Global Cardiovascular Health Program

The MGH Global Cardiovascular Health Program aims to advance cardiovascular health equity globally through deep investment in local partnerships to support cardiovascular clinical infrastructure, bidirectional training and education, transformative research, and focused advocacy.

Cardiovascular disease is the number one cause of death and disability worldwide. 75% of premature cardiovascular deaths occur in low- and middle- income countries (LMICs). Many countries bear a double burden of ischemic heart disease and strokes, as well as an ongoing burden of neglected cardiovascular diseases including rheumatic heart disease.  In high income countries, significant innovations in cardiovascular diagnosis, drug and device therapy have reduced cardiovascular deaths by over 50% in the last 5 decades. However, these evidence-based and highly effective strategies to prevent and control cardiovascular disease such as blood-pressure and cholesterol lowering medications, penicillin treatment for rheumatic heart disease, heart failure treatment, percutaneous interventions, and cardiac surgery, amongst others, are lacking in many LMICs. There is a need to bridge the gaps to improve patient outcomes.

The Mass General Hospital Global Cardiovascular Health Program is an institutional response to the global cardiovascular disease epidemic. It leverages the world-renowned clinic and research expertise of Mass General faculty in various disciplines and draws on the extensive global health architecture that already exists in the Mass General and Harvard ecosystem. This includes the Mass General Global Health Institute, Harvard Institute of Global Health, and the Division of Global Health Equity at Harvard Medical School.

The program was inaugurated in 2023 under the leadership of Dr. Oyere Onuma and has over 15 affiliated Cardiology and Cardiac Surgery faculty and fellows, working across the globe. The program supports an important portfolio of high-impact projects In high-need areas that are co-developed through priority setting with in-country local partners and governments. Our engagement philosophy is centered on providing catalytic and time-bound support to create programs with long term sustainability under local control.

In these projects, Mass General Global Cardiovascular Health Program provides support in the form of technical expertise, planning and initial resources to support implementation. We concurrently work with partners to build a research and education/training scaffold that extends the impact of our work and trains the next cadre of leaders in the field.

Our current roster of ongoing projects include:

• Peripartum cardiomyopathy clinic in Haiti – Dr. Carl Turassini
• Rheumatic Heart Disease screening and secondary prevention in Cabo Verde – Dr. Doreen DeFaria Yeh, Dr. Oyere Onuma
• Pacemaker Implantation in Cabo Verde – Dr. DeFaria Yeh, Dr. Leon Ptaszek, Dr. Bill Hucker
• STEMI system of care in Kenya – Dr. Njambi Mathenge

Cape Verde is an archipelago of 10 islands on the Northwest coast of Africa. Total population is just under 500,000, with a significant number of citizens in the diaspora in Europe and in the United States.

ECHO lab in Praia

Cardiovascular disease is the leading cause of death in Cabo Verde, primarily strokes likely driven by hypertension. There are very basic cardiovascular services in the referral hospitals in Praia (Hospital Aghostino Neto) and Mindelo (Hospital Baptista de Sousa) and the system is dependent on limited numbers of evacuations to Portugal to address any advanced conditions. There are only 11 cardiologists total in Cabo Verde, 5 work in the public system and 6 in private practice.

Following a situational analysis visit in April 2023, the MGH Global Cardiovascular Health Program proposed a long-term and multi-pronged partnership with colleagues and government in Cabo Verde to improve access to and quality of cardiovascular disease care on the islands.

Key Milestones

• Initial engagement in April 2023, collaboration with the Cape Verdean American Medical Society (CVAMS)
• Visit to Hospital Aghostino Neto in Praia, as well as providing clinical services in San Antoa and Fogo
• Primary local partner is Dr. Luis Dias, Head of Cardiology at HUAN, Praia
• MGH GCVHP hosted Dr. Dias and colleagues, including the Honorable Minister of Health, Cabo Verde in October 2023 during the CVAMS annual meeting.
• 04/2024: Initial screening for Rheumatic Heart Disease Program
• 06/2024: Pacemaker implantation program with Boston Cardiac Foundation

How can we impact care and outcomes?

• First local Pacemaker Implantation program in Cape Verde (currently 150 patients on waiting list)- ongoing
• National Rheumatic Heart Disease Screening program in Cape Verde (RHD is still endemic on multiple islands) – ongoing
• Comprehensive program to support the treatment of CV risk factors including high blood pressure, high cholesterol, and diabetes at primary healthcare level.
• Research training and mentorship for local cardiologists in Cape Verde
• Cohort study of CV risk factors and disease incidence in Cape Verde and diaspora populations in Boston
• Improve facilities and equipment for diagnosis and treatment of heart disease
• Decrease mortality and morbidity from cardiovascular disease in Cabo Verde.