Top

Current Rheumatology Reports

Published in:

Open Access 01-03-2018 | Crystal Arthritis (L Stamp, Section Editor)

How Can We Improve Disease Education in People with Gout?

Authors: Theodore R. Fields, Adena Batterman

Published in: Current Rheumatology Reports | Issue 3/2018

Abstract

Purpose of Review

Gout management is currently suboptimal despite excellent available therapy. Gout patient education has been shown to enhance medication adherence and self-management, but needs improvement. We explored the literature on gout patient education including gaps in gout patient knowledge; use of written materials; in-person individual and group sessions; education via nurses, pharmacists, or multi-disciplinary groups; and use of phone, web-based, mobile health app, and text messaging educational efforts.

Recent Findings

Nurse-led interventions have shown significant improvement in reaching urate goals. Pharmacist-led programs have likewise succeeded, but to a lesser degree. A multi-disciplinary approach has shown feasibility. Needs-assessments, patient questionnaires, and psychosocial evaluations can enhance targeted education.

Summary

An interactive and patient-centered approach can enhance gout educational interventions. Optimal programs will assess for and address educational needs related to knowledge gaps, health literacy, race, gender, socio-economic status, and level of social support.

Cutler DM, Everett W. Thinking outside the pillbox—medication adherence as a priority for health care reform. N Engl J Med. 2010;362(17):1553–5. https://doi.org/10.1056/NEJMp1002305.CrossRefPubMed

Dalbeth N, Petrie KJ, House M, Chong J, Leung W, Chegudi R, et al. Illness perceptions in patients with gout and the relationship with progression of musculoskeletal disability. Arthritis Care Res. 2011;63(11):1605–12. https://doi.org/10.1002/acr.20570.CrossRef

Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheumatism. 2011;63(10):3136–41. https://doi.org/10.1002/art.30520.CrossRefPubMed

Chandratre P, Mallen CD, Roddy E, Liddle J, Richardson J. “You want to get on with the rest of your life”: a qualitative study of health-related quality of life in gout. Clin Rheumatol. 2016;35(5):1197–205. https://doi.org/10.1007/s10067-015-3039-2.CrossRefPubMed

Md DB, Andrews LM, Yadao AM, Kahler KH. The effect of gout on health-related quality of life, work productivity, resource use and clinical outcomes among patients with hypertension. Expert Rev Pharmacoecon Outcomes Res. 2012;12:821–9.CrossRef

Spaetgens B, Tran-Duy A, Wijnands JMA, van der Linden S, Boonen A. Health and utilities in patients with gout under the care of a rheumatologist. Arthritis Care Res. 2015;67(8):1128–36. https://doi.org/10.1002/acr.22551.CrossRef

Fisher MC, Rai SK, Lu N, Zhang Y, Choi HK. The unclosing premature mortality gap in gout: a general population-based study. Ann Rheum Dis. 2017;76(7):1289–94. https://doi.org/10.1136/annrheumdis-2016-210588.CrossRefPubMed

Rai SK, Burns LC, De Vera MA, Haji A, Giustini D, Choi HK. The economic burden of gout: a systematic review. Semin Arthritis Rheum. 2015;45(1):75–80. https://doi.org/10.1016/j.semarthrit.2015.02.004.CrossRefPubMed

Doherty M, Jansen TL, Nuki G, Pascual E, Perez-Ruiz F, Punzi L, et al. Gout: why is this curable disease so seldom cured? Ann Rheum Dis. 2012;71(11):1765–70. https://doi.org/10.1136/annrheumdis-2012-201687.CrossRefPubMed

10.

Khanna PP, Perez-Ruiz F, Maranian P, Khanna D. Long-term therapy for chronic gout results in clinically important improvements in the health-related quality of life: short form-36 is responsive to change in chronic gout. Rheumatology (Oxford). 2011;50(4):740–5. https://doi.org/10.1093/rheumatology/keq346.CrossRef

11.

Schumacher HR, Becker MA, Lloyd E, MacDonald PA, Lademacher C. Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study. Rheumatology (Oxford). 2009;48(2):188–94. https://doi.org/10.1093/rheumatology/ken457.CrossRef

12.

Hui M, Carr A, Cameron S, Davenport G, Doherty M, Forrester H, et al. The British Society for Rheumatology Guideline for the Management of Gout. Rheumatology (Oxford). 2017;56(7):1056–9. https://doi.org/10.1093/rheumatology/kex150.CrossRef

13.

Khanna D, Fitzgerald JD, Khanna PP, Bae S, Singh MK, Neogi T, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res. 2012;64(10):1431–46. https://doi.org/10.1002/acr.21772.CrossRef

14.

Richette P, Doherty M, Pascual E, Barskova V, Becce F, Castañeda-Sanabria J, et al. 2016 updated EULAR evidence-based recommendations for the management of gout. Ann Rheum Dis. 2017;76(1):29–42. https://doi.org/10.1136/annrheumdis-2016-209707.CrossRefPubMed

15.

Annemans L, Spaepen E, Gaskin M, Bonnemaire M, Malier V, Gilbert T, et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis. 2008;67(7):960–6. https://doi.org/10.1136/ard.2007.076232.CrossRefPubMed

16.

Juraschek SP, Kovell LC, Miller ER, Gelber AC. Gout, urate-lowering therapy, and uric acid levels among adults in the United States. Arthritis Care Res. 2015;67(4):588–92. https://doi.org/10.1002/acr.22469.CrossRef

17.

Rashid N, Coburn BW, Wu Y, Cheetham TC, Curtis JR, Saag KG, et al. Modifiable factors associated with allopurinol adherence and outcomes among patients with gout in an integrated healthcare system. J Rheumatol. 2015;42(3):504–12. https://doi.org/10.3899/jrheum.140588.CrossRefPubMed

18.

De Vera MA, Marcotte G, Rai S, Galo JS, Bhole V. Medication adherence in gout: a systematic review. Arthritis Care Res. 2014;66(10):1551–9. https://doi.org/10.1002/acr.22336.CrossRef

19.

Scheepers, Lieke E J M, Onna Mv, Stehouwer CDA, Singh JA, Arts ICW, Boonen A. Medication adherence among patients with gout: a systematic review and meta-analysis. Semin Arthritis Rheum 2017. https://doi.org/10.1016/j.semarthrit.2017.09.007.

20.

Ogdie AR, Hoch S, Dunham J, Von Feldt JM. A roadmap for education to improve the quality of care in gout. Curr Opin Rheumatol. 2010;22(2):173–80. https://doi.org/10.1097/BOR.0b013e328335eee3.CrossRefPubMed

21.

Dalbeth N, Choi HK, Terkeltaub R. Review: gout: a roadmap to approaches for improving global outcomes. Arthritis Rheumatol. 2017;69:22–34.CrossRefPubMedPubMedCentral

22.

•• Dalbeth N, Lindsay K. The patient’s experience of gout: new insights to optimize management. Curr Rheumatol Rep. 2012;14:173–8. Outstanding review of the gout experience from the patient’s point of view.CrossRefPubMed

23.

Coburn BW, Bendlin KA, Sayles H, Hentzen KS, Hrdy MM, Mikuls TR. Target serum urate: do gout patients know their goal? Arthritis Care Res. 2016;68(7):1028–35. https://doi.org/10.1002/acr.22785.CrossRef

24.

Wright S, Chapman PT, Frampton C, O’Donnell JL, Raja R, Stamp L. Management of gout in a hospital setting: a lost opportunity. J Rheumatol. 2017;44(10):1493–8. https://doi.org/10.3899/jrheum.170387.CrossRefPubMed

25.

Iversen MD, Hammond A, Betteridge N. Self-management of rheumatic diseases: state of the art and future perspectives. Ann Rheum Dis. 2010;69(6):955–63. https://doi.org/10.1136/ard.2010.129270.CrossRefPubMed

26.

Lorig K, Lubeck D, Kraines RG, Seleznick M, Holman HR. Outcomes of self-help education for patients with arthritis. Arthritis Rheum. 1985;28(6):680–5. https://doi.org/10.1002/art.1780280612.CrossRefPubMed

27.

Ory MG, Ahn S, Jiang L, Lorig K, Ritter P, Laurent DD, et al. National study of chronic disease self-management: six-month outcome findings. J Aging Health. 2013;25(7):1258–74. https://doi.org/10.1177/0898264313502531.CrossRefPubMed

28.

Lindsay K, Gow P, Vanderpyl J, Logo P, Dalbeth N. The experience and impact of living with gout: a study of men with chronic gout using a qualitative grounded theory approach. J Clin Rheumatol. 2011;17:1–6.CrossRefPubMed

29.

Harrold LR, Mazor KM, Velten S, Ockene IS, Yood RA. Patients and providers view gout differently: a qualitative study. Chronic Illness. 2010;6(4):263–71. https://doi.org/10.1177/1742395310378761.CrossRefPubMedPubMedCentral

30.

Dow A, Thibault G. Interprofessional education—a foundation for a new approach to health care. N Engl J Med. 2017;377(9):803–5. https://doi.org/10.1056/NEJMp1705665.CrossRefPubMed

31.

Morris C, Macdonald L, Stubbe M, Dowell A. “It’s complicated”—talking about gout medicines in primary care consultations: a qualitative study. BMC Fam Pract. 2016;17(1):114. https://doi.org/10.1186/s12875-016-0515-y. CrossRefPubMedPubMedCentral

32.

van Mierlo T, Fournier R, Ingham M. Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development. PLoS One. 2015;10(6):e0129364. https://doi.org/10.1371/journal.pone.0129364.CrossRefPubMedPubMedCentral

33.

Ndosi M, Johnson D, Young T, Hardware B, Hill J, Hale C, et al. Effects of needs-based patient education on self-efficacy and health outcomes in people with rheumatoid arthritis: a multicentre, single blind, randomised controlled trial. Ann Rheum Dis. 2016;75(6):1126–32. https://doi.org/10.1136/annrheumdis-2014-207171.CrossRefPubMed

34.

Zangi HA, Ndosi M, Adams J, Andersen L, Bode C, Boström C, et al. EULAR recommendations for patient education for people with inflammatory arthritis. Ann Rheum Dis. 2015;74(6):954–62. https://doi.org/10.1136/annrheumdis-2014-206807.CrossRefPubMed

35.

Zhang LY, Schumacher HR, Su HH, Lie D, Dinnella J, Baker JF, et al. Development and evaluation of a survey of gout patients concerning their knowledge about gout. J Clin Rheumatol. 2011;17(5):242–8. https://doi.org/10.1097/RHU.0b013e318228b4e2.CrossRefPubMed

36.

Harrold LR, Mazor KM, Peterson D, Naz N, Firneno C, Yood RA. Patients’ knowledge and beliefs concerning gout and its treatment: a population based study. BMC Musculoskelet Disord. 2012;13(1):180. https://doi.org/10.1186/1471-2474-13-180.CrossRefPubMedPubMedCentral

37.

Spaetgens B, Pustjens T, Scheepers L, Janssens H, van der Linden S, Boonen A. Knowledge, illness perceptions and stated clinical practice behaviour in management of gout: a mixed methods study in general practice. Clin Rheumatol. 2016;35(8):2053–61. https://doi.org/10.1007/s10067-016-3212-2.CrossRefPubMedPubMedCentral

38.

Richardson JC, Liddle J, Mallen CD, Roddy E, Prinjha S, Ziebland S, et al. “Why me? I don’t fit the mould … I am a freak of nature”: a qualitative study of women’s experience of gout. BMC Womens Health. 2015;15(1):122. https://doi.org/10.1186/s12905-015-0277-z.CrossRefPubMedPubMedCentral

39.

Rifaat A, Batterman A, Horton R, Fields TR. Developing a gout needs assessment incorporating patient perspective on self-management, self-efficacy and disease specific knowledge, to inform a patient education initiative. ACR meeting abstracts. [abstract]. Arthritis Rheumatol. 2016;68(suppl 10). http://acrabstracts.org/abstract/developing-a-gout-needs-assessment-incorporating-patient-perspective-on-self-management-self-efficacy-and-disease-specific-knowledge-to-inform-a-patient-education-initiative.

40.

Weinberger SE, Johnson BH, Ness DL. Patient- and family-centered medical education: the next revolution in medical education? Ann Intern Med. 2014;161(1):73–5. https://doi.org/10.7326/M13-2993.CrossRefPubMed

41.

Duyck SD, Petrie KJ, Dalbeth N. “You don’t have to be a drinker to get gout, but it helps”: a content analysis of the depiction of gout in popular newspapers. Arthritis Care Res. 2016;68(11):1721–5. https://doi.org/10.1002/acr.22879.CrossRef

42.

Spencer K, Carr A, Doherty M. Patient and provider barriers to effective management of gout in general practice: a qualitative study. Ann Rheum Dis. 2012;71:1490–5.CrossRefPubMed

43.

Vaccher S, Kannangara DRW, Baysari MT, Reath J, Zwar N, Williams KM, et al. Barriers to care in gout: from prescriber to patient. J Rheumatol. 2016;43:144–9.CrossRefPubMed

44.

Kirwan JR, Tugwell PS. Overview of the patient perspective at OMERACT 10—conceptualizing methods for developing patient-reported outcomes. J Rheumatol. 2011;38(8):1699–701. https://doi.org/10.3899/jrheum.110388.CrossRefPubMed

45.

Singh JA, Taylor WJ, Simon LS, Khanna PP, Stamp LK, McQueen FM, et al. Patient-reported outcomes in chronic gout: a report from OMERACT 10. J Rheumatol. 2011;38(7):1452–7. https://doi.org/10.3899/jrheum.110271.CrossRefPubMed

46.

Khanna P, Berrocal V, Hays T, Clauw DJ, Williams DA. Focus groups reveal knowledge gaps in patients with gout-a qualitative study. ACR Meeting Abstracts. 2012. http://acrabstracts.org/abstract/focus-groups-reveal-knowledge-gaps-in-patients-with-gout-a-qualitative-study/

47.

Treharne GJ, Richardson AC, Neha T, Fanning N, Janes R, Hudson B, et al. Education preferences of people with gout: exploring differences between indigenous and non-indigenous peoples from rural and urban locations. Arthritis Care Res. 2017. https://doi.org/10.1002/acr.23272.

48.

Krishnan E, Lienesch D, Kwoh CK. Gout in ambulatory care settings in the United States. J Rheumatol. 2008;35:498–501.PubMed

49.

Krishnan E. Gout in African Americans. Am J Med. 2014;127(9):858–64. https://doi.org/10.1016/j.amjmed.2014.03.039.CrossRefPubMed

50.

Singh JA. Facilitators and barriers to adherence to urate-lowering therapy in African-Americans with gout: a qualitative study. Arthritis Res Ther. 2014;16(2):R82. https://doi.org/10.1186/ar4524.CrossRefPubMedPubMedCentral

51.

Singh JA. The impact of gout on patient’s lives: a study of African-American and Caucasian men and women with gout. Arthritis Res Ther. 2014;16(3):R132. https://doi.org/10.1186/ar4589.CrossRefPubMedPubMedCentral

52.

Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90. https://doi.org/10.2105/AJPH.94.12.2084.CrossRefPubMedPubMedCentral

53.

Humphrey C, Hulme R, Dalbeth N, Gow P, Arroll B, Lindsay K. A qualitative study to explore health professionals’ experience of treating gout: understanding perceived barriers to effective gout management. J Prim Health Care. 2016;8(2):149–56. https://doi.org/10.1071/HC15017.CrossRefPubMed

54.

Flurey C, Hewlett S, RODHAM K, White A, Noddings R, Kirwan J. Coping strategies, psychological impact and support preferences of men with rheumatoid arthritis: a multicentre survey. Arthritis Care Res 2017. https://doi.org/10.1002/acr.23422.

55.

Johnston ME, Treharne GJ, Chapman PT, Stamp LK. Patient information about gout: an international review of existing educational resources. J Rheumatol. 2015;42(6):975–8. https://doi.org/10.3899/jrheum.141442.CrossRefPubMed

56.

Robinson PC, Schumacher HR. A qualitative and quantitative analysis of the characteristics of gout patient education resources. Clin Rheumatol. 2013;32(6):771–8. https://doi.org/10.1007/s10067-013-2168-8.CrossRefPubMed

57.

Lawrence Edwards N, Malouf R, Perez-Ruiz F, Richette P, Southam S, DiChiara M. Computational lexical analysis of the language commonly used to describe gout. Arthritis Care Res. 2016;68(6):763–8. https://doi.org/10.1002/acr.22746.CrossRef

58.

Jimenez-Liñan LM, Edwards L, Abhishek A, Doherty M. Adequacy of online patient information resources on gout and potentially curative urate-lowering treatment. Arthritis Care Res. 2017;69(5):748–52. https://doi.org/10.1002/acr.22981.CrossRef

59.

Nguyen AD, Baysari MT, Kannangara DRW, Tariq A, Lau AYS, Westbrook JI, et al. Mobile applications to enhance self-management of gout. Int J Med Inform. 2016;94:67–74. https://doi.org/10.1016/j.ijmedinf.2016.06.021.CrossRefPubMed

60.

Vervloet M, Linn AJ, Van Weert JCM, Bakker DH, Bouvy ML, Dijk LV. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. J Am Med Inform Assoc. 2012;19(5):696–704. https://doi.org/10.1136/amiajnl-2011-000748.CrossRefPubMedPubMedCentral

61.

Galo JS, Mehat P, Rai SK, Avina-Zubieta A, De Vera MA. What are the effects of medication adherence interventions in rheumatic diseases: a systematic review. Ann Rheum Dis. 2016;75:667–73.CrossRefPubMed

62.

Nasser-Ghodsi N, Harrold LR. Overcoming adherence issues and other barriers to optimal care in gout. Curr Opin Rheumatol. 2015;27(2):134–8. https://doi.org/10.1097/BOR.0000000000000141.CrossRefPubMed

63.

Goldfien R, Pressman A, Jacobson A, Ng M, Avins A. A pharmacist-staffed, virtual gout management clinic for achieving target serum uric acid levels: a randomized clinical trial. Permanente J. 2016;20:18. https://doi.org/10.7812/TPP/15-234.

64.

Mikuls TR, Cheetham T, Levy GD, Rashid N, Low K, Coburn BW, Saag K, Chen L, Curtis JR. Improving gout outcomes: the randomized evaluation of an ambulatory care pharmacist-led intervention to optimize urate lowering pathways (RAmP-Up) study [abstract]. Arthritis Rheumatol. 2017;69(suppl 10). http://acrabstracts.org/abstract/improving-gout-outcomes-the-randomized-evaluation-of-an-ambulatory-care-pharmacist-led-intervention-to-optimize-urate-lowering-pathways-ramp-up-study.

65.

•• Rees F, Jenkins W, Doherty M. Patients with gout adhere to curative treatment if informed appropriately: proof-of-concept observational study. Ann Rheum Dis. 2013;72:826–30. Important finding of excellent outcomes with strong nurse-led gout education program.CrossRefPubMed

66.

Abhishek A, Jenkins W, La-Crette J, Fernandes G, Doherty M. Long-term persistence and adherence on urate-lowering treatment can be maintained in primary care-5-year follow-up of a proof-of-concept study. Rheumatology (Oxford). 2017;56(4):529–33. https://doi.org/10.1093/rheumatology/kew395.

67.

Larsson I, Arvidsson S, Bergman S, Arvidsson B. Patients’ perceptions of drug information given by a rheumatology nurse: a phenomenographic study. Musculoskeletal Care. 2010;8(1):36–45. https://doi.org/10.1002/msc.164.CrossRefPubMed

68.

Fields TR, Rifaat A, Yee AMF, Ashany D, Kim K, Tobin M, et al. Pilot study of a multidisciplinary gout patient education and monitoring program. Semin Arthritis Rheum. 2016;46:601–8. https://doi.org/10.1016/j.semarthrit.2016.10.006. CrossRefPubMedPubMedCentral

69.

Lorig K, Gonzalez VM, Ritter P. Community-based Spanish language arthritis education program: a randomized trial. Med Care. 1999;37(9):957–63. https://doi.org/10.1097/00005650-199909000-00011.CrossRefPubMed

70.

Grønning K, Midttun L, Steinsbekk A. Patients’ confidence in coping with arthritis after nurse-led education; a qualitative study. BMC Nurs. 2016;15(1):28. https://doi.org/10.1186/s12912-016-0150-x.CrossRefPubMedPubMedCentral

71.

Dures E, Kitchen K, Almeida C, Ambler N, Cliss A, Hammond A, et al. “They didn’t tell us, they made us work it out ourselves”: patient perspectives of a cognitive-behavioral program for rheumatoid arthritis fatigue. Arthritis Care Res (Hoboken). 2012;64(4):494–501. https://doi.org/10.1002/acr.21562.CrossRef

72.

Buchbinder R, Hall S, Youd JM. Functional health literacy of patients with rheumatoid arthritis attending a community-based rheumatology practice. J Rheumatol. 2006;33:879–86.PubMed

73.

Barton JL, Trupin L, Tonner C, Imboden J, Katz P, Schillinger D, et al. English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis. J Rheumatol. 2014;41(7):1290–7. https://doi.org/10.3899/jrheum.131350.CrossRefPubMedPubMedCentral

74.

Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Database Syst Rev Implement Rep. 2016;14:210–47.CrossRef

75.

Kelley P, Whatson T. Making long-term memories in minutes: a spaced learning pattern from memory research in education. Front Hum Neurosci. 2013;7:589.CrossRefPubMedPubMedCentral

76.

Seewoodharry MD, Maconachie GDE, Gillies CL, Gottlob I, McLean RJ. The effects of feedback on adherence to treatment: a systematic review and meta-analysis of RCTs. Am J Prev Med. 2017;53(2):232–40. https://doi.org/10.1016/j.amepre.2017.03.005.CrossRefPubMed

77.

Murphy LB, Brady TJ, Boring MA, Theis KA, Barbour KE, Qin J, et al. Self-management education participation among US adults with arthritis: who’s attending? Arthritis Care Res. 2017;69(9):1322–30. https://doi.org/10.1002/acr.23129.CrossRef

78.

Zolnierek KBH, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–34. https://doi.org/10.1097/MLR.0b013e31819a5acc.CrossRefPubMed

Title: How Can We Improve Disease Education in People with Gout?
Authors: Theodore R. Fields
Adena Batterman
Publication date: 01-03-2018
Publisher: Springer US
Published in: Current Rheumatology Reports / Issue 3/2018
Print ISSN: 1523-3774
Electronic ISSN: 1534-6307
DOI: https://doi.org/10.1007/s11926-018-0720-x

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

How Can We Improve Disease Education in People with Gout?

Abstract

Purpose of Review

Recent Findings

Summary

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 3/2018

What Is the Evidence for Treat-to-Target Serum Urate in Gout?

Are Doctors the Best People to Manage Gout? Is There a Role for Nurses and Pharmacists?

Calcium-Containing Crystals and Osteoarthritis: an Unhealthy Alliance

Update on Antiphospholipid Syndrome: Ten Topics in 2017

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page