Table 1.2Essential Package of Interventions: Disease-Specific Interventions

 Personal health services, by delivery platform
Disease conditionFiscal, intersectoral, and public health interventionsCommunity basedPrimary health centerFirst-level hospitalReferral and specialized hospitals
Ischemic heart disease, stroke, and peripheral artery diseasea——15. Long-term management with aspirin, beta-blockers,a ACEi, and statins (as indicated) to reduce risk of further events
16. Use of aspirin in all cases of suspected myocardial infarction		17. Use of unfractionated heparin, aspirin, and generic thrombolytics in acute coronary events
18. Management for acute critical limb ischemia with unfractionated heparin and revascularization if available, with amputation as a last resort		19. Use of percutaneous coronary intervention for acute myocardial infarction where resources permit
Heart failure——20. Medical management with diuretics, beta-blockers,b ACEi,b and mineralocorticoid antagonistsb,c21. Medical management of acute heart failure—
 22. Mixed vertical-horizontal insecticide spray programs to prevent Chagas disease—23. Treatment of acute pharyngitis (children) to prevent rheumatic fever d
24. Secondary prophylaxis with penicillin for rheumatic fever or established rheumatic heart disease		——
Diabetes—25. Diabetes self-management education26. Prevention of long-term complications of diabetes through blood pressure, lipid, and glucose management as well as consistent foot care
27. Screening and treatment for albuminuria		—28. Retinopathy screening via telemedicine, followed by treatment using laser photocoagulation
Kidney disease29. If transplantation available, creation of deceased donor programsc—30. Treatment of hypertension in kidney disease, with use of ACEi or ARBs in albuminuric kidney diseasec——
Respiratory disease—31. Self-management for obstructive lung disease to promote early recognition and treatment of exacerbations
32. Exercise-based pulmonary rehabilitation for patients with obstructive lung disease		33. Annual flu vaccination and five-yearly pneumococcal vaccine for patients with underlying lung disease
34. Low-dose inhaled corticosteroids and bronchodilators for asthma and for selected patients with COPDe		35. Management of acute exacerbations of asthma and COPD using systemic steroids, inhaled beta-agonists, and, if indicated, oral antibiotics and oxygen therapy36. Management of acute ventilatory failure due to acute exacerbations of asthma and COPD; in COPD, use of bilevel positive airway pressure preferred

Note: Red type denotes urgent care; blue type denotes continuing care; black type denotes routine care. — = none; ACEi = angiotensin-converting enzyme inhibitors; ARB = angiotensin receptor blocker; COPD = chronic obstructive pulmonary disease.

a

Not applicable to peripheral artery disease.

b

Applicable to heart failure with reduced ejection fraction.

c

Data from high-income countries only.

d

Use available treatment algorithms to determine appropriate antibiotic use.

e

Inhaled corticosteroids are indicated in patients with COPD who have severe disease or frequent exacerbations.

From: Chapter 1, Cardiovascular, Respiratory, and Related Disorders: Key Messages and Essential Interventions to Address Their Burden in Low- and Middle-Income Countries

Cover of Cardiovascular, Respiratory, and Related Disorders
Cardiovascular, Respiratory, and Related Disorders. 3rd edition.
Prabhakaran D, Anand S, Gaziano TA, et al., editors.
© 2017 International Bank for Reconstruction and Development / The World Bank.

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