Jo Wu

Introduction:
Cardiovascular disease (CVD) remains a leading cause of death and disability both globally and in Australia [1,2]. In 2022, an estimated 1.3 million Australian adults were living with CVD [2]. Up to 57% of CVD cases and 22% of all-cause deaths are attributable to key modifiable risk factors, highlighting the substantial potential for prevention [3]. Cardiovascular rehabilitation and secondary prevention programs are highly effective strategies for reducing repeat cardiac and new stroke events, improving quality of life, and supporting long-term cardiovascular health [4–6]. The benefits of cardiovascular rehabilitation are well established and widely endorsed by national [4] and international clinical practice guidelines [5,6].

Cardiovascular rehabilitation has traditionally been delivered via structured, multidisciplinary programs that provide comprehensive risk factor management through supervised exercise training, education, psychosocial support, and by supporting adherence to evidence-based medical therapy [4,7,8]. Programs are delivered across a range of healthcare settings (public, private and community health) and through different modes, including in-person, telehealth, and digital/virtual formats. Models of care also vary and may include centre-based, home-based, hybrid and hub-and-spoke approaches [9].

Contemporary thinking frames cardiovascular rehabilitation within the broader concept of lifelong cardiovascular health, rather than as a time-limited intervention [10]. The 2026 World Heart Federation Roadmap on cardiac rehabilitation [9] defines a cardiovascular health programme as:

“...the systematic provision of ongoing care and support for individuals with, or at elevated risk of, CVD, which in combination with all aspects of evidence-based prevention and rehabilitation will lead to lifelong cardiovascular well-being. Care should be person-centred and encompass all aspects of lifestyle optimisation, clinical management of risk factors, psychosocial support, and adherence to guideline-directed medical therapy.”

This definition reinforces the central role of cardiovascular rehabilitation in supporting lifelong cardiovascular health [10].

In 2014, the Australian Cardiovascular Health and Rehabilitation Association (ACRA) published the inaugural national core components for cardiovascular rehabilitation and secondary prevention to guide practice and promote consistent, high-quality care [11]. Over the past decade, remote and hybrid models, including telehealth, virtual platforms, digital programs and wearable technologies, have gained widespread acceptance, accelerated by the COVID-19 pandemic and rapid technological advances [12].These contemporary delivery modes offer opportunities to improve equity of access, flexibility, and person-centred care, while addressing evolving workforce and health system needs [13]. Regardless of delivery format, all cardiovascular rehabilitation programs should comply with all core components and evidence-based best practices. Maintaining robust standards is essential to ensure quality, consistency, and equity of care across diverse settings.

The aim of this position statement was to update the core components of cardiovascular rehabilitation in Australia to reflect societal, technological, and health system changes since its first iteration in 2014 [11], whilst reaffirming the fundamental principles and enduring evidence base. Recognising variation in local contexts and resources, this document is not intended to be prescriptive and does not function as a clinical guideline. Rather, it informs the delivery of evidence-based, context-sensitive cardiovascular rehabilitation and defines the core components needed to promote lifelong preventative care following a cardiovascular diagnosis.

Methods:
This position statement was developed by a nationally representative, multidisciplinary writing group composed of clinician and academic ACRA members convened through an expression-of-interest call. Additional subject matter experts and two consumers were also appointed. The group reviewed the 2014 version, identified areas requiring update, and undertook an iterative process of evidence gathering and literature synthesis. Subgroups were assigned to draft specific sections based on their areas of expertise. They critically appraised the most current and highest-quality evidence, including meta-analyses, systematic reviews, randomised controlled trials, international guidelines and relevant Australian clinical guidelines or guidance documents to ensure national coherence. Although a comprehensive, systematic search was not conducted, the co-authors used a structured, consensus-driven approach to identify and assess available evidence, drawing on their disciplinary expertise to ensure that the most contemporary and methodologically robust sources informed each section. This process included cross-checking key evidence across subgroups to maintain consistency and rigour. All authors contributed to iterative revisions and resolved discrepancies through discussions. The position statement was internally peer reviewed by three independent international experts. The final manuscript was reviewed and endorsed by the 2026 ACRA Executive Management Committee.

The IMPACT-CKM scoping review protocol aims to map and synthesize global evidence on predictors, mechanisms, and major adverse cardiovascular events (MACE) associated with Cardiovascular–Kidney–Metabolic (CKM) syndrome. The review will use a structured search of biomedical databases to identify studies related to metabolic syndrome, chronic kidney disease, diabetes mellitus, hypertension, and related conditions. It will characterize key risk factors, disease progression patterns, and clinical and social determinants influencing adverse cardiovascular outcomes. The findings will highlight evidence gaps and inform future research, risk stratification, and integrated CKM care strategies.

This registration contains the protocol for a scoping review titled “Interactive AI for Patients with Cardiovascular Disease and Comorbidities.” The review aims to map the existing literature on the feasibility and acceptability of AI-guided mindfulness and relaxation interventions for individuals with cardiovascular disease and comorbidities. It will examine the types of AI-based interventions used, user acceptance, usability, and ease of use across different modalities, including interactive, embodied, and video-based systems. The review will also summarize reported outcomes related to emotional wellbeing, such as anxiety, mood, and psychological distress. This registration outlines the eligibility criteria, search strategy, study selection process, and data charting methods in accordance with scoping review methodology.

Background
Stress adversely affects nursing students’ well-being and clinical communication. This study examined the effects of a newly developed mindfulness-based nursing education programme (MINDNUEDU) on perceived stress, resilience, and heart rate variability (HRV) among nursing students.

Methods
A quasi-experimental, two-arm pre–post design was conducted at a university in Taiwan. Seventy nursing students were allocated to either an eight-week mindfulness intervention group (n = 36) or a standard curriculum control group (n = 34) based on academic scheduling constraints. Primary outcomes were perceived stress, measured using the Perceived Stress Scale, and resilience, measured using the Connor–Davidson Resilience Scale. Secondary outcomes included HRV indices (SDNN, RMSSD, and HF power), assessed within the intervention group. Adjusted between-group differences over time were analyzed using Generalized Estimating Equations, controlling for baseline values and year of study.

Results
After adjustment for baseline differences, significant Group × Time interactions were observed for perceived stress (p = .004) and resilience (p < .001), indicating greater improvements in the intervention group compared with controls. The mean increase in resilience exceeded the minimal clinically important difference. A significant dose–response relationship was also identified, with higher attendance linearly associated with greater reductions in stress (p = .003) and greater gains in resilience (p = .004). Within the intervention group, session-level analyses demonstrated acute post-session increases in parasympathetic-related HRV indices across several weeks.

Conclusions
Participation in the MINDNUEDU programme was associated with reduced perceived stress and increased resilience among nursing students. While physiological findings reflected short-term autonomic changes during sessions rather than confirmed long-term trait adaptation, the results support the feasibility of integrating structured mindfulness training into nursing education. Randomized controlled trials with longitudinal follow-up are needed to confirm sustainability and causal effects.

Background and Aim: The Vietnamese has committed to introducing human papillomavirus (HPV) vaccination into the National Expanded Immunization Program from 2026. To inform effective national implementation, we conducted a review of existing evidence on HPV vaccination coverage, barriers, facilitators, and delivery experiences in Vietnam.

Methods: We searched PubMed, Embase, national health surveys databases for published studies reporting on HPV vaccination in Vietnam. Eligible studies included data on HPV vaccination coverage, uptake determinants, and implementation experiences between 2010 and 2025.

Outcomes: Nationally, HPV vaccination coverage among women aged 15–29 years was of 12.0%. The mean age at first dose was 19.2 years and at last dose was 20.0 years, indicating that vaccination often occurs after the recommended early adolescent period. Limited knowledge and awareness of HPV and cervical cancer prevention were the most consistently reported barriers to vaccine uptake. Among individuals aware of the HPV vaccine, high cost was the primary reason for remaining unvaccinated, cited by 50% - 75% of respondents.
Rural populations experienced greater financial barrier but demonstrated higher acceptability of vaccination. In contrast, urban populations reported greater affordability but lower willingness to vaccinate. Vaccination decisions were typically made jointly by parents and adolescents, following consultation with friends, family members, health workers, and community opinion leaders. Adolescents’ decisions were influenced by perceived sexual activity status, whereas many parents, particularly girls, did not perceive their teenage children to be at risk. Several research gaps were identified, including limited evidence on male vaccination and public-sector implementation strategies.

Conclusion and Future actions: HPV vaccination coverage in Vietnam remains low, with substantial financial, knowledge, and sociocultural barriers. As Vietnam prepares for national introduction of HPV vaccination in 2026, improving affordability, strengthening public awareness, and engaging trusted community stakeholders will be essential to achieving high and equitable coverage.

Vulnerable populations include low-income individuals and families, ethnic minorities living in rural areas, older adults, and people with disabilities [1]. The population at risk for chronic diseases may experience daily social, physical, economic, and environmental challenges [2]. Advancing health services for vulnerable populations by reducing avoidable disparities and ensuring equitable access to high-quality, culturally responsive care is paramount [3].