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Roriz PS, Ferreira IBB, Pontes FB, Machado A, Aguiar TC, Matos MAA, Paiva Filho IM, Menezes RC, Andrade BB. Advancements in reperfusion rates and quality of care for ST-segment elevation myocardial infarction: a ten-year evaluation of Salvador's STEMI network. Front Cardiovasc Med 2024; 11:1381504. [PMID: 39105078 PMCID: PMC11298342 DOI: 10.3389/fcvm.2024.1381504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024] Open
Abstract
Background Continuous investment and systematic evaluation of program accomplishments are required to achieve excellence in ST-segment elevation myocardial infarction (STEMI) care, especially in resource-limited settings. Therefore, this study evaluates the impact of problem-driven interventions on reperfusion use rate in a long-term operating STEMI network from a low- to middle-income country. Methods This is a healthcare improvement evaluation study of Salvador's public STEMI network in a quasi-experimental design, comparing data from 2009 to 2010 (pre-intervention) and 2019-2020 (post-intervention). There were evaluated all confirmed STEMI cases assisted in both periods. The interventions, implemented since 2017, included: expanding the support team, defining criteria to be a spoke, and initiating continuous education activities. The primary outcome was the rate of patients undergoing reperfusion, with secondary outcomes being time from door-to-ECG (D2E) and ECG-to-STEMI-team trigger (E2T). Results Over ten years, the network's coverage increased by 300,000 individuals, and expanded by 1,800 km2. A total of 885 records were analyzed, 287 in the pre-intervention group (182 men [63·4%]; mean [SD] age 62·1 [12·5] years) and 598 in the post-intervention group (356 men [59·5%]; mean [SD] age 61.9 [11·8] years). It was noticed a substantial increase in reperfusion delivery rate (90 [31%] vs. 431 [73%]; P = 001) and reductions in time from D2E (159 [83-340] vs. 29 [15-63], P = 001), and E2T (31 [21-44] vs. 16 [6-40], P = 001). Conclusion The strategies adopted by Salvador's STEMI network were associated with significant improvements in the rate of patients undergoing reperfusion and in D2E and E2T. However, the mortality rate remains high.
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Affiliation(s)
- Pollianna Souza Roriz
- Departamento de Cardiologia, Serviço de Atendimento Móvel de Urgência (SAMU), Salvador, Brazil
- Departamento de Estimulação Cardíaca Artificial, Hospital Ana Nery, Salvador, Brazil
| | | | | | - Antônio Machado
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
| | | | - Marcos Antônio Almeida Matos
- Pós Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
- Departamento de Atenção às Urgências, Secretaria Municipal de Saúde, Salvador, Brazil
| | - Ivan Mattos Paiva Filho
- Departamento de Cardiologia, Serviço de Atendimento Móvel de Urgência (SAMU), Salvador, Brazil
- Departamento de Atenção às Urgências, Secretaria Municipal de Saúde, Salvador, Brazil
| | - Rodrigo Carvalho Menezes
- Instituto de Pesquisa Clínica e Translacional, Curso de Medicina, Faculdade ZARNS, Salvador, Brazil
| | - Bruno Bezerril Andrade
- Pós Graduação em Medicina e Saúde Humana, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
- Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
- Instituto de Pesquisa Clínica e Translacional, Curso de Medicina, Faculdade ZARNS, Salvador, Brazil
- Laboratório de Pesquisa Clínica e Translacional, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
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Hertz JT, Stark K, Sakita FM, Mlangi JJ, Kweka GL, Prattipati S, Shayo F, Kaboigora V, Mtui J, Isack MN, Kindishe EM, Ngelengi DJ, Limkakeng AT, Thielman NM, Bloomfield GS, Bettger JP, Tarimo TG. Adapting an Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Co-Design of the MIMIC Intervention. Ann Glob Health 2024; 90:21. [PMID: 38495415 PMCID: PMC10941691 DOI: 10.5334/aogh.4361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/23/2024] [Indexed: 03/19/2024] Open
Abstract
Background Uptake of evidence-based care for acute myocardial infarction (AMI) is suboptimal in Tanzania, but there are currently no published interventions to improve AMI care in sub-Saharan Africa. Objectives Co-design a quality improvement intervention for AMI care tailored to local contextual factors. Methods An interdisciplinary design team consisting of 20 physicians, nurses, implementation scientists, and administrators met from June 2022 through August 2023. Half of the design team consisted of representatives from the target audience, emergency department physicians and nurses at a referral hospital in northern Tanzania. The design team reviewed multiple published quality improvement interventions focusing on ED-based AMI care. After selecting a multicomponent intervention to improve AMI care in Brazil (BRIDGE-ACS), the design team used the ADAPT-ITT framework to adapt the intervention to the local context. Findings The design team audited current AMI care processes at the study hospital and reviewed qualitative data regarding barriers to care. Multiple adaptations were made to the original BRIDGE-ACS intervention to suit the local context, including re-designing the physician reminder system and adding patient educational materials. Additional feedback was sought from topical experts, including patients with AMI. Draft intervention materials were iteratively refined in response to feedback from experts and the design team. The finalized intervention, Multicomponent Intervention to Improve Myocardial Infarction Care in Tanzania (MIMIC), consisted of five core components: physician reminders, pocket cards, champions, provider training, and patient education. Conclusion MIMIC is the first locally tailored intervention to improve AMI care in sub-Saharan Africa. Future studies will evaluate implementation outcomes and efficacy.
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Affiliation(s)
- Julian T. Hertz
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kristen Stark
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Francis M. Sakita
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University, Moshi, Tanzania
| | | | | | | | - Frida Shayo
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | - Julius Mtui
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | | | | | - Alexander T. Limkakeng
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nathan M. Thielman
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Internal Medicine, Duke University, Durham, North Carolina, USA
| | - Gerald S. Bloomfield
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Janet P. Bettger
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Prattipati S, Tarimo TG, Kweka GL, Mlangi JJ, Samuel D, Sakita FM, Tupetz A, Bettger JP, Thielman NM, Temu G, Hertz JT. Patient and provider perspectives on barriers to myocardial infarction care among persons with human immunodeficiency virus in Tanzania: A qualitative study. Int J STD AIDS 2024; 35:18-24. [PMID: 37703080 PMCID: PMC11139408 DOI: 10.1177/09564624231199507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION People with HIV (PLWH) have an increased risk myocardial infarction (MI), and evidence suggests that MI is under-diagnosed in Tanzania. However, little is known about barriers to MI care among PLWH in the region. METHODS In this qualitative study grounded in phenomenology, semi-structured interviews were conducted in northern Tanzania. Purposive sampling was used to recruit a diverse group of providers who care for PLWH and patients with HIV and electrocardiographic evidence of prior MI. Emergent themes were identified via inductive thematic analysis. RESULTS 24 physician and patient participants were interviewed. Most participants explained MI as caused by emotional shock and were unaware of the association between HIV and increased MI risk. Providers described poor provider training regarding MI, high out-of-pocket costs, and lack of diagnostic equipment and medications. Patients reported little engagement with and limited knowledge of cardiovascular care, despite high engagement with HIV care. Most provider and patient participants indicated that they would prefer to integrate cardiovascular care with routine HIV care. CONCLUSIONS PLWH face many barriers to MI care in Tanzania. There is a need for multifaceted interventions to educate providers and patients, improve access to MI diagnosis, and increase engagement with cardiovascular care among this population.
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Affiliation(s)
| | | | | | | | | | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Anna Tupetz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Janet P Bettger
- Department of Health and Rehabilitation Sciences, Temple University College of Public Health, Philadelphia, PA, USA
| | - Nathan M Thielman
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gloria Temu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania
| | - Julian T Hertz
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA
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Al-Alawy K, Sayegh KA, Moonesar IA. Optimizing interventional cardiology services. Future Cardiol 2023; 19:695-705. [PMID: 37916604 DOI: 10.2217/fca-2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023] Open
Abstract
Cardiovascular disease (CVD) is a common and prominent cause of morbidity and mortality interventional cardiology (IC) remains an important noninvasive intervention to improve patient outcomes and life expectancy. Aim: The study objectives were to explore how IC services could be optimized. Methods: We adopted multiple methods, including policy analysis, literature review and interviews. Results: The most prominent themes were medical devices and service integration and management. IC Consultant interviews suggest the need to balance supply and demand, implement standards of practice and establish centres of excellence. Conclusion: Optimizing IC services requires a comprehensive approach, including regulatory and financial oversight, organizational management, adoption of clinical and technological best practices, ongoing training, multidisciplinary working and service integration.
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Tickley I, Van Blydenstein SA, Meel R. Time to thrombolysis and factors contributing to delays in patients presenting with ST-elevation myocardial infarction at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. S Afr Med J 2023; 113:53-58. [PMID: 37882136 DOI: 10.7196/samj.2023.v113i9.500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Acute coronary syndrome is a public health burden both worldwide and in South Africa (SA). Guidelines recommend thrombolysis within 1 hour of symptom onset and 30 minutes of hospital arrival for patients with ST-elevation myocardial infarction (STEMI) in order to prevent morbidity and mortality. There is a paucity of data pertaining to the time between onset of chest pain and thrombolysis in STEMI patients in SA. OBJECTIVES To elucidate the time to thrombolytic therapy, establish the reasons for treatment delays, and calculate the loss of benefit of thrombolysis associated with delays in treatment of patients presenting with STEMI at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, SA. METHOD A prospective observational study of 100 consecutive patients with STEMI was conducted at CHBAH (2021 - 2022). RESULTS The mean (standard deviation) age was 55.6 (11.6) years, with a male predominance (78%). Thrombolytic therapy was administered to 51 patients, with a median (interquartile range (IQR)) time to thrombolysis of 360 (258 - 768) minutes; 10 of the patients who received a thrombolytic (19.6%) did so within 30 minutes of arrival at the hospital. The median (IQR) time from symptom onset to calling for help was 60 (30 - 240) minutes, the median time from arrival of help to hospital arrival was 114 (48 - 468) minutes, and the median in-hospital delay to thrombolysis after arrival was 105 (45 - 240) minutes. Numerous reasons that led to delay in treatment were identified, but the most frequent was prehospital delays related to patient factors. Late presentation resulted in 26/49 patients (53.1%) not receiving thrombolytic therapy. Five patients died and 43 suffered from heart failure. Thirty per 1 000 participants could have been saved had they received thrombolytic therapy within 1 hour from the onset of chest pain. CONCLUSION Prehospital and hospital-related factors played a significant role in delays to thrombolysis that led to increased morbidity and mortality of patients with STEMI.
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Affiliation(s)
- I Tickley
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - S A Van Blydenstein
- Department of Internal Medicine and Division of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
| | - R Meel
- 1 Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Ndaba L, Mutyaba A, Mpanya D, Tsabedze N. In-Hospital Mortality Outcomes of ST-Segment Elevation Myocardial Infarction: A Cross-Sectional Study from a Tertiary Academic Hospital in Johannesburg, South Africa. J Cardiovasc Dev Dis 2023; 10:348. [PMID: 37623361 PMCID: PMC10455389 DOI: 10.3390/jcdd10080348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
In sub-Saharan Africa, the burden of atherosclerotic cardiovascular disease (ASCVD) is increasing. This study aimed to describe the clinical characteristics of patients with ST-segment elevation myocardial infarction (STEMI) and estimate the in-hospital all-cause mortality rate. We conducted a cross-sectional retrospective single-centre study of STEMI patients who underwent diagnostic coronary angiography with or without percutaneous coronary intervention (PCI) between January 2015 and December 2019. We compared demographic and clinical parameters between survivors and non-survivors with descriptive statistics. Univariable and multivariable logistic regression analyses were performed to determine the predictors of all-cause mortality. The study population consisted of 677 patients with a mean age of 55.5 ± 11.3 years. The in-hospital all-cause mortality rate was 6.2% [95% confidence interval (CI): 4.5-8.3%]. Risk factors for ASCVD included smoking (56.1%), hypertension (52.8%), dyslipidemia (40.0%), and a family history of coronary artery disease (32.7%). A pharmaco-invasive management strategy (treatment with thrombolytic therapy and PCI) was implemented in 36.5% of patients and reduced all-cause mortality risk (OR: 0.16; CI: 0.04-0.71, p = 0.015). The in-hospital all-cause mortality rate in STEMI patients was 6.2%, and a pharmaco-invasive management strategy proved to be an effective approach.
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Affiliation(s)
| | | | | | - Nqoba Tsabedze
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa; (L.N.); (A.M.); (D.M.)
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7
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Ardsby M, Shayo F, Sakita FM, Wilhelms D, Moshi B, Frankiewicz P, Silva LL, Staton CA, Mmbaga B, Joiner A. Emergency unit capacity in Northern Tanzania: a cross-sectional survey. BMJ Open 2023; 13:e068484. [PMID: 36813501 PMCID: PMC9950971 DOI: 10.1136/bmjopen-2022-068484] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Emergency medicine (EM) is a growing field in Sub-Saharan Africa. Characterising the current capacity of hospitals to provide emergency care is important in identifying gaps and future directions of growth. This study aimed to characterise the ability of emergency units (EU) to provide emergency care in the Kilimanjaro region in Northern Tanzania. METHODS This was a cross-sectional study conducted at 11 hospitals with emergency care capacity in three districts in the Kilimanjaro region of Northern Tanzania assessed in May 2021. An exhaustive sampling approach was used, whereby all hospitals within the three-district area were surveyed. Hospital representatives were surveyed by two EM physicians using the Hospital Emergency Assessment tool developed by the WHO; data were analysed in Excel and STATA. RESULTS All hospitals provided emergency services 24 hours a day. Nine had a designated area for emergency care, four had a core of fixed providers assigned to the EU, two lacked a protocol for systematic triage. For Airway and Breathing interventions, oxygen administration was adequate in 10 hospitals, yet manual airway manoeuvres were only adequate in six and needle decompression in two. For Circulation interventions, fluid administration was adequate in all facilities, yet intraosseous access and external defibrillation were each only available in two. Only one facility had an ECG readily available in the EU and none was able to administer thrombolytic therapy. For trauma interventions, all facilities could immobilise fractures, yet lacked interventions such as cervical spinal immobilisation and pelvic binding. These deficiencies were primarily due to lack of training and resources. CONCLUSION Most facilities perform systematic triage of emergency patients, though major gaps were found in the diagnosis and treatment of acute coronary syndrome and initial stabilisation manoeuvres of patients with trauma. Resource limitations were primarily due to equipment and training deficiencies. We recommend the development of future interventions in all levels of facilities to improve the level of training.
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Affiliation(s)
- Malin Ardsby
- Emergency Medicine, Linkopings universitet, Linkoping, Sweden
| | - Frida Shayo
- Emegency Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Francis M Sakita
- Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Daniel Wilhelms
- Emergency Medicine, Linkopings universitet, Linkoping, Sweden
| | - Baraka Moshi
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | | | | | - Catherine A Staton
- Duke Global Health Institute, Durham, North Carolina, USA
- Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Blandina Mmbaga
- Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Anjni Joiner
- Duke Global Health Institute, Durham, North Carolina, USA
- Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Kaboré M, Hien YE, Fassinou LC, Cissé K, Ngwasiri C, Coppieters Y, Samandoulougou FK. National levels, changes and correlates of ideal cardiovascular health among Beninese adults: evidence from the 2008 to 2015 STEPS surveys. BMJ Nutr Prev Health 2022; 5:297-305. [PMID: 36619317 PMCID: PMC9813615 DOI: 10.1136/bmjnph-2021-000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/24/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction A higher number of ideal cardiovascular health (CVH) metrics is associated with a lower risk of cardiovascular-related and all-cause mortality. However, the change in CVH metrics has rarely been studied in sub-Saharan Africa. We investigated the level and changes of CVH metrics and their correlates among Beninese adults between 2008 and 2015. Methods Secondary analysis was performed on data obtained from Benin's 2008 and 2015 WHO Stepwise surveys (STEPS). In total, 3617 and 3768 participants aged 25-64 years were included from both surveys, respectively. CVH metrics were assessed using the American Heart Association definition, which categorised smoking, fruit and vegetable consumption, physical activity, body mass index (BMI), blood pressure (BP), total cholesterol (TC) and glycaemia into 'ideal', 'intermediate' and 'poor' CVH. The prevalence of ideal CVH metrics was standardised using the age and sex structure of the 2013 population census. Results Few participants met all seven ideal CVH metrics, and ideal CVH significantly declined between 2008 and 2015 (7.1% (95% CI 6.1% to 8.1%) and 1.2% (95% CI 0.8% to 1.5%), respectively). The level of poor smoking (8.0% (95% CI 7.1% to 8.9%) and 5.6% (95% CI 4.8% to 6.3%)) had decreased, whereas that of poor BP (25.9% (95% CI 24.5% to 27.4%) and 32.0% (95% CI 30.0% to 33.5%)), poor total cholesterol (1.5% (95% CI 1.0% to 1.9%) and 5.5% (95% CI 4.8% to 6.2%)) and poor fruit and vegetable consumption (34.2% (95% CI 32.4% to 35.9%) and 51.4% (95% CI 49.8% to 53.0%)) significantly increased. Rural residents and young adults (25-34 years) had better CVH metrics. Conclusion The proportion of adults with ideal CVH status was low and declined significantly between 2008 and 2015 in Benin, emphasising the need for primordial prevention targeting urban areas and older people to reduce the burden of cardiovascular disease risk factors.
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Affiliation(s)
- Michael Kaboré
- Département de biochimie et microbiologie, Université Joseph Ki-Zerbo, Ouagadougou, Centre, Burkina Faso
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Bruxelles, Belgium
| | - Yéri Esther Hien
- Département de biochimie et microbiologie, Université Joseph Ki-Zerbo, Ouagadougou, Centre, Burkina Faso
| | - Lucresse Corine Fassinou
- Institut supérieur des sciences de la santé, Université Nazi Boni, Bobo-Dioulasso, Houet, Burkina Faso
| | - Kadari Cissé
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Bruxelles, Belgium
- Biomedical et santé publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Centre, Burkina Faso
| | - Calypse Ngwasiri
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Bruxelles, Belgium
| | - Yves Coppieters
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Bruxelles, Belgium
| | - Fati Kirakoya Samandoulougou
- Centre de Recherche en Epidémiologie, Biostatistique et Recherche Clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Bruxelles, Belgium
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Yao H, Ekou A, Brou I, Niamkey T, Koffi F, Tano S, Kouamé I, N'Guetta R. [Evolution of epidemiology and management of acute coronary syndromes in Abidjan : A cross-sectional study of 1011 patients.]. Ann Cardiol Angeiol (Paris) 2022; 71:130-135. [PMID: 35293317 DOI: 10.1016/j.ancard.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 11/29/2020] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To assess the evolution of the epidemiology and management of patients hospitalized to Abidjan Heart Institute for acute coronary syndrome (ACS). METHODS Cross-sectional study comparing two periods: from January 2002 to December 2009 (period 1) and from January 2010 to December 2016 (period 2), including all patients aged 18 years old, admitted to Intensive Care Unit of Abidjan Heart Institute for ACS. RESULTS One thousand eleven (1011) patients were included among the 6784 patients admitted to Intensive Care Unit of Abidjan Heart Institute for a cardiovascular disease. The overall prevalence of ACS was 14.9%. The prevalence in period 2 was significantly higher than in period 1 (22.6% and 7.3% respectively, p < 0.001). Diabetes (33.5%, p < 0.001) significantly, and smoking (30.7%, p = 0.30) had the largest rises from period 1 to period 2. ST-segment Elevation Myocardial Infarction was the main clinical presentation during both periods. The median time to treatment (p = 0.46) and length of hospital stay (p <0.001) decreased during period 2. Percutaneous coronary intervention (PCI) was performed in 173 patients (22.6%) during the period 2 and 42 patients (5.5%) underwent primary PCI. The rate of fibrinolysis increased significantly between the two periods (9.5%, p <0.001). In-hospital death increased during period 2 (10.4%, p = 0.07). CONCLUSION The burden of ACS and its related mortality have risen alarmingly past years in Côte d'Ivoire. Healthcare policies should help improve the management and outcomes of patients.
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Affiliation(s)
- H Yao
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire
| | - A Ekou
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire
| | - I Brou
- Laboratoire de biostatistique et d'informatique médicale, Centre Hospitalier Universitaire de Cocody, Abidjan, Côte d'Ivoire
| | - T Niamkey
- Service des explorations externes, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - F Koffi
- Service des Urgences, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - S Tano
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire
| | - I Kouamé
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire
| | - R N'Guetta
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, 01 BP V 206 Abidjan, Côte d'Ivoire.
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Yamano T, Kotani K, Kitano N, Morimoto J, Emori H, Takahata M, Fujita S, Wada T, Ota S, Satogami K, Kashiwagi M, Shiono Y, Kuroi A, Tanimoto T, Tanaka A. Telecardiology in Rural Practice: Global Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074335. [PMID: 35410012 PMCID: PMC8998494 DOI: 10.3390/ijerph19074335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022]
Abstract
The management of cardiovascular diseases in rural areas is plagued by the limited access of rural residents to medical facilities and specialists. The development of telecardiology using information and communication technology may overcome such limitation. To shed light on the global trend of telecardiology, we summarized the available literature on rural telecardiology. Using PubMed databases, we conducted a literature review of articles published from January 2010 to December 2020. The contents and focus of each paper were then classified. Our search yielded nineteen original papers from various countries: nine in Asia, seven in Europe, two in North America, and one in Africa. The papers were divided into classified fields as follows: seven in tele-consultation, four in the telemedical system, four in the monitoring system, two in prehospital triage, and two in tele-training. Six of the seven tele-consultation papers reported the consultation from rural doctors to urban specialists. More reports of tele-consultations might be a characteristic of telecardiology specific to rural practice. Further work is necessary to clarify the improvement of cardiovascular outcomes for rural residents.
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Affiliation(s)
- Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
- Correspondence:
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan;
| | - Naomi Kitano
- Health Administration Center, Wakayama Medical University, Wakayama 641-0012, Japan;
| | - Junko Morimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Suwako Fujita
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Keisuke Satogami
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
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11
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Onuma OK. Fixing the Broken Care Pathway for Acute Myocardial Infraction Care in Sub-Saharan Africa. Circ Cardiovasc Qual Outcomes 2022; 15:e008689. [PMID: 35300503 DOI: 10.1161/circoutcomes.121.008689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Oyere K Onuma
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
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12
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Hertz JT, Sakita FM, Kweka GL, Tarimo TG, Goli S, Prattipati S, Bettger JP, Thielman NM, Bloomfield GS. One-Year Outcomes and Factors Associated With Mortality Following Acute Myocardial Infarction in Northern Tanzania. Circ Cardiovasc Qual Outcomes 2022; 15:e008528. [PMID: 35300504 PMCID: PMC9018510 DOI: 10.1161/circoutcomes.121.008528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known about long-term outcomes and uptake of secondary preventative therapies following acute myocardial infarction (AMI) in sub-Saharan Africa. METHODS Consecutive patients presenting with AMI (as defined by the Fourth Universal Definition of AMI Criteria) to a northern Tanzanian referral hospital were enrolled in this prospective observational study. Follow-up surveys assessing mortality, medication use, and rehospitalization were administered at 3, 6, 9, and 12 months following initial presentation, by telephone or in person. Multivariate logistic regression was performed to identify baseline clinical and sociodemographic factors associated with one-year mortality. RESULTS Of 152 enrolled patients with AMI, 5 were lost to one-year follow-up (96.7% retention rate). Mortality rates were 34.9% (53 of 152 participants) during the initial hospitalization, 48.7% (73 of 150 patients) at 3 months, 52.7% (78 of 148 patients) at 6 months, 55.4% (82 of 148 patients) at 9 months, and 59.9% (88 of 147 patients) at one year. Of 59 patients surviving to one-year follow-up, 43 (72.9%) reported persistent anginal symptoms, 5 (8.5%) were taking an antiplatelet, 8 (13.6%) were taking an antihypertensive, 30 (50.8%) had been rehospitalized, and 7 (11.9%) had ever undergone cardiac catheterization. On multivariate analysis, one-year mortality was associated with lack of secondary education (odds ratio, 0.26 [95% CI, 0.11-0.58]; P=0.001), lower body mass index (odds ratio, 0.90 [95% CI, 0.82-0.98]; P=0.015), and higher initial troponin (odds ratio, 1.30 [95% CI, 1.05-1.80]; P=0.052). CONCLUSIONS In northern Tanzania, AMI is associated with high all-cause one-year mortality and use of evidence-based secondary preventative therapies among AMI survivors is low. Interventions are needed to improve AMI care and outcomes.
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Affiliation(s)
- Julian T Hertz
- Division of Emergency Medicine (J.T.H.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Francis M Sakita
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
- Kilimanjaro Christian Medical Centre University College, Moshi, Tanzania (F.M.S.)
| | - Godfrey L Kweka
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
| | - Tumsifu G Tarimo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania (F.M.S., G.L.K., T.G.T.)
| | - Sumana Goli
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Sainikitha Prattipati
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Janet P Bettger
- Department of Orthopaedic Surgery (J.P.B.), Duke University, Durham, NC
- Duke-Margolis Center for Health Policy, Duke University, Washington, District of Colombia (J.P.B.)
| | - Nathan M Thielman
- Department of Internal Medicine (N.M.T.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
| | - Gerald S Bloomfield
- Division of Cardiology (G.S.B.), Duke University School of Medicine, Durham, NC
- Duke Global Health Institute (J.T.H., S.G., S.P., N.M.T., G.S.B.), Duke University, Durham, NC
- Duke Clinical Research Institute, Durham, NC (G.S.B.)
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13
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Rojas SS, Tridandapani S, Lindsey BD. A Thin Transducer With Integrated Acoustic Metamaterial for Cardiac CT Imaging and Gating. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1064-1076. [PMID: 34971531 DOI: 10.1109/tuffc.2021.3140034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Coronary artery disease (CAD) is a leading cause of death globally. Computed tomography coronary angiography (CTCA) is a noninvasive imaging procedure for diagnosis of CAD. However, CTCA requires cardiac gating to ensure that diagnostic-quality images are acquired in all patients. Gating reliability could be improved by utilizing ultrasound (US) to provide a direct measurement of cardiac motion; however, commercially available US transducers are not computed tomography (CT) compatible. To address this challenge, a CT-compatible 2.5-MHz cardiac phased array transducer is developed via modeling, and then, an initial prototype is fabricated and evaluated for acoustic and radiographic performance. This 92-element piezoelectric array transducer is designed with a thin acoustic backing (6.5 mm) to reduce the volume of the radiopaque acoustic backing that typically causes arrays to be incompatible with CT imaging. This thin acoustic backing contains two rows of air-filled, triangular prism-shaped voids that operate as an acoustic diode. The developed transducer has a bandwidth of 50% and a single-element SNR of 9.9 dB compared to 46% and 14.7 dB for a reference array without an acoustic diode. In addition, the acoustic diode reduces the time-averaged reflected acoustic intensity from the back wall of the acoustic backing by 69% compared to an acoustic backing of the same composition and thickness without the acoustic diode. The feasibility of real-time echocardiography using this array is demonstrated in vivo, including the ability to image the position of the interventricular septum, which has been demonstrated to effectively predict cardiac motion for prospective, low radiation CTCA gating.
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14
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Yao H, Ekou A, Niamkey T, Hounhoui Gan S, Kouamé I, Afassinou Y, Ehouman E, Touré C, Zeller M, Cottin Y, N’Guetta R. Acute Coronary Syndromes in Sub-Saharan Africa: A 10-Year Systematic Review. J Am Heart Assoc 2022; 11:e021107. [PMID: 34970913 PMCID: PMC9075216 DOI: 10.1161/jaha.120.021107] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 08/16/2021] [Indexed: 12/17/2022]
Abstract
Background Data in the literature on acute coronary syndrome in sub-Saharan Africa are scarce. Methods and Results We conducted a systematic review of the MEDLINE (PubMed) database of observational studies of acute coronary syndrome in sub-Saharan Africa from January 1, 2010 to June 30, 2020. Acute coronary syndrome was defined according to current definitions. Abstracts and then the full texts of the selected articles were independently screened by 2 blinded investigators. This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. We identified 784 articles with our research strategy, and 27 were taken into account for the final analysis. Ten studies report a prevalence of acute coronary syndrome among patients admitted for cardiovascular disease ranging from 0.21% to 22.3%. Patients were younger, with a minimum age of 52 years in South Africa and Djibouti. There was a significant male predominance. Hypertension was the main risk factor (50%-55% of cases). Time to admission tended to be long, with the longest times in Tanzania (6.6 days) and Burkina Faso (4.3 days). Very few patients were admitted by medicalized transport, particularly in Côte d'Ivoire (only 34% including 8% by emergency medical service). The clinical presentation is dominated by ST-elevation sudden cardiac arrest. Percutaneous coronary intervention is not widely available but was performed in South Africa, Kenya, Côte d'Ivoire, Sudan, and Mauritania. Fibrinolysis was the most accessible means of revascularization, with streptokinase as the molecule of choice. Hospital mortality was highly variable between 1.2% and 24.5% depending on the study populations and the revascularization procedures performed. Mortality at follow-up varied from 7.8% to 43.3%. Some studies identified factors predictive of mortality. Conclusions The significant disparities in our results underscore the need for a multicenter registry for acute coronary syndrome in sub-Saharan Africa in order to develop consensus-based strategies, propose and evaluate tailored interventions, and identify prognostic factors.
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Affiliation(s)
| | | | | | | | | | - Yaovi Afassinou
- Cardiology DepartmentSylvanus Olympio University Teaching HospitalLoméTogo
| | | | | | - Marianne Zeller
- PEC 2EA 7460 Research TeamUniversity of Bourgogne Franche‐ComtéDijonFrance
| | - Yves Cottin
- Cardiology DepartmentDijon University Teaching HospitalDijonFrance
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15
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Isezuo S, Sani MU, Talle A, Johnson A, Adeoye AM, Ulgen MS, Mbakwem A, Ogah O, Edafe E, Kolo P, Nagabea M, Adebayo R, Nwafor E, Daniel F, Zagga M, Umar H, Oboirien I, Sulaiman BA, Abdullahi U, Mijinyawa MS, Buba F, Aje A, Okolie H, Shehu MN, Adamu U, Olusegun-Joseph A, Familoni R, Chibuzor N, Olunuga TO, Ejim E, Rasheed Olaide A, Ojji D, Sanni B, Ajuluchukwu JN, Balogun MO, Omotoso AB, Ajit M, Falase AO. Registry for Acute Coronary Events in Nigeria (RACE-Nigeria): Clinical Characterization, Management, and Outcome. J Am Heart Assoc 2021; 11:e020244. [PMID: 34935419 PMCID: PMC9075212 DOI: 10.1161/jaha.120.020244] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Coronary artery disease was hitherto a rarity in Africa. Acute coronary syndrome (ACS) accounts for coronary artery disease–related morbidity and mortality. Reports on ACS in Africa are few. Methods and Results We enrolled 1072 indigenous Nigerian people 59.2±12.4 years old (men, 66.8%) with ACS in an observational multicentered national registry (2013–2018). Outcome measures included incidence, intervention times, reperfusion rates, and 1‐year mortality. The incidence of ACS was 59.1 people per 100 000 hospitalized adults per year, and comprised ST‐segment–elevation myocardial infarction (48.7%), non–ST‐segment–elevation myocardial infarction (24.5%), and unstable angina (26.8%). ACS frequency peaked 10 years earlier in men than women. Patients were predominantly from urban settings (87.3%). Median time from onset of symptoms to first medical contact (patients with ST‐segment–elevation myocardial infarction) was 6 hours (interquartile range, 20.1 hours), and only 11.9% presented within a 12‐hour time window. Traditional risk factors of coronary artery disease were observed. The coronary angiography rate was 42.4%. Reperfusion therapies included thrombolysis (17.1%), percutaneous coronary intervention (28.6%), and coronary artery bypass graft (11.2%). Guideline‐based pharmacotherapy was adequate. Major adverse cardiac events were 30.8%, and in‐hospital mortality was 8.1%. Mortality rates at 30 days, 3 months, 6 months, and 1 year were 8.7%, 9.9%, 10.9%, and 13.3%, respectively. Predictors of mortality included resuscitated cardiac arrest (odds ratio [OR], 50.0; 95% CI, 0.010–0.081), nonreperfusion (OR, 34.5; 95% CI, 0.004–0.221), pulmonary edema (OR, 11.1; 95% CI, 0.020–0.363), left ventricular diastolic dysfunction (OR, 4.1; 95% CI, 0.091–0.570), and left ventricular systolic dysfunction (OR, 2.1; 95% CI, 1.302–3.367). Conclusions ACS burden is rising in Nigeria, and patients are relatively young and from an urban setting. The system of care is evolving and is characterized by lack of capacity and low patient eligibility for reperfusion. We recommend preventive strategies and health care infrastructure‐appropriate management guidelines.
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Affiliation(s)
- Simeon Isezuo
- Department of Medicine Usmanu Danfodiyo University & Teaching Hospital Sokoto Nigeria
| | - Mahmoud Umar Sani
- Department of Medicine Bayero University Kano & Aminu Kano Teaching Hospital Kano Nigeria
| | - Abdullahi Talle
- Department of Medicine University of Maiduguri Teaching Hospital Maiduguri Nigeria
| | | | | | | | - Amam Mbakwem
- Department of Medicine Lagos University Teaching Hospital Lagos Nigeria
| | - Okechukwu Ogah
- Department of Medicine University College Hospital Ibadan Nigeria
| | - Emmanuel Edafe
- Department of Medicine Bayelsa Specialist Hospital Yenagoa Nigeria
| | - Philip Kolo
- Department of Medicine University of Ilorin Teaching Hospital Ilorin Nigeria
| | - Murtala Nagabea
- Department of Medicine University of Abuja Teaching Hospital Abuja Nigeria
| | - Rasaaq Adebayo
- Department of Medicine Obafemi Awolowo University Teaching Hospital Complex Ile-Ife Nigeria
| | - Eze Nwafor
- Department of Medicine University of Port Harcourt Teaching Hospital Port Harcourt Nigeria
| | - Folasade Daniel
- Department of Medicine Lagos State University Teaching Hospital Lagos Nigeria
| | - Muiyawa Zagga
- Department of Medicine Usmanu Danfodiyo University & Teaching Hospital Sokoto Nigeria
| | - Hayatu Umar
- Department of Medicine Usmanu Danfodiyo University & Teaching Hospital Sokoto Nigeria
| | - Isa Oboirien
- Department of Medicine Usmanu Danfodiyo University & Teaching Hospital Sokoto Nigeria
| | - Balarabe A Sulaiman
- Department of Medicine Bayero University Kano & Aminu Kano Teaching Hospital Kano Nigeria
| | - Umar Abdullahi
- Department of Medicine Bayero University Kano & Aminu Kano Teaching Hospital Kano Nigeria
| | | | - Farouk Buba
- Department of Medicine University of Maiduguri Teaching Hospital Maiduguri Nigeria
| | - Akinyemi Aje
- Department of Medicine University College Hospital Ibadan Nigeria
| | - Henry Okolie
- Department of Medicine Federal Medical Centre Gombe Nigeria
| | | | - Umar Adamu
- Department of Medicine Federal Medical Centre Bida Nigeria
| | | | - Ranti Familoni
- Department of Medicine Olabisi Onobanjo University Teaching Hospital Sagamu Nigeria
| | - Nwuriku Chibuzor
- Department of Medicine Federal Teaching Hospital Abakaliki Nigeria
| | | | - Emmanuel Ejim
- Department of Medicine University of Nigeria Teaching Hospital Enugu Nigeria
| | | | - Dike Ojji
- Department of Medicine University of Abuja Teaching Hospital Abuja Nigeria
| | - Bushra Sanni
- Department of Medicine Federal Medical Centre Katsina Nigeria
| | | | - Michael O Balogun
- Department of Medicine Obafemi Awolowo University Teaching Hospital Complex Ile-Ife Nigeria
| | - Ayodele B Omotoso
- Department of Medicine University of Ilorin Teaching Hospital Ilorin Nigeria
| | - Mullasari Ajit
- Institute of Cardiovascular Disease Madras Medical Mission Chennai India
| | - Ayodele O Falase
- Department of Medicine University College Hospital Ibadan Nigeria
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16
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Chowdhury IZ, Amin MN, Chowdhury MZ, Rahman SM, Ahmed M, Cader FA. Pre hospital delay and its associated factors in acute myocardial infarction in a developing country. PLoS One 2021; 16:e0259979. [PMID: 34818360 PMCID: PMC8612565 DOI: 10.1371/journal.pone.0259979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/29/2021] [Indexed: 01/03/2023] Open
Abstract
Background Early revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka. Methods This retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay. Results The mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5–9.9)], diabetes [OR: 1.7 (95% CI: 1.0–2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3–7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0–3.5)] were significantly associated with pre-hospital delays. Conclusion Acute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.
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Affiliation(s)
| | - Md Nurul Amin
- Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
| | - Mashhud Zia Chowdhury
- Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Mohsin Ahmed
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - F Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
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Fanta K, Daba FB, Asefa ET, Melaku T, Chelkeba L, Fekadu G, Gudina EK. Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study. Front Cardiovasc Med 2021; 8:707700. [PMID: 34604351 PMCID: PMC8484752 DOI: 10.3389/fcvm.2021.707700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia. Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant. Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003-1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975-1.000), serum creatinine (HR = 1.32, 95% CI = 1.056-1.643), Killip class > II (HR = 4.62, 95% CI = 2.502-8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463-5.162), and STEMI (HR = 2.72, 95% CI = 1.006-4.261) were independent predictors of 30-day mortality. Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.
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Affiliation(s)
- Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Fekede Bekele Daba
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene Asefa
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ginenus Fekadu
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR China
- Department of Clinical Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
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18
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Beza L, Leslie SL, Alemayehu B, Gary R. Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review. IJC HEART & VASCULATURE 2021; 35:100823. [PMID: 34195352 PMCID: PMC8233123 DOI: 10.1016/j.ijcha.2021.100823] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle income countries (LMICs). A major factor that is contributing to the poor clinical outcomes among LMICs is largely due to prehospital treatment delays. This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical and health system characteristics that contribute to treatment delays. We conducted a comprehensive review of the relevant literature published in English between January 1990 through May 2020 using predefined inclusion and exclusion criteria. Twenty-nine studies were included and time to treatment was defined from ACS symptom onset to first medical contact and dichotomized further as less than or >12-hours. The mean time from symptom onset to first medical contact was 12.7 h which ranged from 10-minutes to 96 h. There was consensus among studies that being older, female, illiterate, living in a rural area, and financially limited was associated with longer treatment delays. Lack of a developed emergency transportation system, poor communication and organization between community facilities and interventional facilities were also cited as major contributors for ACS treatment delays. Findings from this systematic review provide future directions to potentially reduce prehospital delays in LMICs and improve ACS outcomes.
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Affiliation(s)
- Lemlem Beza
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sharon L. Leslie
- Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia
| | - Bekele Alemayehu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study. PLoS One 2021; 16:e0254609. [PMID: 34255782 PMCID: PMC8277059 DOI: 10.1371/journal.pone.0254609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. METHODS In a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality. RESULTS Of 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21-0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35-5.56, p = 0.006). CONCLUSION In a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting.
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Strassle Rojas S, Collins GC, Tridandapani S, Lindsey BD. Ultrasound-gated computed tomography coronary angiography: Development of ultrasound transducers with improved computed tomography compatibility. Med Phys 2021; 48:4191-4204. [PMID: 34087004 DOI: 10.1002/mp.15023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/06/2021] [Accepted: 05/26/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Cardiovascular disease (CVD) is a leading cause of death worldwide, with coronary artery disease (CAD) accounting for nearly half of all CVD deaths. The current gold standard for CAD diagnosis is catheter coronary angiography (CCA), an invasive, expensive procedure. Computed tomography coronary angiography (CTCA) represents an attractive non-invasive alternative to CCA, however, CTCA requires gated acquisition of CT data during periods of minimal cardiac motion (quiescent periods) to avoid non-diagnostic scans. Current gating methods either expose patients to high levels of radiation (retrospective gating) or lead to high rates of non-diagnostic scans (prospective gating) due to the challenge of predicting cardiac quiescence based on ECG alone. Alternatively, ultrasound (US) imaging has been demonstrated as an effective indicator of cardiac quiescence, however, ultrasound transducers produce prominent streak artifacts that disrupt CTCA scans. In this study, a proof-of-concept array transducer with improved CT-compatibility was developed for utilization in an integrated US-CTCA system. METHODS Alternative materials were tested radiographically and acoustically to replace the radiopaque acoustic backings utilized in low frequency (1-4 MHz) cardiac US transducers. The results of this testing were used to develop alternative acoustic backings consisting of varying concentrations of aluminum oxide in an epoxy matrix via simulations. On the basis of these simulations, single element test transducers designed to operate at 2.5 MHz were fabricated, and the performance of these devices was characterized via acoustic and radiographic testing with micro-computed tomography (micro-CT). Finally, a first proof-of-concept cardiac phased array transducer was developed and its US imaging performance was evaluated. Micro-CT images of the developed US array with improved CT-compatibility were compared with those of a conventional array. RESULTS Materials testing with micro-CT identified an acoustic backing with a measured radiopacity of 1008 HU, more than an order of magnitude lower than that of the acoustic backing (24,000 HU) typically used in cardiac transducers operating in the 1-4 MHz range. When utilized in a simulated transducer design, this acoustic backing yielded a -6-dB fractional bandwidth of 57%, similar to the 54% bandwidth of the transducer with the radiopaque acoustic backing. The developed 2.5 MHz, single element transducer based on these simulations exhibited a fractional bandwidth of 51% and signal-to-noise ratio (SNR) of 14.7 dB. Finally, the array transducer developed with the acoustic backing having decreased radiopacity exhibited a 56% fractional bandwidth and 10.4 dB single channel SNR, with penetration depth >10 cm in phantom and in vivo imaging using the full array. CONCLUSIONS The first attempt at developing a CT-compatible ultrasound transducer is described. The developed CT-compatible transducer exhibits improved radiographic compatibility relative to conventional cardiac array transducers with similar SNR, bandwidth, and penetration depth for US imaging, according to phantom and in vivo cardiac imaging. A CT-compatible US transducer might be used to identify cardiac quiescence and prospectively gate CTCA acquisition, reducing challenges associated with current gating approaches, specifically relatively high rates of non-diagnostic scans for prospective ECG gating and high radiation dose for retrospective gating.
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Affiliation(s)
- Stephan Strassle Rojas
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Graham C Collins
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Srini Tridandapani
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brooks D Lindsey
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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21
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Fanta K, Daba FB, Tegene E, Melaku T, Fekadu G, Chelkeba L. Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study. BMC Emerg Med 2021; 21:41. [PMID: 33789565 PMCID: PMC8010978 DOI: 10.1186/s12873-021-00433-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia. Methods A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant. Results Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81–7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28–13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55–14.55) were independent predictors of time to in-hospital death among ACS patients. Conclusion In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00433-3.
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Affiliation(s)
- Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, P.O.Box: 378, Jimma, Oromia, Ethiopia.
| | - Fekede Bekele Daba
- Department of Clinical Pharmacy, Institute of Health, Jimma University, P.O.Box: 378, Jimma, Oromia, Ethiopia
| | - Elsah Tegene
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, Institute of Health, Jimma University, P.O.Box: 378, Jimma, Oromia, Ethiopia
| | - Ginenus Fekadu
- Department of clinical pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia.,School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New territory, Hong Kong
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, Collage of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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22
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Yuyun MF, Bonny A, Ng GA, Sliwa K, Kengne AP, Chin A, Mocumbi AO, Ngantcha M, Ajijola OA, Bukhman G. A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa. Glob Heart 2020; 15:37. [PMID: 32923331 PMCID: PMC7413135 DOI: 10.5334/gh.808] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022] Open
Abstract
Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9-79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely non-invasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries. Highlights - Atrial fibrillation/flutter prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).- Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9-79%) across SSA countries.- Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.- Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.
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Affiliation(s)
- Matthew F. Yuyun
- Department of Medicine, Harvard Medical School, Boston, US
- Cardiology and Vascular Medicine Service, VA Boston Healthcare System, Boston, US
| | - Aimé Bonny
- District Hospital Bonassama, Douala/University of Douala, CM
- Homeland Heart Centre, Douala, CM
- Centre Hospitalier Montfermeil, Unité de Rythmologie, Montfermeil, FR
| | - G. André Ng
- National Institute for Health Research Leicester Biomedical Research Centre, Department of Cardiovascular Sciences, University of Leicester, UK
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, ZA
| | - Andre Pascal Kengne
- South African Medical Research Council and Department of Medicine, University of Cape Town, ZA
| | - Ashley Chin
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, ZA
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde and Universidade Eduardo Mondlane, Maputo, MZ
| | | | | | - Gene Bukhman
- Department of Medicine, Harvard Medical School, Boston, US
- Division of Cardiovascular Medicine and Division of Global Health Equity, Brigham and Women’s Hospital, Boston, US
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, US
- NCD Synergies project, Partners In Health, Boston, US
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23
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Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective. Glob Heart 2020; 15:15. [PMID: 32489788 PMCID: PMC7218780 DOI: 10.5334/gh.403] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.
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Rohacek M, Burkard T. [Heart Failure in Africa]. PRAXIS 2019; 108:983-990. [PMID: 31771489 DOI: 10.1024/1661-8157/a003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Heart Failure in Africa Abstract. In Africa, mortality due to heart failure is twice as high as in other low- to middle-income countries and five times as high as in high-income countries. Arterial hypertension is by far the most common cause of heart failure, followed by cardiomyopathies and rheumatic heart diseases. At diagnosis, most patients suffer already from an advanced disease stage. Only a few patients are aware of arterial hypertension, and few are treated and have their hypertension well controlled. Only a minority of patients have a well-controlled hypertension. The neglect of chronic non-communicable diseases on the health agenda leads to poor awareness, poor diagnostic resources, preventions strategies and treatment options. International guidelines cannot be properly followed in these circumstances. Information at community level and in healthcare facilities is urgently needed as well as training of healthcare staff, implementation of improved diagnostics and treatment of arterial hypertension and heart failure.
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Affiliation(s)
- Martin Rohacek
- St. Francis Referral Hospital, Ifakara, United Republic of Tanzania
- Ifakara Health Institute, Ifakara, United Republic of Tanzania
- Schweizerisches Tropen- und Public Health-Institut (Swiss TPH)
- Universität Basel, Basel
| | - Thilo Burkard
- Universität Basel, Basel
- Kardiologie, Universitätsspital, Basel
- Medical Outpatient Department and Hypertension Clinic, Universitätsspital, Basel
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25
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Sharma YP, Krishnappa D, Kanabar K, Kasinadhuni G, Sharma R, Kishore K, Mehrotra S, Santosh K, Gupta A, Panda P. Clinical characteristics and outcome in patients with a delayed presentation after ST-elevation myocardial infarction and complicated by cardiogenic shock. Indian Heart J 2019; 71:387-393. [PMID: 32035521 PMCID: PMC7013184 DOI: 10.1016/j.ihj.2019.11.256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/25/2019] [Accepted: 11/11/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Delayed presentation after ST-elevation myocardial infarction (STEMI) and complicated by cardiogenic shock (CS-STEMI) is commonly encountered in developing countries and is a challenging scenario because of a delay in revascularization resulting in infarction of a large amount of the myocardium. We aimed to assess the clinical characteristics, angiographic profile, and predictors of outcome in patients with a delayed presentation after CS-STEMI. METHODS A total of 147 patients with CS-STEMI with time to appropriate medical care ≥12 h after symptom onset were prospectively recruited at a tertiary referral center. RESULTS The median time to appropriate care was 24 h (interquartile range 18-48 h). The mean age was 58.7 ± 11.1 years. Left ventricular pump failure was the leading cause of shock (67.3%), whereas mechanical complications accounted for 14.9% and right ventricular infarction for 13.6% of cases. The overall in-hospital mortality was 42.9%. Acute kidney injury [Odds ratio (OR) 8.04; 95% confidence intervals (CI) 3.08-20.92], ventricular tachycardia (OR 7.04; CI 2.09-23.63), mechanical complications (OR 6.46; CI 1.80-23.13), and anterior infarction (OR 3.18; CI 1.01-9.97) were independently associated with an increased risk of mortality. Coronary angiogram (56.5%) revealed single-vessel disease (45.8%) as the most common finding. Percutaneous coronary intervention was performed in 53 patients (36%), at a median of 36 h (interquartile range 30-72) after symptom onset. CONCLUSION Patients with a delayed presentation after CS-STEMI were younger and more likely to have single-vessel disease. We found a high in-hospital mortality of 42.9%. Appropriate randomized studies are required to evaluate the optimal treatment strategies in these patients.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Darshan Krishnappa
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kewal Kanabar
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ganesh Kasinadhuni
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Rakesh Sharma
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Kamal Kishore
- Department of Biostatistics, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Saurabh Mehrotra
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Krishna Santosh
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ankur Gupta
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Prashant Panda
- Department of Cardiology, Advanced Cardiac Centre (ACC), Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Henriksen TH, Abebe W, Amogne W, Getachew Y, Weedon-Fekjær H, Klein J, Woldeamanuel Y. Association between antimicrobial resistance among Enterobacteriaceae and burden of environmental bacteria in hospital acquired infections: analysis of clinical studies and national reports. Heliyon 2019; 5:e02054. [PMID: 31372534 PMCID: PMC6658825 DOI: 10.1016/j.heliyon.2019.e02054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/17/2019] [Accepted: 07/04/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND WHO has named three groups of gram-negative bacteria "our critical antimicrobial resistance-related problems globally". It is thus a priority to unveil any important covariation of variables behind this three-headed epidemic, which has gained alarming proportions in Low Income Countries, and spreads rapidly. Environmental bacteria including Acinetobacter spp. are common nosocomial pathogens in institutions that have high rates of antimicrobial resistance among other groups of gram-negative bacteria. METHODS Based on two different data sources, we calculated the correlation coefficient (Pearson's r) between pathogenic burden of Acinetobacter spp. and antimicrobial resistance among Enterobacteriaceae in European and African nosocomial cohorts. CLINICAL REPORTS Database search for studies on nosocomial sepsis in Europe and Africa was followed by a PRISMA-guided selection process. NATIONAL REPORTS Data from Point prevalence survey of healthcare-associated infections published by European Centre for Disease Prevention and Control were used to study the correlation between prevalence of Acinetobacter spp. and antimicrobial resistance among K. pneumoniae in blood culture isolates. FINDINGS The two approaches both revealed a strong association between prevalence of Acinetobacter spp. and rates of resistance against 3. generation cephalosporins among Enterobacteriaceae. In the study of clinical reports (13 selected studies included), r was 0.96 (0.80-0.99) when calculated by proportions on log scale. Based on national reports, r was 0.80 (0.56-0.92) for the correlation between resistance rates of K. pneumoniae and proportion of Acinetobacter spp. INTERPRETATION The critical antimicrobial resistance-related epidemics that concern enteric and environmental gram-negative bacteria are not independent epidemics; they have a common promoting factor, or they are mutually supportive. Further, accumulation of antimicrobial resistance in nosocomial settings depends on the therapeutic environment. Burden of Acinetobacter spp. as defined here is a candidate measure for this dependence.
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Affiliation(s)
- Thor-Henrik Henriksen
- Department of Internal Medicine, School of Medicine, Addis Ababa University, Ethiopia
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Ethiopia
- Department of Microbiology, Vestfold Hospital Trust, 3103, Tönsberg, Norway
| | - Workeabeba Abebe
- Department of Pediatrics and Child Health, School of Medicine, Addis Ababa University, Ethiopia
| | - Wondwossen Amogne
- Department of Internal Medicine, School of Medicine, Addis Ababa University, Ethiopia
| | - Yitagesu Getachew
- Department of Internal Medicine, Yekatit 12 Hospital Medical College, Ethiopia
| | - Harald Weedon-Fekjær
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Jörn Klein
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Yimtubezinash Woldeamanuel
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Bogale K, Mekonnen D, Nedi T, Woldu MA. Treatment Outcomes of Patients with Acute Coronary Syndrome Admitted to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819839417. [PMID: 31024218 PMCID: PMC6472164 DOI: 10.1177/1179546819839417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/27/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction that are usually due to an abrupt reduction in coronary blood flow. OBJECTIVE The objective of the study was to assess the treatment outcome and associated factors for ACS. METHODS A retrospective cross-sectional study was conducted from January 1, 2012 to December 31, 2014. RESULTS Of 124 ACS patients who were admitted during the 3 years' period, 90 (72.6%) were diagnosed with ST segment elevation myocardial infarction (STEMI). The mean age was 56.3 ± 13.7 years. The average length of hospital stay was 9.77 ± 6.42 days. The average time from onset of ACS symptoms to presentation in the emergency department was 3.8 days (91.7 hours). In about 76 (61.3%) patients, hypertension was the leading risk factor for development of ACS, and 36.4% of ACS patients were either Killip class III or IV. Biomarkers were measured for 118 (95.2%) patients, and 79.2% of patients had ejection fraction of less than 40% and 29.2% had less than 30%. In-hospital medication use includes loading dose of aspirin (79%), anticoagulants (77.4%), beta blockers (88.1%), statins (85.5%), morphine (12.9%), and nitrates (35.5%). The in-hospital mortality was 27.4%. The predictors for in-hospital mortality were age (P = .042), time from symptom onset to presentation (P = .001), previous history of hypertension (P = .025), being Killip class III and IV (P = .001), and STEMI diagnosis (P = .005). CONCLUSIONS The medical management of ACS patients in Tikur Anbessa Specialized Hospital (TASH) was in line with the recommendations of international guidelines but in-hospital mortality was extremely high (27.4%).
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Affiliation(s)
| | - Desalew Mekonnen
- Department of Internal medicine, School
of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Nedi
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew Woldu
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
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N'Guetta R, Yao H, Ekou A, Séri B, N'Cho-Mottoh MP, Soya E, Konin C, Anzouan-Kacou JB, Seka R. Coronary artery disease in black African patients with diabetes: Insights from an Ivorian cardiac catheterization centre. Arch Cardiovasc Dis 2019; 112:296-304. [PMID: 30898474 DOI: 10.1016/j.acvd.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/20/2018] [Accepted: 01/23/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Coronary angiography data are scarce for black patients with diabetes. AIM To assess coronary angiography findings in patients with diabetes at the Abidjan Heart Institute. METHODS This observational cross-sectional survey was conducted between 1 April 2010 and 31 December 2014. All patients admitted for known or suspected coronary artery disease who underwent coronary angiography were included in the Registre Prospectif des Actes de Cardiologie Interventionnelle de l'Institut de Cardiologie d'Abidjan. We analysed and compared coronary angiographical findings in patients with and without diabetes. RESULTS Eighty patients with diabetes were compared with 353 patients without diabetes. Patients with diabetes were significantly older (58.7±8.9 vs 52.1±11.5 years; P<0.001). Hypertension and hypertriglyceridaemia were significantly associated with diabetes (P<0.001 and P=0.04, respectively). A higher proportion of patients with diabetes had an abnormal coronary angiogram (85.0% vs 67.7%; P=0.002). Coronary artery disease in patients with diabetes was predominantly characterized by multivessel disease (P<0.001). Cardiovascular risk factors associated with diabetes influenced the severity of coronary lesions. A SYNTAX score≥33 was found in a higher proportion of patients with diabetes (12.5% vs 7.1%). In the multivariable logistic regression, after adjustment, age>60 years (hazard ratio 2.53, 95% confidence interval 1.59-4.04; P<0.001) and diabetes (hazard ratio 2.12, 95% confidence interval 1.26-3.57; P=0.004) were associated with multivessel coronary artery disease. CONCLUSIONS In our study, diabetes emerged as a risk factor for multivessel coronary artery disease. Future studies should help to define the long-term prognosis of these patients, and to assess the benefits of myocardial revascularization procedures.
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Affiliation(s)
| | - Hermann Yao
- Abidjan Heart Institute, 01 BP V206 Abidjan, Côte d'Ivoire
| | - Arnaud Ekou
- Abidjan Heart Institute, 01 BP V206 Abidjan, Côte d'Ivoire
| | - Benjamin Séri
- PAC-CI, ANRS Research Site, University Teaching Hospital of Treichville, 18 BP 1954 Abidjan, Côte d'Ivoire
| | | | - Esaïe Soya
- Abidjan Heart Institute, 01 BP V206 Abidjan, Côte d'Ivoire
| | | | | | - Rémi Seka
- Abidjan Heart Institute, 01 BP V206 Abidjan, Côte d'Ivoire
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Yao H, Ekou A, Hadéou A, N'Djessan JJ, Kouamé I, N'Guetta R. Medium and long-term follow-up after ST-segment elevation myocardial infarction in a sub-Saharan Africa population: a prospective cohort study. BMC Cardiovasc Disord 2019; 19:65. [PMID: 30894133 PMCID: PMC6425633 DOI: 10.1186/s12872-019-1043-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/14/2019] [Indexed: 11/26/2022] Open
Abstract
Background Major in-hospital mortality rate in patients with ST-segment Elevation Myocardial Infarction (STEMI) in Sub-Saharan Africa has been reported. Data on follow-up in these patients with STEMI are scarce. We aimed to assess medium and long-term prognosis in patients with STEMI admitted to Abidjan Heart Institute. Methods Prospective cohort study including 260 patients admitted for STEMI to Abidjan Heart Institute, from January 1, 2012 to December 31, 2015. We compared mortality and nonfatal cardiovascular complications in revascularized and non-revascularized groups. Survival curve was generated with the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression. Results Of the 260 patients followed up on a median period of 39 months [28–68 months], 94 patients (36.1%) were revascularized and 166 (63.8%) were non-revascularized. Crude all-cause mortality was 10.4%. It was significantly higher in non-revascularized patients (p = 0.04). There was no difference in the occurrence of nonfatal cardiovascular complications in the 2 groups. In multivariable Cox regression, age ≥ 70 years, female gender and heart failure were the predictive factors for death after adjustment. Conclusions STEMI remains an important cause of mortality in our practice. Healthcare policies should be developed to improve patient care and long-term outcomes.
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Affiliation(s)
- Hermann Yao
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire.
| | - Arnaud Ekou
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Aurore Hadéou
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Jean-Jacques N'Djessan
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Isabelle Kouamé
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Roland N'Guetta
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
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Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care. Prehosp Disaster Med 2018; 33:650-657. [PMID: 30430958 DOI: 10.1017/s1049023x1800105x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Gambia is going through a rapid epidemiologic transition with a dual disease burden of infections and non-communicable diseases occurring at the same time. Acute, time-sensitive, medical emergencies such as trauma, obstetric emergencies, respiratory failure, and stroke are leading causes of morbidity and mortality among adults in the country.ProblemData on medical emergency care and outcomes are lacking in The Gambia. Data on self-reported medical emergencies among adults in a selection of Gambian communities are presented in this report. METHODS A total of 320 individuals were surveyed from 34 communities in the greater Banjul area of The Gambia using a survey instrument estimating the incidence of acute medical emergencies in an adult population. Self-reported travel time to a health facility during medical emergencies and patterns of health-seeking behavior with regard to type of facility visited and barriers to accessing emergency care, including cost and medical insurance coverage, are presented in this report. RESULTS Of the 320 individuals surveyed, 262 agreed to participate resulting in a response rate of 82%. Fifty-two percent of respondents reported an acute medical emergency in the preceding year that required urgent evaluation at a health facility. The most common facility visited during such emergencies was a health center. Eighty-seven percent of respondents reported a travel time of less than one hour during medical emergencies. Out-of-pocket cost of medications accounted for the highest expenditure during emergencies. There was a low awareness and willingness to subscribe to health insurance among individuals surveyed. CONCLUSION There is a high incidence of acute medical emergencies among adults in The Gambia which are associated with adverse outcomes due to a combination of poor health literacy, high out-of-pocket expenditures on medications, and poor access to timely prehospital emergency care. There is an urgent need to develop prehospital acute care and Emergency Medical Services (EMS) in the primary health sector as part of a strategy to reduce mortality and morbidity in the country. TourayS, SanyangB, ZandrowG, TourayI. Incidence and outcomes after out-of-hospital medical emergencies in Gambia: a case for the integration of prehospital care and Emergency Medical Services in primary health care. Prehosp Disaster Med. 2018;33(6):650-657.
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Health-Seeking Behavior of Patients with Acute Coronary Syndrome and Their Family Caregivers. Prehosp Disaster Med 2018; 33:614-620. [PMID: 30394262 DOI: 10.1017/s1049023x18001036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
IntroductionAcute Coronary Syndrome (ACS) is a life-threatening condition. Immediate and proper treatment will decrease mortality rate. Patient awareness on ACS is still lacking and as the consequence, ACS patients do not seek immediate help.ProblemThe patients' efforts to get rid of ACS symptoms. METHODS The study was a descriptive, qualitative study in which a semi-structured, in-depth interview became the instrument. The respondents were 34 participants (including 17 ACS patients and 17 family caregivers). Data analysis was done by triangulation of data sources. RESULTS Three themes were obtained, namely: (1) prefer traditional and self-treatment, for example (a) traditional medicine, (b) taking non-prescription drugs to overcome ACS symptoms, and (c) spontaneous action; (2) using available health resources and facilities that consisted of (a) getting initial treatment at home by nurses, (b) visiting a health center to take care of the symptoms, and (c) using non-ambulance service to visit the health centers; and (3) expectations on health care services to patients composed by sub-themes such as (a) the expectation to get information that supports the healing, and (b) the caring attitude of the heath professional. CONCLUSIONS The results showed that in the prehospital setting when experiencing ACS symptoms, the patients try to overcome the symptoms independently. However, as the symptoms get worse, they utilize health facilities in different ways. At the time of obtaining health services, patients are satisfied with health professionals who show caring attitudes, explain the results of the examination, and provide health education on health care efforts. Thus, to prevent mortality and morbidity, it is important for a health professional to educate the public about ACS, including topics about ACS healthy lifestyles and potential threats if it is too late to get treatment. Furthermore, it is also important for the government to implement prehospital emergency services nation-wide. KumboyonoK, RefialdinataJ, WihastutiTA, RachmawatiSD, AzizAN. Health-seeking behavior of patients with Acute Coronary Syndrome and their family caregivers. Prehosp Disaster Med. 2018;33(6):614-620.
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Nascimento BR, Brant LCC, Marino BCA, Passaglia LG, Ribeiro ALP. Implementing myocardial infarction systems of care in low/middle-income countries. Heart 2018; 105:20-26. [DOI: 10.1136/heartjnl-2018-313398] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 01/09/2023] Open
Abstract
Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.
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[Percutaneous coronary intervention in the management of acute coronary syndromes in Ivory Coast: Challenges and outcomes]. Ann Cardiol Angeiol (Paris) 2018; 67:244-249. [PMID: 29753418 DOI: 10.1016/j.ancard.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 04/24/2018] [Indexed: 11/20/2022]
Abstract
AIM Assess the challenges and outcomes of percutaneous coronary intervention (PCI) in the management of ACS at Abidjan Heart Institute. PATIENTS AND METHODS Prospective survey carried out from April, 1st, 2010 to April, 29th, 2016. Whole patients aged 18-year-old, admitted at Abidjan Heart Institute for ACS, and who underwent PCI were included in the Registre prospectif des actes de cardiologie interventionnelle de l'institut de cardiologie d'Abidjan (REPACI). Indications and outcomes of PCI were analyzed. RESULTS Seven hundred and forty-nine patients were admitted for ACS, of which 165 underwent PCI. Ratio PCI/ACS was 0.22. Mean age was 55.6±9.8 years. Male were predominant (sex-ratio=12.7). Main clinical presentation was ST-elevation myocardial infarction (STEMI) in 75.1% of cases. One-vessel disease was predominant in STEMI (52.4%), and multi-vessel disease in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) (51.2%). Most of patients (86.7%) underwent PCI with stent implantation. PCI was performed successfully in 97.0% of cases. Main non-fatal complications were hematoma (2.4%). In-hospital mortality-rate was 1.2%, and one-year mortality-rate was 1.6%. CONCLUSION PCI is performed in Subsaharan Africa with safety, despite encountered difficulties in its implementation.
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Leong DP, Joseph PG, McKee M, Anand SS, Teo KK, Schwalm JD, Yusuf S. Reducing the Global Burden of Cardiovascular Disease, Part 2: Prevention and Treatment of Cardiovascular Disease. Circ Res 2017; 121:695-710. [PMID: 28860319 DOI: 10.1161/circresaha.117.311849] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this second part of a 2-part series on the global burden of cardiovascular disease, we review the proven, effective approaches to the prevention and treatment of cardiovascular disease. We specifically review the management of acute cardiovascular diseases, including acute coronary syndromes and stroke; the care of cardiovascular disease in the ambulatory setting, including medical strategies for vascular disease, atrial fibrillation, and heart failure; surgical strategies for arterial revascularization, rheumatic and other valvular heart disease, and symptomatic bradyarrhythmia; and approaches to the prevention of cardiovascular disease, including lifestyle factors, blood pressure control, cholesterol-lowering, antithrombotic therapy, and fixed-dose combination therapy. We also discuss cardiovascular disease prevention in diabetes mellitus; digital health interventions; the importance of socioeconomic status and universal health coverage. We review building capacity for conduction cardiovascular intervention through strengthening healthcare systems, priority setting, and the role of cost effectiveness.
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Affiliation(s)
- Darryl P Leong
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.).
| | - Philip G Joseph
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Martin McKee
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Sonia S Anand
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Koon K Teo
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Jon-David Schwalm
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
| | - Salim Yusuf
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Ontario, Canada (D.P.L., P.G.J., S.S.A., K.K.T., J.-D.S., S.Y.); and London School of Hygiene and Tropical Medicine, United Kingdom (M.M.)
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Schutte AE, Conti E, Mels CM, Smith W, Kruger R, Botha S, Gnessi L, Volpe M, Huisman HW. Attenuated IGF-1 predicts all-cause and cardiovascular mortality in a Black population: A five-year prospective study. Eur J Prev Cardiol 2016; 23:1690-1699. [PMID: 27450159 DOI: 10.1177/2047487316661436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/07/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inconsistent findings are reported on whether insulin-like growth factor-1 (IGF-1) is protective or harmful in predicting hypertension, carotid wall thickness and mortality. We determined the five-year prognostic value of IGF-1 for these outcomes in a large Black population prone to hypertension and cardiovascular disease. DESIGN A longitudinal study as part of the PURE (Prospective Urban and Rural Epidemiology) study, North West Province, South Africa. METHODS We measured IGF-1 and IGF binding protein-3 (IGFBP-3) in 1038 HIV-uninfected participants (age range 32-94 years) and assessed blood pressure, carotid intima-media thickness and mortality. RESULTS Over five years 116 deaths occurred. Baseline IGF-1 was similar in survivors and non-survivors (p = 0.50), but tended to be higher in survivors upon adjustment for IGFBP-3 and covariates (p = 0.061). Normotensives and hypertensives (p = 0.072), and those with carotid intima-media thickness < 0.9 mm and ≥ 0.9 mm also displayed similar baseline IGF-1 (p = 0.55). Multivariable-adjusted Cox-regression indicated high IGF-1 predicting lower risk for all-cause mortality (hazard ratio 0.45; 0.23-0.88) and cardiovascular mortality (hazard ratio 0.26; 0.08-0.83) when also adjusting for IGFBP-3. When including normo- and hypertensives at baseline, high IGF-1 was related to normotension at follow-up (hazard ratio 0.68; 0.49-0.95). We found no association with carotid intima-media thickness (hazard ratio 0.59; 0.31-1.14). CONCLUSION In a Black South African population with low socio-economic status and harmful health behaviours, we found a protective independent association between IGF-1 and hypertension, cardiovascular and all-cause mortality, with no association with carotid wall thickness.
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Affiliation(s)
- Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa Medical Research Council, Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Elena Conti
- Department of Clinical and Molecular Medicine, University of Rome, Sapienza, Italy
| | - Catharina Mc Mels
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Wayne Smith
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Shani Botha
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Lucio Gnessi
- Department of Experimental Medicine, Pathophysiology and Endocrinology Unit, University of Rome, Sapienza, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome, Sapienza, Italy IRCCS Neuromed, Pozzilli, Italy
| | - Hugo W Huisman
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa Medical Research Council, Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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