Our Charter

APAC CVD Alliance Charter

Our Charter highlights the Alliance’s policy statements to drive united heart health action in the Asia-Pacific.

01. Background

  • The Asia-Pacific is a dynamic and fast-growing region with socio-economic, ethnic, and cultural diversity with more than 4 billion people and 60% of the world’s population. Rapid urbanisation, aging populations, and sedentary lifestyles have increased the non-communicable disease burden – specifically from heart attacks and stroke – in the region.
  • In Asia, multimorbidity is becoming increasingly common and more people live with chronic diseases such as heart failure (HF), diabetes, kidney disease and lipid disorders.
  • CVDs cause long lasting health, economic and social costs. Yet deaths and disabilities due to CVD have shown no signs of slowing in both developed and emerging economies.
    • From 1990 to 2019, CVD deaths grew by nearly 100%, with nearly 2 in 5 deaths younger than 70 years old. CVD is the leading cause of death in the Asia-Pacific, with East Asia, South Asia and Southeast Asia seeing the largest increase in premature deaths over the last 20 years. Moreover, HF patients in Asia are younger and have higher comorbidities than Western patients.
    • Estimated direct and indirect costs of CVD amounts to US$46.3 billion and 0.9% of GDP in just seven Asian health systems alone (Australia, China, Japan, Singapore, South Korea, Taiwan, Thailand).

    • Many people with CVD rely on informal caregivers, but they too suffer from distressing physical, emotional and economic effects which affects their mental health and quality of life. Several studies have shown that caregivers may feel more social isolation as they replace social activities with caregiving responsibilities.

  • COVID-19 has exacerbated development challenges in the Asia-Pacific, with no country on track to achieve the 17 Sustainable Development Goals (SDGs) by 2030. This includes SDG 3.4, which specifies a one-third reduction in premature mortality from NCDs such as CVD.

02. Considerations

  • Recognising these challenges, united multisectoral action to combat CVD is needed in a diverse Asia-Pacific. The Asia-Pacific Cardiovascular Disease Alliance’s goal is to improve heart health and reduce death and disabilities from heart attacks and strokes.

  • The Alliance aims to do so by uniting action around improving patient advocacy; raising public and policy awareness for CVD to ultimately to increase resourcing for CVD innovations (policies, care models, products or services).

03. Principles

Advance health equity

by prioritising low-resource settings and underserved populations across low, middle and high-income health systems across the Asia-Pacific. Universal health coverage and access to CVD services should also be emphasised as the building blocks of an effective health system.

Adopt a patient-centered approach

across the life-course and care continuum. Recognise that patients have multiple comorbidities including CVD, diabetes, CKD and lipid disorders which necessitates a holistic approach to tackle CVD including from actors outside public health. A broader view of CVD is required comprising other determinants of health including social, environmental, cultural, structural, economic and commercial factors.

Apply evidence-based research

in developing context-specific solutions and findings for CVD action across the Asia-Pacific.

Build interdisciplinary, multisectoral partnerships

across disciplines, specialties, and sectors to create innovative solutions, public awareness, and policy change. A whole-of-government and whole-of-society approach is required to tackle these challenges.

04. Call to action

The Alliance calls on all Asia-Pacific health systems to focus on the following in designing united CVD action.

A. Health systems enablers

Policy & plans

  • Establish national CVD plans that encompass primordial prevention, early detection, primary prevention, secondary prevention, diagnosis, access to treatment, rehabilitation and step-down care.
  • Ensure coordination of CVD policies across other sectors of government, including finance, education, environment and urban planning.
  • Include other non-traditional sectors such as workplaces, community organisations and educational institutes to participate in CVD action.
  • Align national policies with international health resolutions and initiatives including meeting Sustainable Development Goal 3.4 and UHC2030.

Financing

  • Ensure that CVD policies have a long-term, sustainable funding mechanism to achieve better patient outcomes across the care continuum.
  • Ensure that there is a holistic evaluation mechanism to assess the effectiveness and efficacy of CVD policy based on financing.

Research and innovation

  • Develop a favourable environment for implementation of CVD solutions including research to identify context-specific best practices in CVD.
  • Facilitate closer linkages between research findings and policy formulation, dialogue, and reform.
  • Foster innovative approaches to improve CVD health services in technologies, products, practices, services, delivery and policies.
  • Address gaps in heart disease and stroke research for vulnerable and marginalised populations. Ensure that there is gender-specific focus for CVD research.
  • Ensure that there is a national process to regularly update clinical practice guidelines based on the latest evidence-based research. Develop a nationally consistent approach to support health professionals in translation of clinical guidelines.

Data and IT integration

  • Establish a national CVD registry that can incorporate other comorbidities faced by patients.
  • Transition to an electronic medical records system and build interoperability across systems and care settings, including primary healthcare, cardiac rehabilitation, and step-down care, while ensuring data privacy and security for patients.
  • Develop national approaches to the collection and monitoring of CVD data across systems and care settings.

Workforce development

  • Ensure a steady pipeline of health professionals who are adequately trained along all stages of the care continuum. Provide training, education and continuous professional development workplan for all professionals.
  • Strengthen task-sharing and task-shifting using a team-based approach in all care settings.
  • Broaden the healthcare workforce beyond clinicians and nurses and explore opportunities for delegation that improve clinical and operational workflows.

B. Prevention

Primordial prevention

Recognising that the root causes of CVD stem from wider determinants of health in society, health systems should aim to:

  • Collaborate with other national sectors traditionally outside health to align with SDGs 2, 6 and 11 on food security, clean water and sanitation, and sustainable cities respectively.

Primary prevention

Health systems should detect and better manage high-risk CVD patients, including with the following modifiable risk factors:

  • Reduce tobacco use according to each country’s obligations under the WHO Framework Convention of Tobacco Control.
  • Reduce the harmful use of alcohol.
  • Encourage healthy diets by reducing sodium intake, sugar consumption and industrial trans-fats. Encourage nutrition education, labelling and campaigns to increase consumption of fruits and vegetables.
  • Encourage physical activity.
  • Strengthen primary care systems to provide individualised health counselling and health literacy campaigns on the above risk factors.

Secondary prevention.

Lower the risk of an additional event occurring.

  • Ensure that all patients on treatment should have access to appropriate diagnostics, drug therapies, advanced technologies and expertise to prevent re-occurrence of heart attacks, strokes and heart failure rehospitalisation.
  • Ensure that there are integrated care pathways between primary, secondary and tertiary care, proper referral systems in place for primary care to improve further diagnostic work up, to increase medication adherence and inculcate lifestyle changes.
  • A system to regularly monitor and follow-up with patients should be in place.
  • Ensure that comorbid patients are diagnosed for CVD risk such as heart failure.

C. Early detection

Early detection of high-risk CVD patients can save lives and reduce hospital admissions. This lowers the burden on health systems in high-income and low and middle-income countries. Asia-Pacific health systems should aim to:

  • Design clear objectives and target groups for screening, whether at the population level or selected sub-groups based on risk assessments. Ensure these programs are evidence-based and culturally sensitive.
  • Ensure guidelines to detect, assess and manage CVD risk are regularly updated and implemented by healthcare professionals. Validated risk score tools utilised should integrate multiple or combination of risk factors which includes common risk factors, digital biomarkers, biological biomarkers (e.g. LDL-c, HbA1c, LP(a), natriuretic peptides, troponin, kidney function tests, electrolytes or other common parameters deemed appropriate) and measurement of blood pressure.
  • Improve identification and management of hypercholesterolemia, hypertension, heart failure, including through health literacy by equipping the relevant health professionals to engage with patients.
  • Strengthen primary care systems to create an effective and equitable ecosystem to identify high-risk patients and assess eligibility for intervention. Clinicians, nurses and allied health professionals should adopt team-based care.
  • Ensure that there is infrastructure to facilitate early detection, including available diagnostic equipment, reagents, and services.
  • Ensure access to relevant drugs tailored to the individual’s needs with frequent follow up to improve treatment regimen
  • Raise awareness of the importance of early detection, including training for health professionals and public communications campaigns for patients in primary care.

D. Treatment of acute events

Asia-Pacific health systems should be equipped to manage acute CVD events as follows:

  • Raise awareness of signs of acute heart attacks, acute heart failure, and stroke so that patients can receive immediate attention, whether through public communications campaigns, community outreach or other educational opportunities.
  • Implement nationally consistent training for first responders.
  • Examine how ambulance services can be equipped for acute events. Transport links should be improved to reduce waiting times for acute interventions and reduce disparities in urban and rural areas.
  • Ensure dedicated CVD units and cardiac centers are established and adequately resourced in line with health financing guidelines.

E. Cardiac rehabilitation and step-down care

Rehabilitation helps prevent recurrence, improves functional capacity, recovery, and psychological well-being. It allows patients to return to an optimal quality of life. Asia-Pacific health systems should increase the number of cardiac patients participating in rehabilitation as follows:

  • Improve access to cardiac rehabilitation services by designing programs around patients. These programs should be flexible and could include telehealth.
  • Strengthen post-discharge support services for patients and caregivers, including connections with primary care, mental health, peer support services as needed.

05. Conclusion

Improving cardiovascular health in the Asia-Pacific can significantly improve the quality of life for individuals, future-proof health systems, and foster wellbeing and economic prosperity.