CARDIOVASCULAR DISEASE DYNAMICS AND STRUCTURAL CAPACITY OF CARDIOLOGY SERVICES IN THE ALMATY REGION: IMPLICATIONS FOR RURAL HEALTH POLICY

Background. Cardiovascular diseases remain a major public health challenge. In predominantly rural regions, the geographical distribution of healthcare resources may limit access to specialist care.

Objective. To assess trends in registered cardiovascular morbidity and cardiology service capacity in the Almaty Region and estimate cardiologist workforce requirements for 2026.

Materials and methods. A retrospective population-based analytical study used aggregated administrative data. Regional morbidity was assessed for 2019–2024; territorial morbidity, workforce, and bed capacity for 10 territorial units during 2022–2024; and urban and rural hospitalizations for 2022–2025. Surgical and high-technology care indicators were assessed for the available periods. Analyses included descriptive statistics, coefficients of variation, and Pearson correlations. Workforce requirements were estimated using the 2024 dispensary-registered patient population, annual growth, and a planning assumption of one cardiologist per 2,000 patients.

Results. Regional registered cardiovascular morbidity increased from 2,319.7 to 2,497.3 per 100,000 population (+7.7%), with the largest increase observed for ischemic heart disease. In 2024, the mean rate across the 10 territories was 5,101.4 per 100,000, with a coefficient of variation of 65.3%. Rural hospitalizations increased from 1,756 to 2,325 (+32.4%). None of the three correlations reached statistical significance (p > 0.05). The projected requirement for 2026 was 84 cardiologists compared with 71 reported in 2024, yielding a net model-based gap of 13.

Conclusions. Registered cardiovascular morbidity increased, and substantial territorial variability was observed. Correlations remain exploratory. The workforce projection is a planning estimate rather than a confirmed future shortage. Further assessment of workforce distribution, referral pathways, and access to specialist care is warranted.

1. Parato A.G., et al. Global burden of causes of death and life expectancy with reference to cardiovascular diseases. World Heart Journal. 2024;16(2):103–115.

2. Dalakoti M., et al. Primary prevention of cardiovascular disease in Asia: challenges: a narrative review. JACC: Advances. 2025;4(4):101670.

3. Mukasheva G., et al. Incidence and mortality of cardiovascular disease in the Republic of Kazakhstan: 2004–2017. Iranian Journal of Public Health. 2022;51(4):821–829.

4. Bashirov A.U. Epidemiology of chronic heart failure in Kazakhstan and other countries. Ulyanovsk Medico-Biological Journal. 2024;3:17–27.

5. Kausova G.K., Abzaliyeva A.R. Planning and forecasting of healthcare workforce needs (literature review). Bulletin of Kazakh National Medical University. 2017;(3):409-412.

6. Omirbayeva B.S., Serikbayev N.S. Assessment of healthcare productivity in Kazakhstan at system, subsectoral and disease-based levels. Journal of Health Development. 2024;4(59):18–28.

7. Khamzina Zh. Improvement of inpatient healthcare financing system in Kazakhstan within the framework of the Unified National Health System. Journal of Clinical Medicine of Kazakhstan. 2014;(4):75–76.

8. Nauryzbayeva A.A., et al. Global experience in rural health workforce policy development: literature review. West Kazakhstan Medical Journal. 2020;2(62):134–146.

9. Dzhainakbayev N.T., et al. On the need to develop organizational models for rural primary healthcare in Almaty region. Therapist Bulletin. 2012;(1):11–15.

10. Kvedar J., Coye M.J., Everett W. Connected health: review of telemedicine strategies. Health Affairs. 2014;33(2):194–199.

11. Widmer R.J., et al. Digital health interventions for prevention of cardiovascular disease: systematic review. Mayo Clinic Proceedings. 2015;90(4):469–480.

12. Beisenbayeva Zh.M., Konovalov O.E. Physicians’ perspectives on quality of cardiology care in urban and rural Kazakhstan. RUDN Journal of Medicine. 2017;21(3):356–365.

13. Turebayev A.U. Improving healthcare system efficiency in Kazakhstan. Bulletin of Innovative Eurasian University. 2017;(2):14–21.

14. Planey A.M., et al. Structural factors and inequities in travel times to acute care hospitals in rural US South. Milbank Quarterly. 2023;101(3):922–974.

15. Stansberry T.T., Roberson P.N.E., Myers C.R. Rural hospital care quality and health outcomes: integrative review. Nursing Forum. 2023;2023:3928966.

16. Alanazy A.R.M., et al. Urban vs rural emergency medical services outcomes: systematic review. Int J Environ Res Public Health. 2019;16(10):1728.

17. Taylor R.S., Dalal H.M., McDonagh S.T.J. Role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology. 2022;19(3):180–194.

18. Sabgaida T.P. Excess mortality structure during COVID-19 in urban and rural populations. Social Aspects of Population Health. 2021;67(5):1–10.

19. Orazymbetova A.Zh., Sultanbekova G.K. Evaluation of state healthcare programs in Kazakhstan. Journal of Health Development. 2021;2(42):32–40.

20. Aringazina A., Kuandikov T., Arkhipov V. Burden of cardiovascular diseases in Central Asia. Central Asian Journal of Global Health. 2018;7(1):321.

21. Kulkayeva G.U., et al. Issues of specialized outpatient medical care in Kazakhstan. Journal of Health Development. 2023;(53):24–32.

22. Palevskaya S.A., et al. Modern approaches to non-communicable disease prevention in Kazakhstan. Bulletin of Reaviz Medical Institute. 2021;6(54):86–93.

23. Imanova Zh.A., Kuliev R.S., Orynbasaruly A. Access to healthcare services in rural Kazakhstan using mobile medical complexes. Journal of Health Development. 2022;1(45):20–28.

24. Kulkayeva G.U., et al. Analysis of healthcare state programs in Kazakhstan (1998–2024). Journal of Health Development. 2024;3(57):4–12.

25. Dzhobalayeva B.S., Smailova D.S., Semenova Yu.M. Development of rural medicine in developed countries: literature review. Science and Healthcare. 2021;(3):62–68.

26. Baibolova M.K., et al. Cardiac rehabilitation: risk factors and program implementation. Bulletin of Kazakh National Medical University. 2020;(1):87–90.

27. Alzhanova F.G., Satpayeva Z.T., Alibekova G.Zh. Urbanization and demographic trends in Kazakhstan. Greater Eurasia: Development, Security, Cooperation. 2022;5-1:1127–1129.

28. Townsend N., et al. Epidemiology of cardiovascular disease in Europe. Nature Reviews Cardiology. 2022;19(2):133–143.

29. Timmis A., et al. European Society of Cardiology: cardiovascular disease statistics 2021. European Heart Journal. 2022;43(8):716–799.

30. Malvezzi M., et al. Relation between mortality trends of cardiovascular diseases and selected cancers in the European Union, 1970–2017. European Journal of Cancer. 2018;103:341–355.

31. Goh R.S.J., et al. The burden of cardiovascular disease in Asia from 2025 to 2050: a forecast analysis. The Lancet Regional Health – Western Pacific. 2024;49.

32. Chong B., et al. Global burden of cardiovascular diseases: projections from 2025 to 2050. European Journal of Preventive Cardiology. 2025;32(11):1001–1015.

33. Movsisyan N.K., et al. Cardiovascular diseases in Central and Eastern Europe. Annals of Global Health. 2020;86(1):21.

34. Feng J., Zhang Y., Zhang J. Epidemiology and burden of heart failure in Asia. JACC: Asia. 2024;4(4):249–264.

35. Lopez-Jaramillo P., et al. Risk factors, cardiovascular disease, and mortality in South America: PURE substudy. European Heart Journal. 2022;43(30):2841–2851.

36. Shah S., et al. Increased burden of disease and role of health economics: Asia-Pacific region. Expert Review of Pharmacoeconomics & Outcomes Research. 2019;19(5):517–528.

37. Alhuneafat L., et al. Cardiovascular disease burden in the Middle East and North Africa region. Current Problems in Cardiology. 2024;49(3):102341.

38. Piepoli M.F., et al. Update on cardiovascular prevention in clinical practice. European Journal of Preventive Cardiology. 2020;27(2):181–205.

39. Taylor R.S., Dalal H.M., McDonagh S.T.J. The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology. 2022;19(3):180–194.

40. Lloyd-Sherlock P., et al. Reducing cardiovascular disease burden in the Americas region. The Lancet Global Health. 2019;7(5):e604–e612.

41. Lam C.S.P., et al. Tackling cardiovascular disease in the Asia–Pacific region: a Lancet Commission. The Lancet. 2025;406(10507):988–989.