A Comprehensive Analysis

Introduction:

In the modern world, cardiovascular disease (CVD) becomes the major health concern that impacts adversely on public health and wellbeing (Cai et al., 2018). The World Health Organisation (WHO) referred to CVD as the health condition that affects the function of the heart and circulatory system [WHO, 2010]. As per the report from British Heart Foundation (2021), currently, more than 7.6 million people in the UK live with heart and circulatory diseases which impact adversely on the physical and psychological health of people (Alaa et al., 2019). The prevalence of CVD is highest in England as compared to all other countries in the UK. This study will present a systematic review on the impacts of CVD on public health in England, especially in young people residing in the North-West region of England. In this context, this systematic review will first present the background or rationale of the selected topic by using evidence-based information on CVD and its impacts on young people in North West England. Then this study will present the search strategy in which it will discuss the search engine and the online database system that are used by the researcher to retrieve relevant research papers. Then this study will discuss the selection criteria by mentioning inclusion and exclusion criteria which are used for searching relevant research papers. Finally, the systemic review will conduct the quality assessment of the research papers and data analysis.

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Rationale:

The NHS (2019) report shows that the prevalence of CVD in England is more apparent in its North West cities such as Blackburn, Darwen PCT and Manchester PCT (bhf-cvd-statistics-uk-factsheet). The report from British Heart Foundation (2021) shows that deaths due to CVD are most common in the North-Western part of England. Adults above 35 years are most affected by coronary heart diseases and heart stroke in the North West part of England (Drozd et al., 2021). Evidence also shows that 3 out of the 5 deaths due to heart disease are reported in the North-West part of England (Fan et al., 2020). Which majority of deaths are accounted for middle-aged people (45-55 years). The majority of the worst deaths have been registered in the Northwest part of England such as Leicester City PCT, Blackburn with Darwen PCT and Manchester PCT ((bhf-cvd-statistics-uk-factsheet). Whereas lowest deaths due to heart disease are registered in the southern and eastern parts of England such as in Dorset PCT, East Sussex Downs, Westminster PCT and Surrey PCT (Fisher, 2020). The report from WHO (2020) shows that in Islington City PCT of England which is located North West region the death rate is three times higher with 115 in every 100,000 people as compared to the other cities (Fan et al., 2020).

The report from British Heart Foundation (2021) shows that more than 137,153 people are died in 2020 due to CVD in England which is higher than in other countries in the UK such as Wales, Scotland, Northern Ireland (BHF, 2021)). Evidence also suggests that the rate of CVD is increasing at a faster rate in England due to many factors such as for overweight, obesity, irregular lifestyle, sedentary lifestyle and congenital heart illness. On the contrary Gao et al., (2021), along with the biological, social and environmental determinant of health that leads to CVD there are psychological factors that also leads people to develop heart diseases. Evidence suggests that in the North West regions of England, people suffer more from unemployment, lack of education poor health education which impacts their physical and mental health. The poor standard of lifestyle, irregular eating, skipping of meals, and lack of exercise and consumption of unhealthy and cholesterol-rich foods are major factors that increase the vulnerability of adults to CVD. On the contrary, Jones et al., (2018), argued that although lifestyle, food habits and socioeconomic factors are considered as the risk factors for CVD, the most potential key drivers of heart disease are the biological and genetic factors. Many researchers suggest that people who have a congenital cardiac illness or genetically history of heart diseases, are more prevalent to develop CVD in later life as compared to other people (Lautsch et al., 2019).

In this context, the selection of this research topic is highly relevant which will provide new insight into the prevalence and impacts of CVD on adult people in the North West region in England. This systematic review is highly appropriate in the current health care context, which will present the epidemiology and impacts of CVD on public health this systematic review is expected to present evidence-based information regarding the prevention and effective management of CVD that help modern nursing professions to get clear ideas on how CVD can be managed in people and CVD-led deaths can be reduced.

Objectives/ review questions:

PICO Tool:

PICO framework is the widely used tool that researchers use to formulate relevant research questions which are appropriate to the research topic and research rationale (Lees et al., 2019). PICO tool has 4 important key aspects such as population, intervention, comparison and outcomes (PICO), which are used to make real as well as highly authentic research questions that will enable researchers to develop appropriate themes and objectives based on these research questions.

This study will use the PICO tool for framing and answering the clinical research question on CVD and its impacts on public health in England in adults. By using this research tool, the researcher will be able to formulate well-defined research questions which will allow the researcher to evaluate, define and implement 4 important aspects of PICO tools (population, intervention, comparison and outcomes) to represent the participants, study design, population and interference in the research study.

PICO Tool PICO Tool

Research question formulated by using PICO tool:

Research question formulated by using PICO tool Research question formulated by using PICO tool Research question formulated by using PICO tool

Search strategy:

As mentioned by Livingstone et al., (2021), a good systematic research study must have a well-defined sear strategy that will describe the clear pathway in which the researcher searches for relevant research articles on the selected topic. In this systematic research, the researcher has used a relevant online database system that assists this research study to retrieve the relevant research articles that can provide authentic and valid information on CVD and its impacts on public health in England.

Here researcher has used various online database systems such as CINAHL, MeSH (Medical subject headings), PubMed, BNI and Psych Info. Relevant search terms are used to search for appropriate research articles by using an online database system. As mentioned by Ma et al., (2019), when it comes to conducting the authentic search strategy, the researcher needs to use the relevant key terms which will enable the researcher to retry the relevant research articles. Boolean operators AND, OR and NOT are used to extend or narrow the literature search. Following are the key terms that are searched for authentic research articles on CVD.

Search strategy Search strategy

Study selection criteria:

Types of participants:

This research is conducted on young people belonging to the age group 18-45 years who live with CVD in the North West region of England. The health condition of these people has been considered as the important inclusion criteria which are used by the researcher while searching for the relevant research articles on CVD (Patel et al., 2021). The young population who suffer from CVD are included in this study to analyse the impacts that CVD has on the health and wellbeing of these people. This systematic research study has selected such research articles that presented the impacts and health outcomes of CVD in young people in England. As mentioned by Petermann-Rocha et al., (2021), in the North West region of England, there is the highest prevalence of CVD which leads to premature deaths and morbidity in young people. several clinical research articles highlight the key drivers as well as risk factors that are associated with the high vulnerability in young people in the North-West part of England to CVD. In this context, the selection of these participants for searching and travelling the research article on CVD is highly relevant to the objectives of this systematic research.

Types of intervention:

As CVD is a chronic health condition it can be cured permanently, but its impacts on public health can be minimised or managed by using effective clinical interventions (Ramakrishnan et al., 2021). The clinical intervention includes both the pharmacological and non-pharmacological processes. The pharmacological process includes drugs, medicinal therapies, surgery, medicine administration for improving the function of the heart and the circulatory system. For pharmacological management of CVD, the commonly used drugs are aspirin, ACE inhibitors, beta-blockers and Thiazides (Peters and Woodward, 2018). The non-pharmacological management of CVD includes changing lifestyle, improving dietary intake, developing healthy food habits, developing self-management skills, conducting health promotion on reducing risk for CVD. In the non-pharmacological clinical intervention process, nurses and social care providers in England will provide proper health education, dietary advice and living standard related advice to the families, people and communities who live with CVD.

Types of outcomes measures:

The expected outcome of the research study is to increase public awareness regarding the risk factors effective management and prevention of CVD in England. Through conducting this systematic research, it is expected to reduce the prevalence of CVD in the North West region in England by developing self-management skills and health awareness in young people who suffer from CVD (Said et al., 2018). This research study is also expected to improve the quality of life of young people who resides in North-Western England by improving their cardiac and circulatory system. Another important expected outcome of this systematic research is that it will provide evidence-based information to health care providers regarding the clinical intervention strategies that they will use to support the families communities in North West England to reduce their vulnerability to CVD (Soran et al., 2018). This study will also improve the perspectives and knowledge of the public regarding how to maintain a healthy heart and circulatory system thereby reducing risks of cardiac arrest and other cardiac conditions.

Types of studies:

This systematic research conducts the secondary research study in which the relevant research articles on the selected topic is retrieved by using a relevant online database system. These research papers are analysed and evaluated critically to identify their strength and weakness to respect the research topic. The inclusion and exclusion criteria are used (type of participants, geographical area and particular health condition) to select the authentic and highly appropriate research articles on CVD.

Study quality assessment:

Tran et al. (2018), have conducted systematic research on the connection between the impacts of CVD on public health and socioeconomic factors. Here researchers have identified the ways in which the socioeconomic condition of people in England determines the severity of the risk of CVD. Zhang et al., (2021), also mentioned in their study that, in England people residing in the most deprived areas are more likely to suffer from heart disease. This is because the deprived and marginalised people in the North West region of England are more likely to lead an unhealthy and irregular lifestyle which leads them to suggest from CVD. Although these researcher papers have successfully highlighted the socioeconomic condition of people as the potential risk factors for CVD, they failed to present a comprehensive discussion on how other risk factors are associated with CVD and how CVD affects the public health system in England.

Zou et al., (2021), mentioned in their research paper that how CVD affects the other biological function of people by affecting the function of kidneys and other organs. In this context, Pate et al. (2019) mentioned that people who reside in the North West region of England are more likely to suffer from comorbidity and complex health condition. The NHS (2020) reports that most of the CVD cases that have been registered in the North-West part of England are associated with other health conditions such as kidney dysfunction or poor lung function. Although Zhang et al., (2021), have mentioned the impacts of CVD on the biological system of people, they fail to highlight the clinical intervention and treatment process for the effective clinical management of CVD in England.

Tran et al. (2018), have conducted useful research on congenital heart disease in adults in New England. The strength of this research study is it highlights that how congenital heart disease enhances the risk of heart stroke and other organ damage in adults of England. On the contrary Seferidi et al. (2019) have emphasized the role of socioeconomic changes in the UK as well as in England after Brexit in triggering the risk of CVD in people by changing their dietary habits and lifestyle. However, the weakness of the research study is that it does not consider the other risk factors of CVD such as the genetic and biological factors environmental factors and socio-cultural factors.

Cai et al., (2018) emphasized the importance of dietary supplementation to prevent heart disease and cancer. Alaa et al., (2019) highlight that, effective nutritional changes and regular exercise can reduce the risk of CVD in young people. Through improving the regular lifestyle it is possible to improve heart function. However, the weakness of this research study is that it fails to highlight the clinical intervention from the management of CVD.

Data synthesis:

Theme 1: There is the prevalence of CVD in young people residing in the North West region of England:

The British Heart Foundation (2021) reports that, as compared to the other countries in the UK England shows the highest prevalence of CVD. The reports also show that in 2020, nearly 6.4 million people in England suffer from CVD as compared to 700,000 people in Scotland and 340,000 people in Wales (Patel, 2018). NHS (2021) mention that the vulnerability of CVD is higher in its North-West part as compared to the other parts. The reasons behind the higher rate of CVD in Northwest England are considered as the higher rate of deprivation, lack of health education, poor health condition, unhealthy lifestyle and irregular food habits of people (Fan et al., 2020). Many areas in North West England such as Leicester City PCT, Blackburn with Darwen PCT and Manchester PCT show the ever-increasing rate of CVD related deaths.

Theme 2: several risk factors are associated with the prevalence of CVD in North West England:

As mentioned by Fisher (2020), several risk factors are associated with the prevalence of CVD in England, especially in the Northern West region. These risk factors are the socioeconomic condition of people, health inequalities, and biological factors such as genetically history of CVD or heart disease in the family, congenital heart disease, Brexit, sociocultural trend, lifestyle and dietary habits. In North West England, the young population are more likely to have the risk of CVD due to their irregular lifestyle, lack of healthy eating, poor dietary habits, lack of nutritional intake, cholesterol consumption and lack of health education. As mentioned by Gao et al., (2021), deprivation and poverty are strongly associated with increased risk of CVD in people. Evidence suggests that in North West England young people face unemployment and lack of education which leads them to develop unhealthy habits such as smoking, heavy drinking and drug addiction which increase their vulnerability to developing CVD.

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Theme 3: lifestyle changes and pharmacological interventional are important for the movement of CVD:

According to Lautsch et al., (2019), for effective management of CVD, it is important to have good food habits and a healthy lifestyle. For reducing the prevalence of CVD in the young population in England, it is important to improve their lifestyle and food habits. As stated by Jones et al., (2018), through maintaining regular a systemic lifestyle, not skipping meals, doing regular exercise and following a healthy diet according to the health condition young people can easily maintain a healthy heart and circulatory system. People in North West England, which live with CVD or congenital heart disease (CHD) can manage the symptoms and health outcomes of these illnesses by following a good medical regimen and maintaining a healthy lifestyle.

Reference list:

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Cai, Y., Hodgson, S., Blangiardo, M., Gulliver, J., Morley, D., Fecht, D., Vienneau, D., de Hoogh, K., Key, T., Hveem, K. and Elliott, P., 2018. Road traffic noise, air pollution and incident cardiovascular disease: a joint analysis of the HUNT, EPIC-Oxford and UK Biobank cohorts. Environment international, 114, pp.191-201.

Drozd, M., Pujades‐Rodriguez, M., Sun, F., Franks, K.N., Lillie, P.J., Witte, K.K., Kearney, M.T. and Cubbon, R.M., 2021. Causes of death in people with cardiovascular disease: a UK Biobank cohort study. Journal of the American Heart Association, 10(22), p.e023188.

Fan, M., Sun, D., Zhou, T., Heianza, Y., Lv, J., Li, L. and Qi, L., 2020. Sleep patterns, genetic susceptibility, and incident cardiovascular disease: a prospective study of 385 292 UK biobank participants. European heart journal, 41(11), pp.1182-1189.

Fisher, M., 2020. Cardiovascular disease and cardiovascular outcomes in COVID‐19. Practical Diabetes, 37(5), pp.191-193a.

Fulchand, S., 2020. Covid-19 and cardiovascular disease. bmj, 369, p.m1997.

Gao, M., Jebb, S.A., Aveyard, P., Ambrosini, G.L., Perez-Cornago, A., Carter, J., Sun, X. and Piernas, C., 2021. Associations between dietary patterns and the incidence of total and fatal cardiovascular disease and all-cause mortality in 116,806 individuals from the UK Biobank: a prospective cohort study. BMC medicine, 19(1), pp.1-12.

Jones, N.R., Forouhi, N.G., Khaw, K.T., Wareham, N.J. and Monsivais, P., 2018. Accordance to the dietary approaches to stop hypertension diet pattern and cardiovascular disease in a British, population-based cohort. European journal of epidemiology, 33(2), pp.235-244.

Lautsch, D., Wang, T., Yang, L. and Rajpathak, S.N., 2019. Prevalence of established cardiovascular disease in patients with type 2 diabetes mellitus in the UK. Diabetes Therapy, 10(6), pp.2131-2137.

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Petermann-Rocha, F., Parra-Soto, S., Gray, S., Anderson, J., Welsh, P., Gill, J., Sattar, N., Ho, F.K., Celis-Morales, C. and Pell, J.P., 2021. Vegetarians, fish, poultry, and meat-eaters: who has higher risk of cardiovascular disease incidence and mortality? A prospective study from UK Biobank. European Heart Journal, 42(12), pp.1136-1143.

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Zhang, H., Zeng, Y., Yang, H., Hu, Y., Hu, Y., Chen, W., Ying, Z., Sun, Y., Qu, Y., Li, Q. and Valdimarsdóttir, U.A., 2021. Familial factors, diet, and risk of cardiovascular disease: a cohort analysis of the UK Biobank. The American journal of clinical nutrition, 114(5), pp.1837-1846.

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