Systematic review of cardiovascular care delivery across health systems in the Asia–Pacific: a regional roadmap for strengthening cardiovascular care

Figures

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  Central Illustration. Quality indicators for health systems and cardiovascular care in the Asia–Pacific: opportunities and the road ahead. APAC, Asia–Pacific; CVD, cardiovascular disease; CV, cardiovascular; LMICs, low-to-middle income countries; HICs, high-income countries; HAQI, Healthcare Access and Quality Index; EMS, emergency medical services; CR, cardiac rehabilitation; EHR, electronic health record; EDSS, electronic decision support system.

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  Fig. 1. Shared and distinct challenges in care delivery value chain priorities between low-to-middle income countries and high-income countries in the Asia–Pacific. HICs, high-income countries; LMICs, low-to-middle income countries; EMS, emergency medical services; CPR, cardiopulmonary resuscitation; CV, cardiovascular.

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  Fig. 2. Health expenditure sources across the HAQ Index. The proportion of health expenditure sources in the Asia–Pacific, stratified across the healthcare access and quality (HAQ) Index deciles. The health expenditure sources were development assistance for health (DAH), prepaid private health expenditure, out-of-pocket spending, and government health expenditure. The solid line represents the age-standardised cardiovascular disease disability-adjusted life year (DALY) rate (per 100,000) from 1995 to 2021, and the dashed line represents the projected age-standardised DALY rate (per 100,000) till 2050.

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  Fig. 3. Share of total health expenditure, DALYs, and population by HAQ Index decile. The shares of total health expenditure, cardiovascular disease disability-adjusted life years (DALYs), and population size, stratified by each healthcare access and quality index (HAQ) Index decile in the Asia–Pacific (top). The distribution of countries across the share of total health expenditure and total DALYs (bottom).

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  Fig. 4. Healthcare expenditure as a proportion of gross domestic product (GDP) and healthcare expenditure per capita across each country in the Asia–Pacific. (A) Healthcare expenditure as a proportion of GDP, including the source of healthcare expenditure, per country. The line represents the cardiovascular disease age-standardised disability-adjusted life year (DALY) rate (per 100,000 population). (B) Health expenditure per capita, including the source of healthcare expenditure, per country. The line represents cardiovascular disease age-standardised DALY rate (per 100,000 population).

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  Fig. 5. Distribution of countries in the Asia–Pacific across Healthcare Access and Quality (HAQ) Index and Sociodemographic Index (SDI). The distribution of countries within the Asia–Pacific across the HAQ Index and SDI, stratified across the range of cardiovascular disease disability-adjusted life year (DALY) rate (per 100,000 population). Dotted vertical lines represent the different SDI categories.

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  Fig. 6. Age-standardised DALY rates over time for each Healthcare Access and Quality (HAQ) Index decile. Cardiovascular disease age-standardised disability-adjusted life year (DALY) rates (per 100,000 population) over time for each HAQ Index decile, stratified by global and Asia–Pacific estimates. Solid lines represent the age-standardised DALY rate (per 100,000) from 1995 to 2021, and dashed lines represent the projected age-standardised DALY rate (per 100,000) till 2050.

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  Fig. 7. The correlation between age-standardised morbidity and mortality rates, and total health expenditure per capita, across countries in the Asia–Pacific in 2021. Increasing total health expenditure per capita (Purchasing Power Parity [PPP] adjusted in 2024 US dollar [USD]) correlated with decreasing (A) age-standardised disability-adjusted life year (DALY) rates (per 100,000 population), as well as (B) age-standardised mortality rates (per 100,000 population). Countries across the Asia–Pacific were stratified based on Healthcare Access and Quality (HAQ) Index decile, and population size.

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  Fig. 8. Health spending efficiencies and cardiovascular disease burden across the Asia–Pacific in 2021. The total health expenditure per capita (Purchasing Power Parity [PPP] adjusted in 2024 US dollar [USD]) residual Z-scores plotted against the (A) age-standardised disability-adjusted life year (DALY) rates (per 100,000 population), and (B) age-standardised mortality rates (per 100,000 population) residual Z-scores for each country depict the four quadrants of health spending efficiencies and effectiveness—countries with low healthcare spending but high cardiovascular disease (CVD) burden, high healthcare spending and high CVD burden, low healthcare spending and low CVD burden, and high healthcare spending but low CVD burden. Countries were further stratified based on Healthcare Access and Quality (HAQ) Index decile, and population size.