Cardiovascular evaluation in Malaysian children is infrequent, often limited to obesity risk, lacking a comprehensive tool, but screening programs could improve primordial prevention.
There is a prevailing lack of systematic cardiovascular health assessment among children and adolescents in Malaysian primary care, highlighting the need for comprehensive, adapted screening tools for primordial prevention.
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Abstract Background In 2022 the American Heart Association introduced "Life’s Essential 8", a framework for promoting cardiovascular health (CVH) comprising eight modifiable factors: healthy diet, physical activity, nicotine exposure, sleep, body mass index, blood pressure, cholesterol, and glucose. High CVH predicts very low rates of cardiovascular disease (CVD) but is typically lost over the life course. Primordial prevention of this loss is needed beginning early in life, particularly in low- and middle-income countries (LMICs), with their high CVD burden. While healthcare priorities often focus on treatment rather than prevention, prevention should begin in early childhood. Purpose To explore current experience and practices related to cardiovascular evaluation in Malaysian children and adolescents in primary care settings. Methods A qualitative study used semi-structured interviews among key stakeholders - policymakers, primary care doctors, nurses, and medical assistants, as well as adolescents (12-18 years) and parents of young children (5-11 years). We conducted one-to-one in-depth interviews and focus group discussions. Interviews were transcribed verbatim, coded, and analysed using thematic analysis. Results 51 participants were interviewed. Four key themes emerged: (1) cardiovascular evaluation of children is infrequent across the various primary care services - maternal and child health clinics, adolescent clinics, outpatient clinics, and school health services; (2) assessment rarely includes all of the 8 CVH metrics and primarily focuses on children and adolescents at risk of obesity; (3) the previous lack of a comprehensive and standardized CVH assessment tool has hindered adoption of this practice; but (4) CVH screening programs and campaigns are perceived as potentially effective strategies for engaging adolescents and parents. Conclusions This study highlights (1) the prevailing lack of a systematic approach to CVH assessment among children and adolescents, with selective screening dependent on a child's risk profile and resource availability; and (2) opportunities to integrate primordial CVD prevention into existing primary care services in Malaysia through child and adolescent clinics, school health team services, and community campaigns. A comprehensive, culturally and linguistically adapted tool to assess CVH among children and adolescents is needed and may soon be available.
Lim et al. (Sat,) reported a other. Cardiovascular evaluation in Malaysian children is infrequent, often limited to obesity risk, lacking a comprehensive tool, but screening programs could improve primordial prevention.