Introduction
Cardiovascular disease (CVD) is the leading cause of disability and premature mortality globally, responsible for 366 million disability-adjusted life years (DALYs) and 17.8 million deaths in 2017.1 Furthermore, ischaemic heart disease (IHD) accounts for the majority of health lost to CVD in all regions of the world.2 The burden of CVD disproportionately affects those living in low/middle-income countries (LMIC), where cardiovascular conditions and risk factors are on the rise as a result of an ongoing epidemiological transition.2 Additionally, the mortality rate from CVD in LMIC is significantly above that in high-income countries.3 In Brazil alone, CVD is responsible for nearly one-third of total deaths and 14% of total DALYs.1
In response to the growing health impact of CVD, the WHO has set a target of a 25% reduction in CVD-associated premature mortality by 2025.4 Achievement of this target requires countries to make improvements along the entire continuum of care. This includes efforts to improve primary prevention by addressing CVD risk factors, timely and appropriate treatment of acute cardiovascular events such as acute coronary syndromes and evidence-based secondary prevention programmes to limit adverse long-term outcomes.5–7 Within this continuum, public knowledge of CVD risk factors, symptoms of acute cardiac events and appropriate bystander response is key to modifying health behaviours and improving health outcomes.8 9
Building on a similar programme in the USA,10 the Global HeartRescue project is a public health initiative that aims to improve access to and quality of care, and health outcomes, for acute cardiovascular events such as acute myocardial infarction (AMI) and sudden cardiac arrest. HeartRescue intends to foster local ownership of each country programme by engaging multisector stakeholders, including governments, medical professional societies, local healthcare providers, patients and families. The programme focuses on minimising critical delays to treatment by coordinating performance and outcomes measurement, education, training and the application of evidence-based best practices.
To inform the development of high-impact interventions in underserved communities in Brazil, a baseline survey was completed in three municipalities in eastern Brazil. This paper presents findings from the HeartRescue landscape assessment of public knowledge of CVD risk factors and AMI symptoms as well as cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) awareness and training. Results of a similar landscape assessment in three megacities in China and India have been previously published.11