Michael R. Kidd

Aims: Heart failure (HF) is a global health challenge with increasing burden. This study characterized HF across different severity levels to inform service delivery and health system responses. Methods and results: Using Global Burden of Disease (GBD) Study 2021 data, we analyzed age-standardized rates of prevalence and years lived with disability (YLDs) for HF, stratified into four levels based on symptom severity as determined by the GBD: treated, mild, moderate and severe. Estimates were stratified by sex, region, and underlying causes. Spearman's rank correlation tests were used to assess the relationships between burden and sociodemographic index (SDI) and universal health coverage (UHC). Temporal trends and contributions were evaluated using estimated annual percentage changes and decomposition analyses. The overall prevalence of HF was 55.5 million (M), and using GBD symptom severity categories, there were 20.5 M treated HF globally in 2021, resulting in 1.3 M YLDs. Mild HF was 10.3 M (0.4 M YLDs), moderate HF was 6.7 M (0.5 M YLDs), and severe HF was 18.0 M (3.1 M YLDs). Ischaemic heart disease remained the leading underlying cause of HF. Males experienced a burden 25% higher than females. Geographic variation was observed, with higher YLDs due to treated HF correlating with lower SDI and UHC levels, while no significant association for mild, moderate, or severe HF. During 1990–2021, prevalence and YLDs increased across all groups with an increase of 0.2%, predominantly driven by population growth and ageing. Conclusion: The burden of HF is projected to rise significantly. Advancing strategies to strengthen health systems and address disparities in access to guideline-directed care, particularly in low- and middle-income countries, is an important focus for action.

Background: To investigate the geographic distribution of multiple neurodevelopmental disorders (NDDs) across different US states. Methods: Using data from 2016 to 2023 National Survey of Children’s Health, we estimated the prevalence and combinations of multiple NDDs (defined as having ≥2 NDDs) at the state level among 272 598 children and adolescents aged 3–17 years. We also reported state-level prevalence estimates and combinations stratified by sociodemographic characteristics. Results: Participant numbers ranged from 4391 in the Nevada to 11 275 in California during 2016–2023. Over half were male (51.7%), with a mean age of 10.2 years (standard deviation: 4.5). The national multiple NDDs prevalence was 8.1% (95% Confidence Interval [CI]: 7.9%–8.3%), with Kentucky reporting the highest prevalence at 10.5% (95% CI: 9.3%–11.8%) across states. Stratified analyses by period, age groups, sex, ethnicity, country of birth, household income, insurance coverage, and family education levels consistently showed the highest prevalence in southern states such as Florida, Kentucky, Louisiana, Maine, New Hampshire, and Oklahoma. Across states, the most common multiple NDDs combination was attention-deficit/hyperactivity disorder concurrent with learning disabilities (18.2%). Conclusion: Disparities in multiple NDDs prevalence were observed across US states. These state-level estimates can help decision-makers target programs and allocate resources to address community needs.

High-quality research in general practice is vital to provide evidence-informed care to patients in the community, and the UK has led the world in developing academic general practice as a discipline. However, capacity within the academic GP workforce has been a longstanding concern, and two recent publications have highlighted the now critical situation. The Academy of Medical Sciences (AoMS) report Future-Proofing UK Health Research⁴ found that, while academic training posts in hospital specialties had fallen from 5% to 3%, academic GPs remained vastly under-represented at just 0.05% of the GP workforce, and the Medical Research Council (MRC) report Clinical Researchers in the United Kingdom: Reversing the Decline to Improve Population Health and Promote Economic Growth⁵ highlighted the diminishing number of academic GPs.

Background: Mobile health (mHealth) apps are increasingly being used to capture patient health data, provide information, and guide self-management, with reported improvements in health care service delivery and outcomes. However, the impact of integrating mHealth app data into electronic medical record or electronic health record (EMR/EHR) systems remains underexplored. Objective: This study aims to identify what is known about the impact of integrating mHealth app data into EMR/EHR systems on health care delivery and patient outcomes. Methods: A scoping review was conducted to identify original studies that investigated the integration of patient-facing mHealth app data into EMR/EHR systems and the impact on health care outcomes. The PubMed, Embase, Web of Science, Cochrane Library, CINAHL, ProQuest, and PsycINFO databases were searched for papers published between January 2014 and July 2024. Two authors independently screened and extracted data on study characteristics, mHealth app features, details of integration with EMR/EHR systems, and effects on health care delivery and patient outcomes. Results: Nineteen studies with 113,135 participants were included. Among these, 6 were randomized clinical trial studies, 8 were conducted in the United States, 12 occurred in hospital settings, 15 involved adult participants, and 6 targeted diabetes management. Main features of the apps and EMR/EHR systems can be categorized into tracking or recording health data (n=19), app data integrated into EMR/EHR systems (n=19), app data summarized or presented on EMR/EHR interface (n=19), communication with the health care team (n=12), reminders or alerts (n=10), synchronization with other apps or devices (n=8), educational information (n=4), and using existing portal credentials to app access (n=2). Most studies reported benefits of integrating the app and EMR/EHR, such as enhanced patient education and self-management (n=5), real-time data recorded and shared with clinicians (n=4), support for clinical decision-making (n=3), improved communication between patients and clinicians (n=7), and improved patient outcomes (n=13). Challenges identified included high drop-off rates in app usage (n=3), limited accessibility due to device restrictions (n=3), incompatibility between mHealth apps and EMR/EHR systems (n=3), increased clinical workload in response to additional information (n=3), data accuracy issues due to network connectivity (n=1), and data security concerns (n=1). Conclusions: Evidence suggests that the effective integration of mHealth app data into EMR/EHR systems can enhance both clinicians’ health care delivery and patients’ health outcomes. However, current literature is limited, and future opportunities remain to examine the impact on long-term outcomes, such as mortality, readmissions, and costs, and assess the scalability and sustainability of integration among more broader health conditions and disabilities across diverse health care settings.

Strong primary care (PC) services are the foundation of high-performing health care systems and can support effective responses to public health emergencies. Primary care practitioners (PCPs) and PC services played crucial roles in supporting global health system responses to the COVID-19 pandemic. However, these contributions have come at a cost, impacting on PC services and affecting patient care. This secondary analysis of data from an integrative systematic review across international PC settings aimed to identify and describe burdens and challenges experienced by PCPs and PC services in the context of their contributions to COVID-19 pandemic responses. We conducted an integrative systematic review and narrative analysis, searching PubMed/Medline, Scopus, Proquest Central and Cochrane Database of Systematic Reviews, plus reference lists of key publications. Included studies were published in peer-reviewed English or Chinese language journals, and described collective responses to COVID-19 undertaken in PC settings or by PCPs. Narrative data regarding impacts on PC services and challenges experienced by PCPs were extracted and analysed using inductive coding and thematic analysis. From 1745 screened papers 108, representing 90 countries, were included. Seventy-eight contained data on negative impacts, challenges or issues encountered in PC. Ten ‘pressure points’ affecting PC during COVID-19 were identified, clustered in four themes: demand to adopt new ways of working; pressure to respond to fluctuating community needs; strain on PC resources and systems; and ambiguity in interactions with the broader health and social care system. PCPs and PC services made critical functional contributions to health system responsiveness during the COVID-19 pandemic. However, both practitioners and PC settings were individually and collectively impacted during this period as a result of changing demands in the PC environment and the operational burden of additional requirements imposed on the sector, offering lessons for future pandemics. This study articulates ten empirically derived ‘pressure points’ that provide an initial understanding of burdens and demands imposed on the international primary care sector during the COVID-19 pandemic. The impact of these contributions should inform future pandemic planning, guided by involvement of PCPs in public health preparedness and policy design.

Dual antiplatelet therapy with P2Y₁₂ inhibitors (P2Y₁₂i) and aspirin following acute myocardial infarction (AMI) prevents future ischaemic events. People with atrial fibrillation (AF) also require oral anticoagulants (OAC), increasing bleeding risk. Guidelines recommend post-discharge prescribing of direct OAC with clopidogrel and discontinuation of P2Y₁₂i after 12 months, but little is known about use in clinical practice. To describe post-discharge use of OACs and P2Y₁₂i in people with AF and a history of OAC use hospitalised for AMI. We identified 1,330 people hospitalised for AMI with a diagnosis of AF and history of OAC use in New South Wales, Australia, July 2018-June 2020. We identified three aspects of post-discharge antithrombotic medicine use with possible safety implications: (1) not being dispensed OACs; (2) dispensing OAC and P2Y₁₂i combinations associated with increased bleeding (involving warfarin, ticagrelor or prasugrel); and (3) P2Y₁₂i use longer than 12 months. After discharge, 74.3% of people were dispensed an OAC, 45.4% were dispensed a P2Y₁₂i, and 35.8% were dispensed both. People with comorbid heart failure or cancer were less likely to receive OACs. Only 11.2% of people dispensed both an OAC and P2Y₁₂i received combinations associated with increased bleeding; this was more common among people with chronic kidney disease or prior warfarin or statin use. 44.6% of people dispensed both medicines continued P2Y₁₂i for over 12 months; this was more common in people who received a revascularisation or lived in areas of social disadvantage. We identified potential gaps in pharmacotherapy, including underuse of recommended therapies at discharge, use of combinations associated with increased bleeding, and P2Y₁₂i use beyond 12 months. Prescribing vigilance across both hospital and community care is required.