populations, and (3) develop bespoke risk prediction tools across diverse ethnic groups.Results:Enrollment began in January 2019 and is ongoing with initial results to be published mid-2021.Conclusions:There is an urgent need for more real-life population health studies based on analyses of routine health data available in EHRs. Findings from our study will
Brandts J, Dharmayat KI, Ray KK, et al., 2020, Familial hypercholesterolemia: is it time to separate monogenic from polygenic familial hypercholesterolemia?, Current Opinion in Lipidology, Vol: 31, Pages: 111-118, ISSN: 0957-9672
PURPOSE OF REVIEW: This review explores the concepts of monogenic and the so-called polygenic familial hypercholesterolemia and how the identification of familial hypercholesterolemia as a monogenic condition and its separation from polygenic primary hypercholesterolemia may have implications for clinical practice. RECENT FINDINGS: Through genetic testing, a mutation in any of the three known autosomal dominant familial hypercholesterolemia-causing genes is found in 60-80% of cases with a clinical diagnosis of definite familial hypercholesterolemia. As individuals with a polygenic basis for their hypercholesterolemia do not follow the same inheritance pattern observed in monogenic familial hypercholesterolemia, the use of family-based cascade screening in individuals with a polygenic origin is not recommend, as only 30% of relatives have an elevated LDL-C compared to the 50% in monogenic families. The presence of a causative monogenic mutation associates the highest cardiovascular risk vs. not having a mutation or having a polygenic background, providing prognostic information independent of LDL-C. It may also help assess intensity of interventions. Treatment adherence also seems to be higher after monogenic confirmation of hypercholesterolemia. SUMMARY: Knowledge about the genetic status of an individual with clinical familial hypercholesterolemia (monogenic vs. polygenic) can provide a more informed understanding to evaluating risk, managing disease and opportunities for screening strategies.
Hu P, Dharmayat KI, Stevens CAT, et al., 2020, Prevalence of familial hypercholesterolemia among the general population and patients with atherosclerotic cardiovascular disease: a systematic review and meta-analysis., Circulation, Vol: 141, Pages: 1742-1759, ISSN: 0009-7322
Background:Contemporary studies suggest that familial hypercholesterolemia (FH) is more frequent than previously reported and increasingly recognized as affecting individuals of all ethnicities and across many regions of the world. Precise estimation of its global prevalence and prevalence across World Health Organization regions is needed to inform policies aiming at early detection and atherosclerotic cardiovascular disease (ASCVD) prevention. The present study aims to provide a comprehensive assessment and more reliable estimation of the prevalence of FH than hitherto possible in the general population (GP) and among patients with ASCVD.Methods:We performed a systematic review and meta-analysis including studies reporting on the prevalence of heterozygous FH in the GP or among those with ASCVD. Studies reporting gene founder effects and focused on homozygous FH were excluded. The search was conducted through Medline, Embase, Cochrane, and Global Health, without time or language restrictions. A random-effects model was applied to estimate the overall pooled prevalence of FH in the general and ASCVD populations separately and by World Health Organization regions.Results:From 3225 articles, 42 studies from the GP and 20 from populations with ASCVD were eligible, reporting on 7 297 363 individuals/24 636 cases of FH and 48 158 patients/2827 cases of FH, respectively. More than 60% of the studies were from Europe. Use of the Dutch Lipid Clinic Network criteria was the commonest diagnostic method. Within the GP, the overall pooled prevalence of FH was 1:311 (95% CI, 1:250–1:397; similar between children [1:364] and adults [1:303], P=0.60; across World Health Organization regions where data were available, P=0.29; and between population-based and electronic health records–based studies, P=0.82). Studies with ≤10 000 participants reported a higher prevalence (1:200–289) compared with larger cohorts (1:365–407; P<0.001). The pooled pre
Dharmayat K, Tran T, Hardy V, et al., 2019, Sustainability of ‘mHealth’ interventions in sub-Saharan Africa: a stakeholder analysis of an electronic community case management project in Malawi, Malawi Medical Journal, Vol: 31, Pages: 177-183, ISSN: 1995-7270
BackgroundThe global health community as well as the funding agencies are currently engaged in ensuring a greater focus on worthwhile research-based programmes are sustainable. Despite its importance, few studies have analysed the sustainability of global health interventions. In this paper, we aim to explore the barriers and facilitators for the wider implementation and sustainability of a mobile health (mHealth) intervention (Supporting LIFE Community Case Management programme) in Malawi, Africa.MethodsBetween January to March 2017, a qualitative approach was employed involving 13 in-depth semi-structured interviews with key stakeholders across all levels of healthcare provision in Malawi to explore their perceptions on the implementation and sustainability of the mHealth programme. Data were analysed thematically by two reviewers. ResultsThe findings indicate that, overall, the programme was successful in achieving its goals. However, absence of monetary resources, the limited visibility outside the healthcare sector, the lack of integration with community-based and nationwide programmes, services and information and communication technologies, and the limited local capacity in relation to the maintenance, further development, and management of the programme present challenges to its wider implementation and sustainability.ConclusionsFuture developments should be aligned with the strategic goals and interests of the Ministry of Health and engage with national and international stakeholders to develop shared goals and strategies for nationwide scale-up. They should also focus on building local capacity through training of trainers and ensure that training methods and guidelines are appropriately accredited based on national policies. These findings provide a framework for a variety of stakeholders who are engaged in sustaining mHealth programmes in resource-poor settings and can be used to inform evidence based policy in utilising technology for healthcare deliver
Ide N, Hardy V, Chirambo B-G, et al., 2019, "People welcomed this innovation with two hands”: A qualitative report of an mHealth intervention for community case management in Malawi, Annals of Global Health, Vol: 85, Pages: 61-70, ISSN: 2214-9996
IntroductionCommunity Case Management (CCM) aims to improve outcomes among children under-5 with malaria, diarrhea, and pneumonia, but its effectiveness in Malawi is limited by inconsistent standards of delivery, characteristic of paper-based interventions. This may lead to negative impacts on child health outcomes and inefficient use of health system resources. This study evaluated the acceptability and impact of the Supporting LIFE Community Case Management App (SL eCCM App) by Health Surveillance Assistants (HSAs) and caregivers in two districts of Northern Malawi. MethodsData were collected through semi-structured interviews with HSAs and caregivers as part of a nested study within a larger trial. We used deductive and inductive approaches to data analysis. Relevant constructs were identified from the Consolidated Framework for Implementation Research and combined with emerging concepts from the data. The Framework Method was used to chart and explore data, leading to the development of themes. Results17 HSAs and 28 caregivers were interviewed. Participants were generally enthusiastic about the SL eCCM App. Nearly all HSAs expressed a preference for the App over routine paper-based CCM. Most HSAs claimed the App was more reliable and less error prone, facilitated more accurate diagnoses and treatment recommendations, and enhanced professional confidence and respect in the community. Some HSAs believed additional features would improve usability of the App, others identified mobile network or electricity shortages as barriers. Not all caregivers understood the purpose of the App, but most welcomed it as a health and technological advancement. ConclusionThe SL eCCM App is acceptable to both HSAs and caregivers, and in most cases, preferred, as it was believed to foster improvements in CCM delivery. Our findings suggest that mobile health interventions for CCM, such as the SL eCCM App, may have potential to improve the effectiveness and efficiency of care to chil
Woringer M, Dharmayat KI, Greenfield G, et al., 2019, American Heart Association's Cholesterol CarePlan as a smartphone-delivered web app for patients prescribed cholesterol-lowering medication: Protocol for an observational feasibility study, JMIR Research Protocols, Vol: 8, ISSN: 1929-0748
Background: Adoption of healthy lifestyle and compliance with cholesterol-lowering medication reduces the risk of cardiovascular disease (CVD). The use of digital tools and mobile technology may be important for sustaining positive behavioral change.Objective: The primary objective of this study is to evaluate the feasibility and acceptability of administering the Cholesterol CarePlan Web app developed by the American Heart Association aimed at improving lifestyle and medication adherence among patients prescribed cholesterol-lowering medication. The secondary objective is to assess the Web app’s efficacy.Methods: A prospective, observational feasibility study will be conducted to demonstrate whether the Web app may be successfully taken up by patients and will be associated with improved clinical and behavioral outcomes. The study will aim to recruit 180 study participants being prescribed cholesterol-lowering medication for at least 30 days across 14 general practices in London, England. Potentially eligible patients will be invited to use the Web app on a smartphone and visit general practice for three 20-minute clinical assessments of blood pressure, height, weight, smoking, and nonfasting cholesterol over 24 weeks. The feasibility of administering the Web app will be judged by recruitment and dropout statistics and the sociodemographic and comorbidity profile of consenting study participants, consenting nonparticipants, and all potentially eligible patients. Acceptability will be assessed using patients’ readiness to embrace new technologies, the usability of the Web app, and patient satisfaction. The efficacy of the Web app will be assessed by changes in medication adherence and clinical risk factors by levels of the Web app compliance.Results: This study is currently funded by the American Heart Association. Initial study recruitment will take place between February and July 2018 followed by patient follow-up. Patient level data will be obtained i
Woringer M, Dharmayat KI, Greenfield G, et al., 2018, American Heart Association’s Cholesterol CarePlan as a Smartphone-Delivered Web App for Patients Prescribed Cholesterol-Lowering Medication: Protocol for an Observational Feasibility Study (Preprint), JMIR Research Protocols, ISSN: 1929-0748
<sec> <title>BACKGROUND</title> <p>Adoption of healthy lifestyle and compliance with cholesterol-lowering medication reduces the risk of cardiovascular disease (CVD). The use of digital tools and mobile technology may be important for sustaining positive behavioral change.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The primary objective of this study is to evaluate the feasibility and acceptability of administering the Cholesterol CarePlan Web app developed by the American Heart Association aimed at improving lifestyle and medication adherence among patients prescribed cholesterol-lowering medication. The secondary objective is to assess the Web app’s efficacy.</p> </sec> <sec> <title>METHODS</title> <p>A prospective, observational feasibility study will be conducted to demonstrate whether the Web app may be successfully taken up by patients and will be associated with improved clinical and behavioral outcomes. The study will aim to recruit 180 study participants being prescribed cholesterol-lowering medication for at least 30 days across 14 general practices in London, England. Potentially eligible patients will be invited to use the Web app on a smartphone and visit general practice for three 20-minute clinical assessments of blood pressure, height, weight, smoking, and nonfasting cholesterol over 24 weeks. The feasibility of administering the Web app will be judged by recruitment and dropout statistics and the sociodemographic and comorbidity profile of consenting study participants, consenting nonparticipants, and all potentially eligible patients. Acceptability will be assessed using patients’ readiness to embrace new technologies, the usa
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