Reinforcement of Peer-Coaching and Clinical Audit to improve Implementation of the Package of Essential Non-Communicable Diseases (PEN) in Nepal: A Pilot Implementation Study Method

Introduction: Nepal endorsed and implemented the WHO Package of Essential Non-communicable Disease Intervention. However, its implementation is far from satisfactory. We designed and implemented an intervention to reinforce peer coaching and clinical audit mechanisms in primary- level health facilities, and tested its feasibility and preliminary effectiveness. This paper details the methodology used in designing, implementing and assessing the intervention. Methods: The study adoptes a hybrid type II implementation trial design. The intervention assignment followed a non-blinded, two-arm, parallel randomized controlled trial design with a 1:1 allocation ratio. Seventeen primary-level public health facilities with at least one trained staff were randomized. The clinical staff at the intervention health facilities received peer-coaching and clinical audit reinforcement, while the control group followed their usual practice. The study was conducted over a 12-month duration. A mixed-method approach, applying pre-post assessment and thematic analysis, to inform the intervention development and assess implementation outcomes and its effectiveness was. The study was guided by the Proctor framework. Ethical clearance was obtained from the Nepal Health Research Council (Registraion number: 30212021). Discussion: The tools and methods that guide intervention implementation and assessment have the potential to be replicated in various settings to design strategies to improve Package of Essential Non-communicable Disease Intervention adoption and sustainment. Trial Registration: This trial is registered with ClinicalTrials.gov (www.clinicaltrials.gov) on 30 May 2025, Identifier: NCT05794399

Primary Prevention of Cardiovascular Disease in Asia: Opportunities and Solutions: A Narrative Review

IMPORTANCE: Asia faces a rapidly rising burden of cardiovascular disease (CVD). Preventive cardiology efforts may help address the CVD epidemic. OBSERVATIONS: Solutions to address the CVD burden include a cardiovascular risk assessment framework, improving health screening efforts, better cardiovascular risk factor management, novel innovation strategies encompassing targeted lifestyle measures, and strengthening governmental efforts. With the region's wide socioeconomic and other disparities, contextualizing and practical adaptation of various strategies into local practices, especially in low-middle-income countries, will determine the success of CVD prevention efforts. CONCLUSIONS: A differential approach addressing cardiovascular risk factor screening, prevention, and management that considers the context-specific socioeconomic, governmental, and cultural aspects in diverse Asian populations may help reduce the rapidly rising CVD trajectory in Asia

Primary Prevention of Cardiovascular Disease in Asia: Challenges: A Narrative Review

IMPORTANCE: Asia is home to 60% of the world's population, including the world's two most populous countries, India (1.1B) and China (1.2B). With cardiovascular disease burden and mortality increasing, the role of preventive cardiology is increasingly important. OBSERVATIONS: The challenges in addressing the cardiovascular disease burden in Asia include unique cardiometabolic features of the different populations, heterogeneity of risk factors among Asian countries, differing levels of health literacy and socioeconomic status, suboptimal infrastructure to support preventive care especially in the primary care sector, high out-of-pocket costs, and environmental pollution. CONCLUSIONS: Asia is a large continent that comprises diverse populations with varying cultures, socioeconomic status, and health literacy levels. Effective preventive cardiology may require differential health care resource allocation and financing models

Transcatheter Closure of Atrial Septal Defect and Balloon Pulmonary Valvuloplasty with Inoue Balloon in Adult Patients.

Secundum type atrial septal defect combined with pulmonic stenosis is a relatively uncommon condition in adult patients. When occurred separately they can be treated with transcatheter intervention. When they occur together ideal treatment option is not clear. We report a case of combined percutaneous pulmonary valvuloplasty done with the Inoue balloon and transcatheter atrial septal defect closure in an adult patient.</jats:p

Cardiac Society of Nepal (CSN) and World Heart Federation (WHF) Cardiovascular Diseases Scorecard Project

Cardiac Society of Nepal in coordination with World Heart Federation created this scorecard or Cardiovascular profile for identification of different markers for the incidence and prevalence of heart disease in Nepal. The objective of the scorecard was to understand and assess national CVD action from a civil society perspective in an effort to complement and support official government surveillance, monitoring and reporting on CVD.</jats:p

Left Main Atresia: Supply from the right coronary circulation- a rare coronary artery anomaly

Coronary artery anomalies are rare incidental findings, about 20% with clinical significance of possible increased risk of related adverse cardiac events including sudden death. Multi detector computed tomography has become the first-line imaging modality to visualize the origin and course of anomalous blood vessels, assisting the further categorization and treatment recommendations. We present a case of 52 years old woman with left main atresia and right coronary artery supplying the entire cardiac muscles through the connection of posterior lateral artery to the distal segment of the left circumflex artery.</jats:p