CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 178 AFRICA Review Article Disparities in patients’ understanding of cardiovascular disease management Rumaanah Ayob, Muhammed Vally, Razeeya Khan, Ané Orchard Abstract Non-communicable diseases, including cardiovascular disease (CVD), are some of the leading causes of mortality worldwide. Despite the effectiveness of early diagnostic and treatment options, patient screening, disease detection and disease progression remain a challenge, resulting in suboptimal outcomes. Consequently, cardiovascular diseases remain underdiagnosed and undertreated, particularly in developing countries. Several barriers, including paucity of recommended cardiovascular health information and low literacy levels, lead to a poor understanding of the importance of intervention in terms of modifiable risk factors as well as treatment adherence. This narrative review focuses on cardiovascular patients’ understanding of their disease, and the need for compliance with their medication and lifestyle modifications. Low levels of perception and insufficient knowledge of CVDs among patients continue to be indispensably important factors in health behaviour. Increased awareness of these issues has the potential to improve the effectiveness of the multidisciplinary cardiovascular team and ultimately improve the care provided to these patients. Keywords: lifestyle modifications, treatment adherence, macrovascular, microvascular, risk factors, complications, hypertension, diabetes, dyslipidaemia Submitted 1/6/22; accepted 1/9/23 Published online 22/5/24 Cardiovasc J Afr 2024; 35: 178–184 www.cvja.co.za DOI: 10.5830/CVJA-2024-007 Cardiovascular disease burden Cardiovascular disease (CVD) is one of the leading causes of death worldwide1 and the leading cause of disability-adjusted life years globally.2 CVD is a lifestyle disease that is defined as heart and blood vessel disease, and is related to atherosclerosis.3 Each year, an estimated 17.9 million people will die from CVDs, mostly from coronary heart disease and stroke, and these are projected to remain the leading cause of deaths worldwide.1 Of the cardiovascular-related deaths occurring worldwide, 80% of the deaths occur in low- and middle-income countries (LMICs) with an equal preponderance among men and women.4 Despite improvements made to reduce cardiovascular mortality rates, one in every four deaths is caused by coronary artery disease in the United States.5 The World Health Organisation conducted a study on global ageing and adult health (SAGE Wave 1), and an analysis of this data carried out by Ruan et al.6 described the prevalence of the two main CVDs (angina and stroke) and its association with behavioural and socio-economic risk factors. The datasets were obtained from six LMICs, including South Africa, and demonstrated that poor lifestyle choices contribute greatly to the risk of CVD. In 2007, 41.7% of deaths due to ischaemic heart disease and 49.6% due to stroke in South Africans aged 30 years and older, were attributed to hypertension.7 The high mortality rates related to hypertension are on an upward trend, and the prevalence of hypertension has doubled over the past two decades (24% in 1998 to 45% in 2016).8 The American Heart Association9 emphasises that young adolescents and adults can live healthier lives by paying special attention to the following seven aspects of life: eating a healthy diet, engaging in daily physical activity, avoiding smoking and tobacco products, maintaining a healthy weight and favourable body mass index (BMI), as well as keeping cholesterol, blood pressure and glucose levels within the healthy recommended range.9 Lack of knowledge and awareness of CVD may impede preventative efforts as well as CVD treatment10 and are associated with poor disease outcomes.11 Non-adherence to treatment can result in detrimental consequences and markedly reduces the chances of optimal outcomes.12 A study conducted among Toronto and Vancouver participants found that the main reasons for delay in patient presentation to the emergency room and therefore a delay in patient treatment was the inability of patients to identify the warning symptoms of a cardiovascular emergency.10 Therefore, increasing knowledge of CVD warning signs and risk factors among communities is imperative to control the disease.13 Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Rumaanah Ayob, BPharm, PG Dip Prevent Cardiovasc Med, Rumaanah.Ayob1@students.wits.ac.za Muhammed Vally, BPharm, MPS, MSc (Med), PG Dip Diabetes, PG Dip Prevent Cardiovasc Med, SA Cert in Asthma Care, PCDT Razeeya Khan, BPharm, MSc (Med), PCDT Ané Orchard, Ane.Orchard@wits.ac.za, BPharm, PhD, PG Dip HSE
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