Healthcare workers' knowledge, attitudes, and practices towards cardiovascular disease prevention: a multi-national cross-sectional study
Authors: Heng K J Q , Loong S S E , Chew H S J , Yap J , Cader A , Prajapati D , Lee D , Shariff E , Cuenza L , Honda S , Tan W C J , Yeo K K , Wang W , Foo R , Dalakoti M 
Published: October 2024

Abstract

Introduction
Prior studies have shown that improved primordial prevention of cardiovascular disease (CVD) may significantly delay its onset. Healthcare workers (HCWs) are well-placed to influence healthy lifestyle habits for CVD prevention. However, it is unclear how well HCWs fare in this role given the multiple demands on their time in clinical practice.

Purpose
We sought to understand the CVD prevention knowledge, attitudes and practices (KAPs) of HCWs across 25 nations. Insights gained could help inform efforts to optimise CVD prevention by HCWs.
Methodology: Data was collected via an anonymous, online questionnaire which consisted of pre-validated CVD prevention and smoking cessation subscales adapted from the Preventive Medicine Attitudes and Activities Questionnaire (PMAAQ). The subscales have been previously validated in a study population of primary care residents in the US, demonstrating validity and reliability.

Results
668 HCWs (60% doctors, 28% nurses, 12% medical students) from 25 nations responded to the survey. Overall, 74.86% of HCWs routinely assessed patients’ cardiovascular (CV) risk profiles in clinical practice. 65.65% of HCWs counselled patients who were asymptomatic for CVD on tangible lifestyle changes to improve their CV risk profiles, while 68.22% of HCWs did so when patients were overweight. Of note, only 51.26% of HCWs implemented comprehensive smoking cessation interventions for their patients. Practising HCWs demonstrated higher levels of CVD prevention promotion than medical students in all aspects (Fig 1b), except for self-reported importance of CVD risk factor counselling in primary prevention (Tukey HSD diff: 0.31, p-value: 0.051). Among practising HCWs, there were no significant differences in their promotion of CVD prevention across varying lengths of clinical practice. HCWs from higher income nations[1] tended to fare worse than their lower income counterparts in the promotion of CVD prevention (Fig 1a).

Conclusion
A large multi-national survey reveals significant gaps in the promotion of CVD prevention by HCWs, highlighting key differences in CVD prevention practices based on national income status. The results also demonstrate significant differences between medical students and practising HCWs’ CVD prevention behaviours, highlighting the role of continuing education for the promotion of long-term positive CVD prevention clinical practices amongst HCWs. Further efforts may target the medical education of early-career HCWs, especially in higher income nations.
[1] National income level is defined as per the World Bank's classification, with the exception of Taiwan which is not classified as an independent nation under the World Bank. However, Taiwan is still labelled as a high income nation as her GNI (US$33,565) fits the criterion of the World Bank's definition of a high income nation (GNI per capita of &gt;US$13,846).Table 1:Participant demographicsFigure 1a and 1b