Cardiovascular Prevention and Pharmacotherapy

Volume 6(1); January 2024

Review Articles

Atrial fibrillation: when and how to treat?: Young Keun On; Cardiovasc Prev Pharmacother. 2024;6(1):1-7. Published online January 26, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e4

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Abstract PDF: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia, characterized by an irregular and rapid beating of the atria, which results in a loss of effective atrial contraction. The estimated prevalence of AF in the general population is approximately 0.4%. Research on the incidence of AF indicates a significant increase with age. AF presents a significantly higher risk of stroke compared to normal sinus rhythm, with the risk increasing approximately fivefold. It is estimated that around 5% of AF patients suffer a stroke annually. Roughly 20% to 25% of thromboembolic strokes can be attributed to AF, and AF is also associated with a twofold increase in overall mortality. The goals of AF treatment are symptom relief, restoration of normal cardiac function, prevention of thromboembolism, and reduction in mortality. Therefore, the treatment principles can be summarized into three categories: thromboembolism prevention, rate control, and rhythm control. In the treatment of AF, the first step should be to identify and eliminate any underlying causes or triggers. Caution should be exercised regarding the potential for drug-induced arrhythmias or extracardiac side effects. Safety considerations should take precedence over efficacy when selecting antiarrhythmic drugs. Nonpharmacological treatment methods are employed when anti-arrhythmic drug therapy alone is insufficient, particularly in relatively young individuals (under 70 years) without preexisting heart disease, who have experienced frequent transitions from atrial premature contractions or AF instigated by atrial premature contractions. Monitoring the patient's progress is vital, with a focus on comprehensive care for patients with AF.

Using medical big data for clinical research and legal considerations for the protection of personal information: the double-edged sword: Raeun Kim, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2024;6(1):8-16. Published online January 22, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e1

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Abstract PDF: The advent of medical big data has increased the scope of the clinical use of such data; however, these data have raised serious concerns regarding personal privacy protection, which hinders their usage. For instance, as the pseudonymization or anonymization of data increases, the quality of its clinical use decreases. Thus, a balanced approach is required to maximize clinical data use while protecting personal information as much as possible. However, Korea’s existing laws mandate several kinds of consent; soliciting some of these types of consent can be cumbersome. Moreover, while the collection of medical data by hospitals requires considerable time and money, its ownership is difficult to ascertain. To bridge the enormous gap between the protection of personal information and the use of clinical data, the European Union and countries such as Finland have already proposed various modes of guaranteeing the free movement of personal information that simultaneously strengthen people’s personal rights. Similarly, Korea has initiated the MyData Service, although it faces several limitations. Therefore, this study reviews Korea’s current healthcare big data system, the laws governing data sharing and usage, and compares them with similar laws enacted by the European Union and Finland. It then provides future direction for Korea’s personal information protection legislation. Ultimately, governments must expand and elaborate upon the scope and content of personal information protection laws to enable the development of healthcare and other industries without sacrificing either personal information protection or clinical use of medical data.

Recent evidence on target blood pressure in patients with hypertension: Hack-Lyoung Kim; Cardiovasc Prev Pharmacother. 2024;6(1):17-25. Published online January 22, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e3

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Abstract PDF: Hypertension is a significant risk factor for a variety of cardiovascular diseases, including stroke, coronary artery disease, heart failure, and peripheral arterial disease. Achieving and maintaining a specific target blood pressure (BP) is crucial for effectively reducing the risk associated with these conditions. This involves customizing treatments to meet the individual needs of patients with hypertension, ensuring that each person receives the most appropriate care for their particular circumstances. Previously, based on the findings from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study conducted over the past decade, the target BP for patients with hypertension was set at <140/90 mmHg, regardless of the patient's risk profile. However, new insights from reanalyzed data of studies such as the SPRINT (Systolic Blood Pressure Intervention Trial), the STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) study, and ACCORD subgroup reanalysis have led to a change in this approach. These studies support a more aggressive target BP of <130/80 mmHg, especially for high-risk patients. The purpose of this article is to offer a thorough review of these updated recommendations and to explain the reasoning behind the revised target BP guidelines for individuals with hypertension.

Diverse perspectives on remote collaborative care for chronic disease management: Seo Yeon Baik, Hakyoung Park, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2024;6(1):26-32. Published online January 25, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e5

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Abstract PDF: Remote collaborative care is a program that improves medical services by linking local and remote physicians with residents in areas where access to medical facilities is limited, utilizing information and communication technology. As a result, patients can obtain medical advice and counseling at local hospitals without needing to travel to distant facilities. This care model involves communication between doctors, facilitating the accurate transfer of medical information and reducing the risk of misunderstandings. For instance, managing conditions such as blood pressure or blood glucose is more straightforward because a local hospital can assess the patient's status while a remote hospital simultaneously provides high-quality, specialized medical services. With the rise in poorly controlled hypertension or diabetes, the need for remote collaborative care has also increased. This care model enables local hospitals to maintain continuous patient care with the support of remote facilities. This is particularly true following acute cardiovascular treatment, where local hospitals, assisted by remote institutions, can safely offer high-quality services such as rehabilitation and follow-up care. Although remote hospitals have many advantages with the increasing number of patients, many difficulties remain in commercializing unsystematized remote collaborative care. Specifically, low reimbursements for medical services must be addressed, proper equipment is needed, more time and effort must be invested, and the liability issue must also be dealt with. Nevertheless, remote collaborative care using information and communication technology will be necessary in the future. Medical staff need to objectively examine the advantages and disadvantages of remote collaborative care from various perspectives and find ways to revitalize it.

Original Article

Current status of remote collaborative care for hypertension in medically underserved areas: Seo Yeon Baik, Kyoung Min Kim, Hakyoung Park, Jiwon Shinn, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2024;6(1):33-39. Published online January 22, 2024; DOI: https://doi.org/10.36011/cpp.2024.6.e2

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Abstract PDF: Background
Remote collaborative care (ReCC) is a legally recognized form of telehealth that facilitates communication between physicians. This study aimed to analyze the effectiveness of ReCC services and establish a foundation for the usefulness and effectiveness of ReCC.
Methods
This retrospective cohort study utilized data from the Digital Healthcare Information System (DHIS) managed by the Korea Social Security Information Service. We extracted data on patients who were registered from January 2017 through September 2023 to investigate the effects of various factors.
Results
A total of 10,407 individuals participated in the remote collaborative consultation service provided by the DHIS. Of these participants, those aged ≥80 years represented 39.2% (4,085 patients), while those aged 70 to 79 years comprised 36.9% (3,838 patients). The conditions treated included hypertension, affecting 69.2% (7,203 patients), and diabetes, affecting 21.1% (2,201 patients). Although various measurement items were recorded, most data beyond blood pressure readings were missing, posing a challenge for analysis. Notably, there was a significant reduction in blood pressure that was sustained at follow-up intervals of 1, 3, 6, and 12 months post-baseline (all P<0.05).
Conclusions
Owing to the lack of data, follow-up assessments for conditions other than hypertension proved to be challenging. Medical staff should increase their focus on and engagement with the system. Remote consultations have demonstrated efficacy in managing hypertension in medically underserved areas, where access to healthcare services is often limited. This suggests the potential for expanded use of remote chronic care in the future.

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