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GOALPoST

Improving Global access to Oral AnticoaguLants to Prevent Stroke in aTrial fibrillation

 

The GOALPoST Study aims to establish robust evidence on the efficacy and safety of NOACs versus VKAs in preventing stroke worldwide.

The GOALPoST team

Biraj Karmacharya

Abiodun Adeoye

He received the 2014 Early Career Investigator Travel Grant by the World Heart Federation and the 2003 AyoIyun Award by the West African College of Physician (WACP) for the best part-one candidate in internal medicine. Over the years, his research activities have centered on environmental and genomic determinants of hypertension-associated target organ damage such as stroke, heart failure, and kidney failure. As a fellow of the World Heart Federation on Twin Center Ttraining at Madras Medical Mission, India, he conducted a study on the non-invasive ultrasonographic assessment of carotid artery atherosclerosis in patients undergoing coronary bypass surgery (CABG) to mitigate the incidences of stroke peri-operatively. He has collaborations in several other studies such as the Cardiovascular Research Training Institute (CaRT), a Forgaty International center / NIH sponsored capacity building program, and the NIH funded Stroke Investigative Research and Education Network (SIREN), the largest stroke study in Africa.

Mariachiara Di Cesare

She obtained a Master’s degree in statistics and demography and a Ph.D. in Demography from the University of Rome ‘La Sapienza’. Much of her work has focused on health with a special interest in risk factors associated with non-communicable diseases. In particular, she has been working on inequalities in non-communicable diseases, risk factors contributing to cardio-metabolic mortality, and the role of early nutrition on child development. Her current research focuses on the global dynamics of social inequalities in undernutrition and adiposity and on preventing obesity among children.

Ferdous Hakim

Academically, he has completed his graduation in medicine (MBBS) followed by a Master in Public Health (MPH) with a major in Epidemiology. He has received post-graduate academic training in medicine and cardiology for a total of two years and worked for eight years in internal medicine/cardiology in tertiary hospitals. His experience in clinical and public health research is for more than 15 years in different hospitals and health-based development organizations. At the World Health Organization (WHO), he participated in writing proposals and developing tools for the generation of evidence in the area of public health importance. He has devoted himself to capacity building on research both within the organization and also outside with government and other stakeholders.

Xinyi Leng

Xinyi is currently a Research Assistant Professor at the Division of Neurology, Department of Medicine and Therapeutics, at the Chinese University of Hong Kong (CUHK). She has research interests in ischemic stroke and intracranial atherosclerotic disease (ICAD), which accounts for 30-50% of ischemic stroke in the Chinese population. She has obtained an MBBS (2009) and a Master’s degree in Clinical Medicine (2011) from Capital Medical University, Beijing, China, and received two-year clinical training (2009-2011) in neurology in Beijing Tiantan Hospital. She received her Ph.D. in Medical Sciences (2014) and 2-year postdoctoral training in stroke research (2015-2017) at CUHK. She has also obtained a Certificate for Neurosonology from the American Society of Neuroimaging (2013). Xinyi has been conducting research in stroke and ICAD through community-based and clinical studies, including epidemiology, imaging, treatment and prognosis of ischemic stroke patients and patients with symptomatic and asymptomatic ICAD.

Lis Neubeck

Lis Neubeck is a cardiac nurse with over 20 years of experience in a range of cardiac in-patient and out-patient settings. She is currently Head of the Centre for Cardiovascular Health in the School of Health and Social Care at Edinburgh Napier University. She is an Honorary Professor at Sydney Nursing School, Charles Perkins Centre, University of Sydney. She is an Adjunct Professor at School of Nursing and Midwifery, Faculty of Medicine, Nursing, and Health Sciences at Flinders University, Adelaide, and is an Honorary Senior Research Fellow at the George Institute for Global Health. Her research focuses on innovative solutions to secondary prevention of cardiovascular disease, identification and management of atrial fibrillation, and the use of new technologies to improve access to health care. Lis is Immediate Past President of the Australian Cardiovascular Health and Rehabilitation Association (2015-2017), served on the board of the Cardiovascular Nursing Council of the Cardiac Society of Australia and New Zealand (2013-2016), and was the Australian representative on the Global Alliance for Prevention of Cardiovascular Disease of the World Heart Federation.

Stephanie Partridge

She is an Accredited Practising Dietitian and Postdoctoral Research Fellow with the Westmead Applied Research Centre and Prevention Research Collaboration at The University of Sydney. She completed her undergraduate (B Sc Hons I) and postgraduate studies (Ph.D.) at The University of Sydney. Her Ph.D. research, funded by a competitive Australian Postgraduate Award Scholarship, investigated the effectiveness of a mobile health lifestyle program for preventing obesity in young adults. She was awarded the 2016 Joan Woodhill Doctorate Prize for Excellence in Research by the Dietitians Association of Australia for the significance of her research in the field of nutrition and dietetics.  Her current research focuses on scalable, low-cost and engaging technology-focused healthy lifestyle programs to improve eating behaviors, physical activity, and mental wellbeing of adolescents.

Ezequiel Zaidel

Ezequiel Zaidel is an MD cardiologist and professor of Pharmacology. He currently works at a Coronary and Heart Failure Unit at Sanatorio Güemes, Buenos Aires. His areas of research are mainly cardiovascular pharmacology, atrial fibrillation and stroke prevention, and also advanced heart failure.

Background

Stroke is a major contributor to death, disability, and dementia, affecting about 62 million people globally, out of whom 87% live in low-and middle-income countries (LMICs). In randomized clinical trials (RCTs) and subsequent meta-analyses, non-vitamin K antagonists oral anticoagulant medications (NOACs) showed superiority to vitamin K antagonists (VKAs) in reducing the composite endpoint of stroke and systemic embolism by 19% (add absolute rates), all-cause mortality by 10%, and intracranial hemorrhage by 50%. While NOACs are largely used amongst high-income countries, this is not the case in low and middle-income countries, in which access depends on a series of complex factors such as supply, cost, patients and health carers perception. The overall aim of this proposal is to scale up NOACs to improve stroke prevention globally.

Specific aims

  1. To submit an application for NOACs to the WHO EML for the prevention of stroke and systemic embolism in patients with non-valvular AF;
  2. To explore perceptions and experiences of using NOACs in patients with AF and their health care providers and caregivers;
  3. To develop a Rapid Assessment Protocol for Direct Oral Anticoagulants access and use (RAP-NOACs) in Nepal and Nigeria.

Methodology

This work aims to establish robust evidence on the efficacy and safety of NOACs versus VKAs in preventing stroke worldwide. Furthermore, the team will synthesize the perspectives of patients, providers and policymakers on NOACs use to determine the potential barriers and facilitators to increasing the access of NOACs in resource-limited settings. The reports thus produced will be utilized for the submission to add NOACs to the WHO EML, which if approved, will be an important step in reducing inequity in NOACs accessibility globally. Additionally, the team will assess the burden of AF and stroke in Nigeria and Nepal, determine the gap in knowledge on the use of NOACs, identify the barriers to access to NOAC, and proffer solutions. These two country experiences will be important to create approach and tools should such investigations are required in other settings. The team believe that together, these complementary aims will help advance the access to NOAC in resource-limited settings.

 

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