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Bozkurt B, Ahmad T, Alexander K, Baker WL, Bosak K, Breathett K, Carter S, Drazner MH, Dunlay SM, Fonarow GC, Greene SJ, Heidenreich P, Ho JE, Hsich E, Ibrahim NE, Jones LM, Khan SS, Khazanie P, Koelling T, Lee CS, Morris AA, Page RL, Pandey A, Piano MR, Sandhu AT, Stehlik J, Stevenson LW, Teerlink J, Vest AR, Yancy C, Ziaeian B. HF STATS 2024: Heart Failure Epidemiology and Outcomes Statistics An Updated 2024 Report from the Heart Failure Society of America. J Card Fail 2024:S1071-9164(24)00232-X. [PMID: 39322534 DOI: 10.1016/j.cardfail.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
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Awindaogo F, Acheamfour-Akowuah E, Doku A, Kokuro C, Agyekum F, Owusu IK. Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry. JMIR Res Protoc 2024; 13:e52616. [PMID: 38588528 PMCID: PMC11036190 DOI: 10.2196/52616] [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: 09/10/2023] [Revised: 12/23/2023] [Accepted: 12/24/2023] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care. OBJECTIVE This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana. METHODS We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring. RESULTS This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024. CONCLUSIONS This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research. TRIAL REGISTRATION ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52616.
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Affiliation(s)
| | | | - Alfred Doku
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Francis Agyekum
- Department of Medicine and Therapeutics, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Isaac Kofi Owusu
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Robbertse PPS, Doubell AF, Esterhuizen TM, Herbst PG. Antiretroviral therapy and HIV-associated cardiovascular disease: a prospective cardiac biomarker and CMR tissue characterization study. ESC Heart Fail 2024; 11:748-758. [PMID: 38100145 DOI: 10.1002/ehf2.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 08/01/2023] [Accepted: 11/10/2023] [Indexed: 02/24/2024] Open
Abstract
AIMS Biochemical markers are fundamental in cardiac evaluation, and various novel assays have recently been discovered. We prospectively evaluated the hearts of newly diagnosed people living with human immunodeficiency virus (PLWH) using cardiac biomarkers, compared them with human immunodeficiency virus (HIV)-uninfected controls, and correlated our prospective findings with cardiovascular magnetic resonance imaging (CMR). METHODS AND RESULTS Newly diagnosed, antiretroviral therapy (ART)-naïve PLWH were recruited along with HIV-uninfected, age-matched, and sex-matched controls. All participants underwent measurement of high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), soluble ST2 (sST2), and galectin-3, as well as a CMR study with multiparametric mapping. The HIV group started ART and was re-evaluated 9 months later. The cardiac biomarkers and their correlation with CMR parameters were evaluated in and between groups. Compared with controls (n = 22), hs-cTnT (4.0 vs. 5.1 ng/L; P = 0.004), NT-proBNP (23.2 vs. 40.8 ng/L; P = 0.02), and galectin-3 (6.8 vs. 9.0 ng/mL; P = 0.002) were all significantly higher in the ART-naïve group (n = 73). After 9 months of ART, hs-cTnT (5.1 vs. 4.3 ng/L; P = 0.02) and NT-proBNP (40.8 vs. 28.5 ng/L; P = 0.03) both decreased significantly and a trend of decrease was seen in sST2 (16.5 vs. 14.8 ng/L; P = 0.08). Galectin-3 did not demonstrate decrease over time (9.0 vs. 8.8 ng/mL; P = 0.6). The cardiac biomarkers that showed the best correlation with CMR measurements native T1, T2, and extracellular volume were NT-proBNP (rs ≥ 0.4, P < 0.001) and galectin-3 (rs ≥ 0.3, P < 0.01). CONCLUSIONS Our cardiac biomarker data support the presence of subclinical myocardial injury, remodelling, and fibrosis at HIV diagnosis, and ART had a positive influence on these blood markers. It remains unclear if the underlying pathological processes were fully addressed by ART. The ability of cardiac biomarkers to detect and track tissue abnormalities diagnosed with CMR showed promise. With additional research, this could lead to improvements in screening and monitoring myocardial abnormalities, even in CMR-limited settings.
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Affiliation(s)
- Pieter-Paul S Robbertse
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- University of Pittsburgh HIV-Comorbidities Research Training Programme in South Africa, Cape Town, South Africa
| | - Anton F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Tonya M Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Philip G Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Klassen SL, Okello E, Ferrer JME, Alizadeh F, Barango P, Chillo P, Chimalizeni Y, Dagnaw WW, Eiselé JL, Eberly L, Gomanju A, Gupta N, Koirala B, Kpodonu J, Kwan G, Mailosi BGD, Mbau L, Mutagaywa R, Pfaff C, Piñero D, Pinto F, Rusingiza E, Sanni UA, Sanyahumbi A, Shakya U, Sharma SK, Sherpa K, Sinabulya I, Wroe EB, Bukhman G, Mocumbi A. Decentralization and Integration of Advanced Cardiac Care for the World's Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease. Glob Heart 2024; 19:33. [PMID: 38549727 PMCID: PMC10976983 DOI: 10.5334/gh.1313] [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: 12/12/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
Rheumatic and congenital heart disease, cardiomyopathies, and hypertensive heart disease are major causes of suffering and death in low- and lower middle-income countries (LLMICs), where the world's poorest billion people reside. Advanced cardiac care in these counties is still predominantly provided by specialists at urban tertiary centers, and is largely inaccessible to the rural poor. This situation is due to critical shortages in diagnostics, medications, and trained healthcare workers. The Package of Essential NCD Interventions - Plus (PEN-Plus) is an integrated care model for severe chronic noncommunicable diseases (NCDs) that aims to decentralize services and increase access. PEN-Plus strategies are being initiated by a growing number of LLMICs. We describe how PEN-Plus addresses the need for advanced cardiac care and discuss how a global group of cardiac organizations are working through the PEN-Plus Cardiac expert group to promote a shared operational strategy for management of severe cardiac disease in high-poverty settings.
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Affiliation(s)
- Sheila L. Klassen
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
| | - Emmy Okello
- Department of Medicine, Makerere University, Kampala, Uganda
| | | | - Faraz Alizadeh
- Department of Cardiology, Boston Children’s hospital, Boston, United States
- Department of Pediatrics, Harvard Medical School, Boston, United States
| | - Prebo Barango
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Pilly Chillo
- Muhimbili University of Health and Allied Sciences, Department of Internal Medicine, Dar Es Salaam, Tanzania
| | - Yamikani Chimalizeni
- Kamuzu University of Health Sciences, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Wubaye Walelgne Dagnaw
- Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States
| | | | - Lauren Eberly
- Division of Cardiovascular Medicine, Department of Medicine, Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute, Penn Cardiovascular Center for Health, University of Pennsylvania, Philadelphia, United States
| | - Anu Gomanju
- Kathmandu Institute of Child Health, Kathmandu, Nepal
- Global Alliance for Rheumatic and Congenital Hearts, Philadelphia, United States
| | - Neil Gupta
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
- Department of Global Health and Social Medicine, Program in Global NCDs and Social Change, Harvard University, Boston, United States
| | - Bhagawan Koirala
- Department of Cardiothoracic & Vascular Surgery – Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, United States
| | - Gene Kwan
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, United States
- Partners In Health, Boston, United States
- Department of Global Health and Social Medicine, Harvard University, Boston, United States
| | | | | | - Reuben Mutagaywa
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Colin Pfaff
- Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, United States
| | - Daniel Piñero
- Departamento de Ecología Evolutiva, Instituto de Ecología, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Fausto Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Emmanuel Rusingiza
- Department of Pediatrics, Pediatric Cardiology Unit, University Teaching Hospital of Kigali, Kigali, Rwanda
- College of Medicine and Health Sciences, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Usman Abiola Sanni
- Partners in Health, Sierra Leone
- Department of Paediatrics, Federal Medical Centre, Birnin Kebbi, Nigeria
| | - Amy Sanyahumbi
- Pediatric Cardiology, Baylor College of Medicine, Texas Children’s Hospital, Houston, United States
- Baylor Center of Excellence, Lilongwe, Malawi
| | - Urmila Shakya
- Pediatric Cardiology Department, Shahid Gangalal National Heart Centre, Kathmandu, Nepal
- National Academy of Medical Sciences, Kathmandu, Nepal
| | - Sanjib Kumar Sharma
- Cardiology and Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kunjang Sherpa
- Department of Cardiology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Isaac Sinabulya
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Emily B. Wroe
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
| | - Gene Bukhman
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, United States
- Department of Global Health and Social Medicine, Harvard University, Boston, United States
| | - Ana Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique
- Instituto Nacional de Saúde, Maputo, Mozambique
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Doku A, Tuglo LS, Boima V, Agyekum F, Aovare P, Ali Abdulai M, Godi A, Peters RJG, Agyemang C. Prevalence of Cardiovascular Disease and Risk Factors in Ghana: A Systematic Review and Meta-analysis. Glob Heart 2024; 19:21. [PMID: 38404614 PMCID: PMC10885824 DOI: 10.5334/gh.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024] Open
Abstract
Background The increasing cardiovascular disease (CVD) burden threatens the global population as the major cause of disability and premature death. Data are scarce on the magnitude of CVD among the population in West Africa, particularly in Ghana. This study examined the available scientific evidence to determine the pooled prevalence (PP) of CVD and risk factors in Ghana. Methods We searched electronic databases such as PubMed, Google Scholar, the Cochrane Library, Science Direct and Africa Journal Online databases to identify literature published from the start of the indexing of the database to 10th February 2023. All articles published in the English language that assessed the prevalence of CVD or reported on CVD in Ghana were included. Two authors independently performed the study selection, assessed the risk of bias, extracted the data and checked by the third author. The effect sizes and pooled odds ratio (POR) were determined using the random-effects DerSimonian-Laird (DL) model. Result Sixteen studies with 58912 participants from 1954 to 2022 were included in the meta-analysis. Six studies out of 16 reported more than one prevalence of CVD, giving a total of 59 estimates for PP. The PP of CVD in the general population in Ghana was 10.34% (95% Cl: [8.48, 12.20]; l2 99.54%, p < 0.001). Based on the subgroup analysis, the prevalence of CVD was higher in hospital-based settings at 10.74% (95%, confidence interval [Cl]: 8.69, 12.79) than in community-based settings at 5.04% (95% Cl: 2.54, 7.53). The risk factors were male gender (pooled odds ratio [POR]: 1.66; 95% CI: 1.02, 2.70), old age (POR: 1.32; 95% CI: 1.21, 1.45), unemployment (POR: 2.62; 95% CI: 1.33, 5.16), diabetes (POR: 2.79; 95% CI: 1.62, 4.81) and hypertension (POR: 3.41; 95% CI: 1.75, 6.66). Conclusion The prevalence of CVD was high in Ghana. Urgent interventions are needed for the prevention and management of the high burden of CVD and its risk factors.
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Affiliation(s)
- Alfred Doku
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Lawrence Sena Tuglo
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
- Department of Epidemiology, School of Public Health, Nantong University, 9 Seyuan Road, Nantong, Jiangsu, China
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Francis Agyekum
- Department of Medicine and Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Pearl Aovare
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
| | - Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, P.O Box 200, Kintampo-B/E, Ghana
| | - Anthony Godi
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ron J. G. Peters
- Department of Cardiology, University Amsterdam Medical Center, University of Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, University of Amsterdam Medical Centre, University of Amsterdam, Netherlands
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Coulibaly I, N'Djessan JJ, Adoubi A, Yao H, Gbetchedji S, Soya E, Ncho-Mottoh MP, Angoran I, Kouamé S, Tro G, Touré C, Anzouan-Kacou JB. [Acute heart failure with altered ejection fraction : Electrocardiographic signs with mortality at the Abidjan cardiology institute]. Ann Cardiol Angeiol (Paris) 2024; 73:101628. [PMID: 37984237 DOI: 10.1016/j.ancard.2023.101628] [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: 03/07/2023] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Heart failure with impaired ejection fraction (HFIEF) represents the end-stage of most cardiac diseases, and is responsible for a high mortality rate. In order to identify patients at risk, numerous clinical and paraclinical prognostic factors have been proposed. The electrocardiogram (ECG), easy to perform and inexpensive, retains a powerful role in the prognostic evaluation of heart failure patients. The aim was to evaluate ECG signs associated with mortality in a retrospective cohort of patients with ICFEA. METHODOLOGY The study was observational and analytical based on retrospective data collected from patients benefiting from a primary hospitalization for ICFEA at the Abidjan Heart Institute from January 2018 to July 2020. RESULTS Of the 370 patients included, 197 had died by August 1, 2020, representing an overall mortality of 53%. Mortality progressed gradually up to one year, then remained unchanged up to 30 months. In multivariate Cox regression including ECG variables only, the presence of intra-ventricular conduction disorders (OR: 1.80; 95% CI [1.01-3.25]), microvoltage (OR: 1.82; 95% CI [1.05-16]), and pathological Q waves (OR: 1.70; 95% CI [1.02-2.83]), were significantly associated with overall mortality. When ECG variables and clinical, paraclinical and therapeutic demographic variables were included, only the presence of pathological Q waves (OR:1.74; 95% CI [1.01-3.01]) persisted as a risk factor for mortality. Hypertension and treatment of heart failure, in particular ACEI/ARII, beta-blockers and ARM, were protective factors. The presence of Q waves was associated with a significant reduction in survival, based on curves obtained using the Kaplan-Meier model. CONCLUSION ICFEA is responsible for high mortality, mainly in the year following the 1st hospitalization for cardiac decompensation. The presence of pathological Q waves is the only electrocardiographic sign that remains statistically associated with a poor prognosis, after adjustment.
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Affiliation(s)
- I Coulibaly
- Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - J J N'Djessan
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, Côte d'Ivoire.
| | - A Adoubi
- Service d'hospitalisation de médecine, Centre Hospitalier Universitaire de Bouaké, Côte d'Ivoire
| | - H Yao
- Service des explorations externes, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - S Gbetchedji
- Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - E Soya
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - M P Ncho-Mottoh
- Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - I Angoran
- Service des explorations externes, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - S Kouamé
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - G Tro
- Service d'hospitalisation de médecine, Centre Hospitalier Universitaire de Bouaké, Côte d'Ivoire
| | - C Touré
- Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - J B Anzouan-Kacou
- Service des explorations externes, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
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Shahid I, Khan MS, Fonarow GC, Butler J, Greene SJ. Bridging gaps and optimizing implementation of guideline-directed medical therapy for heart failure. Prog Cardiovasc Dis 2024; 82:61-69. [PMID: 38244825 DOI: 10.1016/j.pcad.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Despite robust scientific evidence and strong guideline recommendations, there remain significant gaps in initiation and dose titration of guideline-directed medical therapy (GDMT) for heart failure (HF) among eligible patients. Reasons surrounding these gaps are multifactorial, and largely attributed to patient, healthcare professionals, and institutional challenges. Concurrently, HF remains a predominant cause of mortality and hospitalization, emphasizing the critical need for improved delivery of therapy to patients in routine clinical practice. To optimize GDMT, various implementation strategies have emerged in the recent decade such as in-hospital rapid initiation of GDMT, improving patient adherence, addressing clinical inertia, improving affordability, engagement in quality improvement registries, multidisciplinary clinics, and EHR-integrated interventions. This review highlights the current use and barriers to optimal utilization of GDMT, and proposes novel strategies aimed at improving GDMT in HF.
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Affiliation(s)
- Izza Shahid
- Division of Preventive Cardiology, Houston Methodist Academic Institute, Houston, TX, USA
| | | | - Gregg C Fonarow
- Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA; Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA.
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Tziastoudi M, Pissas G, Golfinopoulos S, Filippidis G, Dousdampanis P, Eleftheriadis T, Stefanidis I. Sodium-Glucose Transporter 2 (SGLT2) Inhibitors and Iron Deficiency in Heart Failure and Chronic Kidney Disease: A Literature Review. Life (Basel) 2023; 13:2338. [PMID: 38137939 PMCID: PMC10744560 DOI: 10.3390/life13122338] [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: 11/10/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Heart failure (HF) and chronic kidney disease (CKD) are associated with high mortality. In both disorders, impaired iron homeostasis, mostly in the form of a functional iron deficiency, is a frequent co-morbidity. In HF, functional iron deficiency and management by i.v. iron supplementation have been proven to affect both prognosis and functional capacity. In the same context, iron supplementation is routine for the adequate management of renal anemia in CKD. In numerous recent studies in HF and in CKD, sodium-glucose transporter 2 (SGLT2) inhibitor treatment has been proven to significantly reduce mortality. Furthermore, the same trials showed that these drugs alleviate iron deficiency and anemia. These effects of SGLT2 inhibitors may be due to an amelioration of inflammation with reduced interleukin-6 (IL-6) and to an enhancement of autophagy with increased sirtuin 1 (SIRT1), both associated with modified production of hepcidin and enhanced ferritinophagy. However, the exact pathogenic basis of the beneficial SGLT2 inhibitor action is not fully elucidated. Nevertheless, effects on iron homeostasis might be a potential explanatory mechanism for the powerful SGLT2 inhibitors' cardiovascular and renal outcome benefits. In addition, the interaction between iron supplementation and SGLT2 inhibitors and its potential impact on prognosis remains to be clarified by future studies. This review represents a significant effort to explore the complex relationships involved, seeking to elucidate the intricate mechanisms by which SGLT2 inhibitors influence iron homeostasis.
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Affiliation(s)
- Maria Tziastoudi
- Clinic of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larisa, Greece; (G.P.); (S.G.); (G.F.); (P.D.); (T.E.)
| | | | | | | | | | | | - Ioannis Stefanidis
- Clinic of Nephrology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larisa, Greece; (G.P.); (S.G.); (G.F.); (P.D.); (T.E.)
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Mwita JC, Joubert A, Saidu H, Sani MU, Damasceno A, Mocumbi AO, Sinxadi P, Viljoen CA, Hoevelmann J, Gebreyesus MS, Denti P, Wasmann R, Maartens G, Wiesner L, Stewart S, Davison B, Cotter G, Sliwa K. Objectively measured medication adherence using assays for carvedilol and enalaprilat in patients with heart failure in Mozambique and Nigeria. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200213. [PMID: 37811486 PMCID: PMC10556761 DOI: 10.1016/j.ijcrp.2023.200213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
Background Poor medication adherence leads to poor health outcomes and increased healthcare costs among patients with heart failure (HF). This study aimed to objectively assess medication adherence by measuring carvedilol and enalaprilat plasma concentrations among patients with HF. Methods The present sub-study of the Safety, Tolerability, and Efficacy of Rapid Optimization, helped by NT-proBNP testing, of Heart Failure therapies (STRONG-HF) study involved adult patients with acute HF admitted in two Mozambican and two Nigerian hospitals who were not optimally treated with oral enalapril and carvedilol. Patients in the high-intensity arm of the STRONG-HF study, and those not meeting the biomarker criteria for persistent congestion, were included in the "frequent visit" (FV) arm. In the FV arm, blood for bioanalysis of plasma enalaprilat or/and carvedilol was drawn at the 2,6,12th week post-discharge. Patients in the usual care arm of STRONG-HF were included in the "standard visit" (SV) arm, which followed the usual local practice with blood sampling in week 12. Results The study involved 113 (79 FV and 34 SV) participants with a mean age of 48.6 years and a mean left ventricular (LV) ejection fraction of 33.1%. Theenalaprilat below the lower level of quantification (LLOQ) was documented in 7.7%, 11.9%, and 15.6% of participants in FV during the 2,6 and 12th weeks. Carvedilol concentration below LLOQ was documented in 37%, 30%, and 44.4% of participants in the FV arm during the 2,6 and 12th weeks, respectively. For the SV arm, enalaprilat and carvedilol concentrations below LLOQ in the twelfth week were documented in 37.3% and 42.9% of patients, respectively. Conclusion Up to a third of patients using enalapril and carvedilol did not take any medication during the 12 weeks of follow-up. Non adherence was more common in patients who had less follow up, emphasizing the importance of close follow up to adherence. No adherence was also more common in medications know to have more side effects such as carvedilol.
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Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Andre Joubert
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Hadiza Saidu
- Department of Medicine Bayero University Kano & Murtala Muhammed Specialist Hospital, Kano, Nigeria
| | - Mahmoud Umar Sani
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Research Unit, Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Ana Olga Mocumbi
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Instituto Nacional de Saúde, Vila de Marracuene, Mozambique
| | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- SAMRC/UCT Platform for Pharmacogenomics Research and Translation, South African Medical Research Council, Cape Town, South Africa
| | - Charle Andre Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julian Hoevelmann
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Manna Semere Gebreyesus
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Roeland Wasmann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Beth Davison
- Momentum Research, Inc., Chapel Hill, NC, USA
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Gad Cotter
- Momentum Research, Inc., Chapel Hill, NC, USA
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Wei S, Miranda JJ, Mamas MA, Zühlke LJ, Kontopantelis E, Thabane L, Van Spall HGC. Sex differences in the etiology and burden of heart failure across country income level: analysis of 204 countries and territories 1990-2019. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:662-672. [PMID: 36577147 PMCID: PMC10627811 DOI: 10.1093/ehjqcco/qcac088] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/19/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Heart failure (HF) is a global epidemic. OBJECTIVE To assess global sex differences in HF epidemiology across country income levels. METHODS AND RESULTS Using Global Burden of Disease (GBD) data from 204 countries and territories 1990-2019, we assessed sex differences in HF prevalence, etiology, morbidity, and temporal trends across country sociodemographic index or gross national income. We derived age-standardized rates. Of 56.2 million (95% uncertainty interval [UI] 46.4-67.8 million) people with HF in 2019, 50.3% were females and 69.2% lived in low- and middle-income countries; age-standardized prevalence was greater in males and in high-income countries. Ischaemic and hypertensive heart disease were top causes of HF in males and females, respectively. There were 5.1 million (95% UI 3.3-7.3 million) years lived with disability, distributed equally between sexes. Between 1990 and 2019, there was an increase in HF cases, but a decrease in age-standardized rates per 100 000 in males (9.1%, from 864.2 to 785.7) and females (5.8%, from 686.0 to 646.1). High-income regions experienced a 16.0% decrease in age-standardized rates (from 877.5 to 736.8), while low-income regions experienced a 3.9% increase (from 612.1 to 636.0), largely consistent across sexes. There was a temporal increase in age-standardized HF from hypertensive, rheumatic, and calcific aortic valvular heart disease, and a decrease from ischaemic heart disease, with regional and sex differences. CONCLUSION Age-standardized HF rates have decreased over time, with larger decreases in males than females; and with large decreases in high-income and small increases in low-income regions. Sex and regional differences offer targets for intervention.
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Affiliation(s)
- Sunny Wei
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | - J Jamie Miranda
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - Mamas A Mamas
- Cardiovascular Research Group, Keele University, Stoke-on-Trent ST5 5BG, UK
| | - Liesl J Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town 7700, South Africa
| | - Evan Kontopantelis
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester M13 9PL, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
- St. Joseph's Healthcare, Research Institute of St. Joseph's, Hamilton, ON L8N 4A6, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 2006, South Africa
- Hamilton Health Sciences, Population Health Research Institute, Hamilton, ON L8L 2X2, Canada
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11
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Mcharo TL, Iseselo MK, Kahema SE, Tarimo EAM. Experiences of family caregivers in caring for patients with heart failure admitted at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania: A qualitative study. PLoS One 2023; 18:e0280698. [PMID: 37729150 PMCID: PMC10511101 DOI: 10.1371/journal.pone.0280698] [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: 01/05/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Heart failure (HF) continues to be a global health problem with its ramifications more pronounced in underdeveloped countries. Family members play a pivotal part in patient management which may influence the patient's overall quality of life. Prolonged delay in attendance to health care facilities among patients indicates ineffective support from family caregivers. In the Tanzanian context, there is limited information about the experiences of family caregivers in caring for patients with HF. This study explored family caregivers' experiences in caring for HF patients. METHODS A qualitative descriptive study design was conducted at Jakaya Kikwete Cardiac Institute in Dar es Salaam, Tanzania. A purposive sampling technique was used to select the potential participants. A sample size of 10 family caregivers of patients with HF was included in the study. Thematic analysis was used to derive the main theme and sub-themes. RESULTS Three major themes were identified: demands for supportive care, new caring role and lifestyle, and professional support in caring for patients with HF. Caregivers needed social and financial support to facilitate the caring process. Learning to provide the required care at the right time was the new role acquired by caregivers while failing to participate in social events and caregiving in an unfavourable environment were reported as challenges in caregiving. However, compliance with instruction and effective interaction among the nurses and caregivers were considered to be positive professional support. CONCLUSION Caregivers need social and financial support to provide effective care to their patients. Caregiving is a learning process that needs continuous educational support to adapt to the new caring roles and challenges. Nurses should conduct regular assessments to explore caregivers' needs, challenges, and concerns and provide timely counselling that can facilitate coping.
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Affiliation(s)
- Tunzo L. Mcharo
- Department of Nursing, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Masunga K. Iseselo
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Samwel Edward Kahema
- Department of Medical Laboratory, Morogoro College of Health and Allied Sciences, Morogoro, Tanzania
| | - Edith A. M. Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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12
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Shehu MN, Adamu UG, Ojji DB, Ogah OS, Sani MU. The Pandemic of Coronary Artery Disease in the Sub-Saharan Africa: What Clinicians Need to Know. Curr Atheroscler Rep 2023; 25:571-578. [PMID: 37606811 DOI: 10.1007/s11883-023-01136-9] [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] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally with an accelerated increase in CVD‑related death in Africa and other low‑middle‑income countries. This review is aimed at highlighting the burden of coronary artery disease CAD, its peculiarities as well as challenges of management in sub-Saharan Africa. RECENT FINDINGS Recent data revealed a shift from high incidence of CVDs associated with poverty and malnutrition (such as rheumatic heart disease) initially, which are now falling, to rising incidence of other non-communicable CVDs (such as hypertension, coronary artery disease (CAD), and heart failure). Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide, which is projected to supersede communicable diseases in the future. Previous studies have shown that CAD was rare among Africans. Those studies conducted in Africa in the 1940s-1960s reported that Black Africans were almost immune to developing CAD and were even thought to have specific genetic make-up protecting them from CAD. However, the continent is now experiencing a steady rise in the prevalence of CAD associated with severe disease burden, compared to other regions of the world. The changes seen have been attributed to the current epidemiological transition with increase in CVD risk factors that are poorly controlled, lack of awareness as well as the poor health facilities to tackle the menace of the disease. The Global Burden of Disease (GBD) estimates have also shown that over the past three decades the highest contribution to CVD burden in Africa is attributed to atherosclerotic diseases, with 71.4, 37.7, and 154% increases in the burden of ischemic heart disease, stroke, and peripheral artery disease respectively. There is a steady increase of CAD prevalence in Africa as a result of increase in CV risk factors. Hypertension, obesity, diabetes, dyslipidemia, and cigarette smoking are the rapidly rising risk factors for CAD on the continent. Africa also faces challenges in diagnosis and management of CAD. There is need for increased public and health personnel awareness on prevention and control of commonly identifiable risk factors, provision of prehospital emergency services, and provision of modern therapeutic facilities for treatment of CAD including reperfusion therapy. These are priority areas where efforts could be intensified in the future with potential to improve the current rate of progress of the disease on the continent.
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Affiliation(s)
- Muhammad N Shehu
- Department of Internal Medicine, General Amadi Rimi Specialist Hospital Katsina, Batagarawa, Nigeria
| | - Umar G Adamu
- Department of Internal Medicine, Federal Medical Centre, Bida, Niger State, Nigeria
| | - Dike B Ojji
- Department of Internal Medicine, University of Abuja, Teaching Hospital, Abuja, Nigeria
| | - Okechukwu S Ogah
- Department of Internal Medicine, University College Hospital, Ibadan, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria.
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13
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Jonathan IA, Kifai E, Chillo P. Spectrum of cardiac diseases among young and older adults defined by echocardiography at Jakaya Kikwete Cardiac Institute: A prospective cross-sectional study. BMC Cardiovasc Disord 2023; 23:359. [PMID: 37464288 PMCID: PMC10355001 DOI: 10.1186/s12872-023-03367-9] [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: 02/14/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide, with data showing an increasing trend. Previously uncommon, CVDs of lifestyle are now increasing in many Sub-Sahara African (SSA) countries including Tanzania. The study aimed at determining the spectrum and distribution of CVDs among young (< 45 years) and older (≥ 45 years) adults referred for echocardiography at Jakaya Kikwete Cardiac Institute (JKCI). METHODS Hospital-based cross sectional study was conducted among adult patients referred for echocardiography at JKCI between July and December 2021. Patient's socio-demographic and clinical characteristics were recorded. CVD diagnoses were made using established diagnostic criterias. Comparisons were done using chi-square test and student's t-test. Multivariable logistic regression analysis was used to determine factors associated with abnormal echocardiography. A significance level was set at p-value < 0.05. RESULTS In total 1,050 patients (750 old and 300 young adults) were enrolled. The mean ± SD age was 62.2 ± 10.4 years and 33.5 ± 7.4 years for older and young adults respectively. Hypertension was the commonest indication for echocardiography both in the young (31%) and older (80%) adults. Majority of older adults were found to have abnormal echocardiography (90.7%), while only 44.7% of the young adults had abnormal echocardiography (p < 0.001). For the older adults, the commonest diagnoses were HHD (70.3%), IHD (9.7%), and non-ischemic cardiomyopathy (6.1%) while for young adults, HHD (16.7%), non-ischemic cardiomyopathy (8%), RHD (8%) and MVP (4.3%) were the commonest. The differences in the echocardiographic diagnoses between young and older adults were statistically significant, p < 0.001. Being an older adult, hypertensive, overweight/obese were independently associated with abnormal echocardiography (p < 0.01). CONCLUSION Hypertensive heart disease is the most common diagnosis among adult patients referred for echocardiography at JKCI, both in young and older adults. Primary prevention, early detection and treatment of systemic hypertension should be reinforced in order to delay or prevent its complications.
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Affiliation(s)
- Irene Abela Jonathan
- School of Medicine, Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, P.O. BOX 65001, Tanzania.
| | - Engerasiya Kifai
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania
| | - Pilly Chillo
- School of Medicine, Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es salaam, P.O. BOX 65001, Tanzania
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania
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14
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Yang Y, Huang Y. Association between bone mineral density and cardiovascular disease in older adults. Front Public Health 2023; 11:1103403. [PMID: 37427263 PMCID: PMC10328748 DOI: 10.3389/fpubh.2023.1103403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/12/2023] [Indexed: 07/11/2023] Open
Abstract
Background and aims Cardiovascular disease and osteoporosis are common diseases in older adults with high morbidity. The study on the interaction between the two in pathogenic mechanisms has been paid much attention by the majority of researchers. This study aimed to explore the relationship between bone mineral density and cardiovascular disease in older adults. Methods The primary data was downloaded from the National Health and Nutrition Examination Survey database of the United States. Multivariate logistic regression model, generalized additive model, and smooth curve fitting were used to explore the relationship between bone mineral density and cardiovascular events risk. When a curve relationship was found, a two-piecewise linear model was used to calculate the inflection point. In addition, subgroup analysis was also performed. Results A total of 2097 subjects were included in this study. After adjusting for potential confounders, no significant association was found between lumbar bone mineral density and cardiovascular disease, while femur bone mineral density had a non-linear relationship with cardiovascular disease, with an inflection point of 0.741 gm/cm2. When bone mineral density was <0.741 gm/cm2, the risk of cardiovascular disease decreased speedily. Once bone mineral density exceeded this value, the risk of cardiovascular disease continued to decrease, but the trend became significantly slower. Compared with patients with normal bone mass, osteoporosis was associated with a 2.05-fold increased risk of cardiovascular disease (95% CI 1.68-5.52). There were no significant differences in interaction tests of all subgroups (p for interaction >0.05) except race. Conclusion Our results indicated that bone mineral density was closely associated with the prevalence of cardiovascular disease in older adults over 60 years old, especially the femur bone mineral density was negatively non-linear associated with cardiovascular disease risk, with an inflection point of 0.741 gm/cm2.
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15
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Mailosi BGD, Ruderman T, Klassen SL, Kachimanga C, Aron MB, Boti M, Kumwenda K, Bukhman G, Muula AS, Banda NPK, Kwan GF. Decentralized Heart Failure Management in Neno, Malawi. Glob Heart 2023; 18:35. [PMID: 37334396 PMCID: PMC10275181 DOI: 10.5334/gh.1210] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Cardiovascular disease (CVD) is a major cause of death in Malawi. In rural districts, heart failure (HF) care is limited and provided by non-physicians. The causes and patient outcomes of HF in rural Africa are largely unknown. In our study, non-physician providers performed focused cardiac ultrasound (FOCUS) for HF diagnosis and longitudinal clinical follow-up in Neno, Malawi. Objectives We described the clinical characteristics, HF categories, and outcomes of patients presenting with HF in chronic care clinics in Neno, Malawi. Methods Between November 2018 and March 2021, non-physician providers performed FOCUS for diagnosis and longitudinal follow-up in an outpatient chronic disease clinic in rural Malawi. A retrospective chart review was performed for HF diagnostic categories, change in clinical status between enrollment and follow-up, and clinical outcomes. For study purposes, cardiologists reviewed all available ultrasound images. Results There were 178 patients with HF, a median age of 67 years (IQR 44 - 75), and 103 (58%) women. During the study period, patients were enrolled for a mean of 11.5 months (IQR 5.1-16.5), after which 139 (78%) were alive and in care. The most common diagnostic categories by cardiac ultrasound were hypertensive heart disease (36%), cardiomyopathy (26%), and rheumatic, valvular or congenital heart disease (12.3%).At follow-up, the proportion of New York Heart Association (NYHA) class I patients increased from 24% to 50% (p < 0.001; 95% CI: 31.5 - 16.4), and symptoms of orthopnea, edema, fatigue, hypervolemia, and bibasilar crackles all decreased (p < 0.05). Conclusion Hypertensive heart disease and cardiomyopathy are the predominant causes of HF in this elderly cohort in rural Malawi. Trained non-physician providers can successfully manage HF to improve symptoms and clinical outcomes in limited resource areas. Similar care models could improve healthcare access in other rural African settings.
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Affiliation(s)
| | - Todd Ruderman
- Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi
| | - Sheila L. Klassen
- Partners In Health, Boston, MA, 02199, USA
- Center for Integration Science, Division of Global Health Equity and Division of Cardiovascular Medicine, Brigham and Women’s Hospital, USA
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Medson Boti
- Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi
| | | | - Gene Bukhman
- Partners In Health, Boston, MA, 02199, USA
- Center for Integration Science, Division of Global Health Equity and Division of Cardiovascular Medicine, Brigham and Women’s Hospital, USA
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Adamson S. Muula
- Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Gene F. Kwan
- Partners In Health, Boston, MA, 02199, USA
- Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA USA 02118, USA
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Mboweni N, Maseko M, Tsabedze N. Heart failure with reduced ejection fraction and atrial fibrillation: a Sub-Saharan African perspective. ESC Heart Fail 2023; 10:1580-1596. [PMID: 36934444 PMCID: PMC10192282 DOI: 10.1002/ehf2.14332] [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: 06/23/2022] [Revised: 01/06/2023] [Accepted: 02/07/2023] [Indexed: 03/20/2023] Open
Abstract
Cardiovascular diseases are a well-established cause of death in high-income countries. In the last 20 years, Sub-Saharan Africa (SSA) has seen one of the sharpest increases in cardiovascular disease-related mortality, superseding that of infectious diseases, including HIV/AIDS, in South Africa. This increase is evidenced by a growing burden of heart failure and atrial fibrillation (AF) risk factors. AF is a common comorbidity of heart failure with reduced ejection fraction (HFrEF), which predisposes to an increased risk of stroke, rehospitalizations, and mortality compared with patients in sinus rhythm. AF had the largest relative increase in cardiovascular disease burden between 1990 and 2010 in SSA and the second highest (106.4%) increase in disability-adjusted life-years (DALY) between 1990 and 2017. Over the last decade, significant advancements in the management of both HFrEF and AF have emerged. However, managing HFrEF/AF remains a clinical challenge for physicians, compounded by the suboptimal efficacy of guideline-mandated pharmacotherapy in this group of patients. There may be an essential role for racial differences and genetic influence on therapeutic outcomes of HFrEF/AF patients, further complicating our overall understanding of the disease and its pathophysiology. In SSA, the lack of accurate and up-to-date epidemiological data on this subgroup of patients presents a challenge in our quest to prevent and reduce adverse outcomes. This narrative review provides a contemporary overview of the epidemiology of HFrEF/AF in SSA. We highlight important differences in the demographic and aetiological profile and the management of this subpopulation, emphasizing what is currently known and, more importantly, what is still unknown about HFrEF/AF in SSA.
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Affiliation(s)
- Nonkanyiso Mboweni
- School of PhysiologyUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Internal Medicine, Division of Cardiology, Charlotte Maxeke Johannesburg Academic HospitalUniversity of the WitwatersrandGautengJohannesburgSouth Africa
| | - Muzi Maseko
- School of PhysiologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Nqoba Tsabedze
- Department of Internal Medicine, Division of Cardiology, Charlotte Maxeke Johannesburg Academic HospitalUniversity of the WitwatersrandGautengJohannesburgSouth Africa
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Tsabedze N, du Plessis A, Mpanya D, Vorster A, Wells Q, Scholtz L, Manga P. Cardiovascular Magnetic Resonance Imaging Findings in Africans with Idiopathic Dilated Cardiomyopathy. Diagnostics (Basel) 2023; 13:diagnostics13040617. [PMID: 36832105 PMCID: PMC9954988 DOI: 10.3390/diagnostics13040617] [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: 01/04/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
In sub-Saharan Africa, idiopathic dilated cardiomyopathy (IDCM) is a common yet poorly investigated cause of heart failure. Cardiovascular magnetic resonance (CMR) imaging is the gold standard for tissue characterisation and volumetric quantification. In this paper, we present CMR findings obtained from a cohort of patients with IDCM in Southern Africa suspected of having a genetic cause of cardiomyopathy. A total of 78 IDCM study participants were referred for CMR imaging. The participants had a median left ventricular ejection fraction of 24% [interquartile range, (IQR): 18-34]. Late gadolinium enhancement (LGE) was visualised in 43 (55.1%) participants and localised in the midwall in 28 (65.0%) participants. At the time of enrolment into the study, non-survivors had a higher median left ventricular end diastolic wall mass index of 89.4 g/m2 (IQR: 74.5-100.6) vs. 73.6 g/m2 (IQR: 51.9-84.7), p = 0.025 and a higher median right ventricular end-systolic volume index of 86 mL/m2 (IQR:74-105) vs. 41 mL/m2 (IQR: 30-71), p < 0.001. After one year, 14 participants (17.9%) died. The hazard ratio for the risk of death in patients with evidence of LGE from CMR imaging was 0.435 (95% CI: 0.259-0.731; p = 0.002). Midwall enhancement was the most common pattern, visualised in 65% of participants. Prospective, adequately powered, and multi-centre studies across sub-Saharan Africa are required to determine the prognostic significance of CMR imaging parameters such as late gadolinium enhancement, extracellular volume fraction, and strain patterns in an African IDCM cohort.
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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
- Correspondence:
| | - Andre du Plessis
- Diagnostic Radiology, Midstream Mediclinic, Centurion 1692, South Africa
| | - Dineo Mpanya
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Anelia Vorster
- Diagnostic Radiology, Midstream Mediclinic, Centurion 1692, South Africa
| | - Quinn Wells
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Leonie Scholtz
- Diagnostic Radiology, Midstream Mediclinic, Centurion 1692, South Africa
| | - Pravin Manga
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
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Hassannejad R, Shafie D, Turk-Adawi KI, Hajaj AM, Mehrabani-Zeinabad K, Lui M, Kopec JA, Abdul Rahim HF, Safiri S, Fadhil I, Anwar WA, Mokdad AH, Shariful Islam SM, Sarrafzadegan N. Changes in the burden and underlying causes of heart failure in the Eastern Mediterranean Region, 1990-2019: An analysis of the Global Burden of Disease Study 2019. EClinicalMedicine 2023; 56:101788. [PMID: 36593790 PMCID: PMC9803705 DOI: 10.1016/j.eclinm.2022.101788] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/28/2022] Open
Abstract
Background The burden of heart failure (HF) is high globally, but information on its burden in the Eastern Mediterranean Region (EMR) is limited. This study provides a systematic analysis of the burden and underlying causes of HF in the EMR, including at the country level, between 1990 and 2019. Methods We used the 2019 Global Burden of Disease (GBD) data for estimates of prevalence, years lived with disability (YLDs), and underlying causes of HF in the EMR. Age-standardised prevalence, YLDs, and underlying causes of HF were compared by 5-year age groups (considering 15 years old and more), sex (male and female), and countries. Findings In contrast with the decreasing trend of HF burden globally, EMR showed an increasing trend. Globally, the HF age-standardised prevalence and YLDs decreased by 7.06% (95% UI: -7.22%, -6.9%) and 6.82% (95% UI: -6.98%, -6.66%) respectively, from 1990 to 2019. The HF age-standardised prevalence and YLDs in the EMR in 2019 were 706.43 (95% UI: 558.22-887.87) and 63.46 (95% UI: 39.82-92.59) per 100,000 persons, representing an increase of 8.07% (95% UI: 7.9%, 8.24%) and 8.79% (95% UI: 8.61%, 8.97%) from 1990, respectively. Amongst EMR countries, the age-standardised prevalence and YLDs were highest in Kuwait, while Pakistan consistently had the lowest HF burden. The dramatic increase of the age-standardised prevalence and YLDs were seen in Oman (28.79%; 95% UI: 28.51%, 29.07% and 29.56%; 95% UI: 29.28%, 29.84%), while Bahrain witnessed a reduction over the period shown (-9.66%; 95% UI: -9.84%, -9.48% and-9.14%; 95% UI: -9.32%, -8.96%). There were significant country-specific differences in trends of HF burden from 1990 to 2019. Males had relatively higher rates than females in all age groups. Among all causes of HF in 2019, ischemic heart disease accounted for the highest age-standardised prevalence and YLDs, followed by hypertensive heart disease. Interpretation The burden of HF in the EMR was higher than the global, with increasing age-standardised prevalence and YLDs in countries of the region. A more comprehensive approach is needed to prevent underlying causes and improve medical care to control the burden of HF in the region. Funding None.
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Affiliation(s)
- Razieh Hassannejad
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karam I. Turk-Adawi
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Ahmad Mohammad Hajaj
- QU Health Research and Graduate Studies, QU Health, Qatar University, Doha, Qatar
| | - Kamran Mehrabani-Zeinabad
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Michelle Lui
- Faculty of Medicine, School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Jacek A. Kopec
- Faculty of Medicine, School of Population & Public Health, University of British Columbia, Vancouver, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Hanan F. Abdul Rahim
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Saeid Safiri
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ibtihal Fadhil
- Eastern Mediterranean NCD Alliance, Dubai, United Arab Emirates
| | - Wagida A. Anwar
- Community Medicine Department, Faculty of Medicine, Ain Shams University, Egypt
- Armed Forces College of Medicine (AFCM), Egypt
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | | | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Faculty of Medicine, School of Population & Public Health, University of British Columbia, Vancouver, Canada
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Assefa E, Tegene E, Abebe A, Melaku T. Treatment outcomes and associated factors among chronic ambulatory heart failure patients at Jimma Medical Center, South West Ethiopia: prospective observational study. BMC Cardiovasc Disord 2023; 23:26. [PMID: 36650423 PMCID: PMC9843931 DOI: 10.1186/s12872-023-03055-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Heart failure has been one of the major causes of hospitalization across the world. Focusing on the treatment outcomes of ambulatory heart failure patients will reduce the burden of heart failure such as hospitalization and improve patient quality of life. Even if research is conducted on acute heart failure patients, there is limited data about treatment outcomes of chronic ambulatory heart failure patients. Therefore, this study aimed to assess treatment outcomes and associated factors of chronic ambulatory heart failure patients at Jimma Medical Center, South West Ethiopia. METHODS A hospital-based prospective observational study was conducted on 242 chronic ambulatory heart failure patients at Jimma Medical Center from November 2020 to June 2021. The data were collected with pretested data collection format, and analyzed with Statistical Package for Social Sciences version 23. Both univariate and multivariate logistic regression model were used to identify factors associated with treatment outcomes of outpatient heart failure, and with a reported p value < 0.05, 95% confidence interval (CI) was considered statistical significance. RESULT From 242 patients, 126 (52.1%) were males and 121 (50.0%) patients were aged between 45 and 65 years. Regarding treatment outcomes, 51 (21.1%) of patients were hospitalized, and 58 (24.0%) and 28 (11.6%) of patients had worsened and improved clinical states respectively. Clinical inertia [AOR = 2.820; 95% CI (1.301, 6.110), p = 0.009], out-of-pocket payment [AOR = 2.790; 95% CI (1.261, 6.172), p = 0.011] and New York Heart Association class II [AOR = 2.534; 95% CI (1.170, 5.488), p = 0.018] were independent predictors of hospitalization. CONCLUSION Hospitalization of ambulatory heart failure patients was relatively high. More than half of the patients had clinical inertia. And also, this study showed most ambulatory HF patients had inadequate self-care. Clinical inertia, out-of-pocket payment, and New York Heart Association class II were independent predictors of hospitalization in ambulatory heart failure patients. Therefore, it is better to give more attention to ambulatory heart failure patients to prevent hospitalization and the burden of heart failure.
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Affiliation(s)
- Erkihun Assefa
- grid.449142.e0000 0004 0403 6115School of Pharmacy, College of Medicine, and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Elsah Tegene
- Department of Internal Medicine, Jimma Medical Center, Jimma, Ethiopia
| | - Abinet Abebe
- grid.449142.e0000 0004 0403 6115School of Pharmacy, College of Medicine, and Health Sciences, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Tsegaye Melaku
- grid.411903.e0000 0001 2034 9160School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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Altered cardiac structure and function in newly diagnosed people living with HIV: a prospective cardiovascular magnetic resonance study after the initiation of antiretroviral treatment. Int J Cardiovasc Imaging 2023; 39:169-182. [PMID: 36598696 PMCID: PMC9412796 DOI: 10.1007/s10554-022-02711-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
HIV associated cardiomyopathy (HIVAC) is a poorly understood entity that may progress along a continuum. We evaluated a group of persons newly diagnosed with HIV and studied the evolution of cardiac abnormalities after ART initiation. We recruited a group of newly diagnosed, ART naïve persons with HIV and a healthy, HIV uninfected group. Participants underwent comprehensive cardiovascular evaluation, including cardiovascular magnetic resonance imaging. The HIV group was started on ART and re-evaluated 9 months later. The cardiovascular parameters of the study groups were compared at diagnosis and after 9 months. The ART naïve group's (n = 66) left- and right end diastolic volume indexed for height were larger compared with controls (n = 22) (p < 0.03). The left ventricular mass indexed for height was larger in the naïve group compared with controls (p = 0.04). The ART naïve group had decreased left- and right ventricular ejection fraction (p < 0.03) and negative, non-linear associations with high HIV viral load (p = 0.02). The left ventricular size increased after 9 months (p = 0.04), while the systolic function remained unchanged. The HIV group had a high rate of non-resolving pericardial effusions. HIV infected persons demonstrate structurally and functionally altered ventricles at diagnosis. High HIV viral load was associated with left- and right ventricular dysfunction. Cardiac parameters and pericardial effusion prevalence did not show improvement with ART. Conversely, a concerning trend of increase was observed with left ventricular size. These subclinical cardiac abnormalities may represent a stage on the continuum of HIVAC that can progress to symptomatic disease if the causes are not identified and addressed.
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Robbertse PPS, Doubell AF, Lombard CJ, Talle MA, Herbst PG. Evolution of myocardial oedema and fibrosis in HIV infected persons after the initiation of antiretroviral therapy: a prospective cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:72. [PMID: 36529806 PMCID: PMC9760320 DOI: 10.1186/s12968-022-00901-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infected persons on antiretroviral therapy (ART) have been shown to have functionally and structurally altered ventricles and may be related to cardiovascular inflammation. Mounting evidence suggests that the myocardium of HIV infected individuals may be abnormal before ART is initiated and may represent subclinical HIV-associated cardiomyopathy (HIVAC). The influence of ART on subclinical HIVAC is not known. METHODS Newly diagnosed, ART naïve persons with HIV infection were enrolled along with HIV uninfected, age- and sex-matched controls. All participants underwent comprehensive cardiovascular assessment, including contrasted cardiovascular magnetic resonance (CMR) with multiparametric mapping on a 1.5T CMR system. The HIV group was started on ART (tenofovir/lamivudine/dolutegravir) and prospectively evaluated 9 months later. Cardiac tissue characterisation was compared in, and between groups using the appropriate statistical tests for the cross sectional data and the paired, prospective data respectively. RESULTS Seventy-three ART naïve HIV infected individuals (32 ± 7 years, 45% female) and 22 healthy non-HIV subjects (33 ± 7 years, 50% female) were enrolled. Compared with non-HIV healthy subjects, the global native T1 (1008 ± 31 ms vs 1032 ± 44 ms, p = 0.02), global T2 (46 ± 2 vs 48 ± 3 ms, p = 0.006), and the prevalence of pericardial effusion (18% vs 67%, p < 0.001) were significantly higher in the HIV infected group at diagnosis. Global native T1 (1032 ± 44 to 1014 ± 34 ms, p < 0.001) and extracellular volume (ECV) (26 ± 4% to 25 ± 3%, p = 0.001) decreased significantly after 9 months on ART and were significantly associated with a decrease in the HIV viral load, decreased high sensitivity C-reactive protein, and improvement in the CD4 count (p < 0.001). Replacement fibrosis was significantly higher in the HIV infected group than controls (49% vs 10%, p = 0.02). The prevalence of late gadolinium enhancement did not change significantly over the 9-month study period (49% vs 55%, p = 0.4). CONCLUSION Subclinical HIVAC may already be present at the time of HIV diagnosis, as suggested by the combination of subclinical myocardial oedema and fibrosis found to be present before administration of ART. Markers of myocardial oedema on tissue characterization improved on ART in the short term, however, it is unclear if the underlying pathological mechanism is halted, or merely slowed by ART. Mid- to long term prospective studies are needed to evaluate subtle myocardial changes over time and to assess the significance of subclinical myocardial fibrosis.
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Affiliation(s)
- Pieter-Paul S Robbertse
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
- University of Pittsburgh HIV-Comorbidities Research Training Programme in South Africa, Cape Town, South Africa.
| | - Anton F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Carl J Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mohammed A Talle
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Department of Medicine, Faculty of Clinical Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Philip G Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Ndongala NJ, Maepa C, Nyondo E, Amstutz A, du Reau de la Gaignonnière B. Etiology, characteristics and occurrence of heart diseases in rural Lesotho (ECHO-Lesotho): A retrospective echocardiography cohort study. PLoS One 2022; 17:e0278406. [PMID: 36520796 PMCID: PMC9754242 DOI: 10.1371/journal.pone.0278406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In 2019, 600'000 people in Africa died of heart failure and heart diseases will increase on the continent. It is crucial to understand the regional etiologies and risk factors for heart failure and underlying heart diseases. However, echocardiography data from rural Africa are scarce and from Lesotho non-existent. This study aims to examine the occurrence, characteristics and etiology of heart failure and heart diseases using echocardiography data from a referral hospital in rural Lesotho. METHODS We conducted a retrospective cohort study at Seboche Mission Hospital, the only referral hospital in Butha-Buthe district (Lesotho) with an echocardiography department. We included data from all individuals referred to the department between January 2020 and May 2021. From non-hospitalized patients echocardiographic diagnosis, sex and age were available, from hospitalized patients additional sociodemographic and clinical data could be extracted. RESULTS In the study period, a total of 352 echocardiograms were conducted; 213 had abnormal findings (among them 3 children). The majority of adult participants (130/210; 64%) were female and most frequent heart diseases were hypertensive (62/210, 30%), valvular (39/210, 19%) and chronic pulmonary (37/210, 18%). Heart failure represented 11% of hospitalizations in the same period. Among the 126 hospitalized heart failure patients, the most common etiology was chronic pulmonary heart disease (32/126; 25%). Former mine workers and people with a history of tuberculosis were more likely to have a chronic pulmonary heart disease. CONCLUSIONS The leading cause of heart disease in this setting is hypertension. However, in contrast to other African epidemiological studies, chronic pulmonary heart disease is unexpectedly common. There is an urgent need to improve awareness and knowledge about lung diseases, make diagnostic and therapeutic options available and increase prevention.
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Affiliation(s)
| | | | - Emmanuel Nyondo
- Charlotte Maxeke Johannesburg Academic, University of the Witwatersrand, Division of Cardiothoracic Surgery, Johannesburg, South Africa
| | - Alain Amstutz
- University of Basel, Basel, Switzerland
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- * E-mail:
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Ahmed H, Tadesse A, Alemu H, Abebe A, Tadesse M. Undernutrition was a prevalent clinical problem among older adult patients with heart failure in a hospital setting in Northwest Ethiopia. Front Nutr 2022; 9:962497. [DOI: 10.3389/fnut.2022.962497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
BackgroundUndernutrition is a frequently noticed medical problem in patients with heart failure. It is caused by poor nutrient intake, malabsorption, systemic inflammation, neurohumoral activation, oxidative stress, and hypermetabolic state. Undernutrition results in a decrease in the quality of life and the survival rate in patients with heart failure. There is a paucity of documentation on undernutrition among patients with heart failure in sub-Saharan African countries. The study aimed to determine the magnitude and associated factors of undernutrition among older adult patients with heart failure in the hospital setting in Northwest Ethiopia.MethodsAn institutional-based cross-sectional study was conducted at the University of Gondar Hospital, Northwest Ethiopia, between 1 June 2021 and 31 October 2021. A consecutive sampling method was used to recruit 262 study subjects. A Mini-nutritional assessment-full form (MNA-FL) Questionnaire was used to extract nutritional information among patients with heart failure. Patients with heart failure, who scored MNA-FL score <17, were declared to have undernutrition. The data were entered into EPI Info version 4.6.0.0 and then exported to SPSS version 26 for analysis. Explanatory variables associated with undernutrition in patients with heart failure were analyzed by applying a logistic regression model. A P-value of <0.05 was used to declare a significant association.ResultsA total of 262 patients with heart failure were included in the study. The mean age (± SD) of the study subjects was 64.6 (± 9.2) years. Hypertensive heart disease (111/262, 42%) was the most common cause of heart failure. Hypertension was the frequently observed comorbid disease. Based on the MNA-FL score for nutritional status, 75 out of 262 (28.6%, 95% CI: 22.9–34.4%) were undernourished (MNA-FL < 17), while 124 out of 262 (47.3%, CI: 41.5–53.1%) were at risk of undernutrition (MNA-FL = 17–23.5). The remaining 63 out of 262 (24.1%, 95% CI: 18.2–29.8%) study subjects were well nourished (MNA-FL > 24). On a multivariate analysis, patients with severe heart failure (New York Heart Association (NYHA) functional class III/IV) (AOR = 4.287, CI: 2.012–9.134, P-value < 0.001), with a duration of illness of 3–5 years (AOR = 3.225, CI: 1.138–9.137, P-value = 0.028), with a duration of illness of >5 years (AOR = 4.349, CI: 1.592–11.879, P-value = 0.001), presence of comorbidities (AOR = 2.29, CI: 1.06–4.96, P-value = 0.036), who underwent treatment with loop diuretics (AOR = 2.983, CI: 1.407–6.326, P-value = 0.040), and who reside in a rural area (AOR = 5.119, CI: 2.481–10.560, P-value < 0.001) were at risk of developing undernutrition.ConclusionUndernutrition was a significant clinical problem in older patients with heart failure. Nutritional interventions should be prioritized for patients with chronic and severe heart failure.
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Mkoko P, Solomon K, Chin A. Two decades of implantable cardioverter defibrillator implantation and follow-up at a South African referral centre: trends, indications and long-term outcomes in a resource-limited setting. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022; 23:19. [PMID: 35937563 PMCID: PMC9340675 DOI: 10.1186/s42444-022-00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
More than two-thirds of cardiovascular deaths occur in low- and middle-income countries. Sudden cardiac deaths (SCD) from ventricular arrhythmias are an important cause of cardiovascular deaths. Implantable cardioverter defibrillators (ICD) are an important therapeutic strategy for detecting and terminating ventricular arrhythmias in patients at risk of SCD. The profile of patients treated with ICDs in South Africa is unknown. Further, with changing lines of evidence, the implantation trends are undetermined. The objectives of this study were to determine the profile of ICD recipients and implantation trends in a South African quaternary hospital.
Methods
This was a retrospective review of all patients implanted with ICDs at Groote Schuur Hospital from 01 January 1998 to 31 December 2020. A standardised data collection form was used to collect baseline demographic data, information on clinical presentation and ICD follow-up data for the history of ICD shock therapies.
Results
A total of 253 ICDs were implanted; 75% for secondary prevention and 25% for primary prevention. 67.2% of the implanted ICDs were single-chamber ICDs, dual-chamber ICDs were implanted in 12.3% and Cardiac resynchronisation with a defibrillator (CRT-D) in 20.6%. There was an upward trajectory of ICD implantations during the study period. Increasing numbers of dual-chamber devices and CRT-D were implanted over time. ICD recipients had a mean (standard deviation) age of 50 (14) years and were predominantly male (69%). Primary prevention ICD recipients were younger than secondary prevention recipients, with a mean (SD) age of 46 (14) years versus 51 (14) years, p = 0.019. The secondary prevention group presented with ventricular tachycardia in 81%, ventricular fibrillation in 13% and cardiopulmonary resuscitation without documented heart rhythm in 5.3% (10/190). After a median (interquartile range) follow-up of 44 (15; 93) months, there was an overall mortality rate of 16.2%, with no mortality difference between the primary and secondary prevention patient groups.
Conclusion
There is an increase in the annual number of ICDs implanted at a South African referral centre. ICDs are predominantly implanted for secondary prevention. However, over time the number of devices implanted for primary prevention is steadily increased. During follow-up, there was no mortality difference between the primary prevention and the secondary prevention groups.
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Minja NW, Nakagaayi D, Aliku T, Zhang W, Ssinabulya I, Nabaale J, Amutuhaire W, de Loizaga SR, Ndagire E, Rwebembera J, Okello E, Kayima J. Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward. Front Cardiovasc Med 2022; 9:1008335. [PMID: 36440012 PMCID: PMC9686438 DOI: 10.3389/fcvm.2022.1008335] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.
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Affiliation(s)
- Neema W. Minja
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Doreen Nakagaayi
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Twalib Aliku
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Wanzhu Zhang
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nabaale
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Willington Amutuhaire
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Sarah R. de Loizaga
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Emma Ndagire
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | | | - Emmy Okello
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Kayima
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Gtif I, Abdelhedi R, Ouarda W, Bouzid F, Charfeddine S, Zouari F, Abid L, Rebai A, Kharrat N. Oxidative stress markers-driven prognostic model to predict post-discharge mortality in heart failure with reduced ejection fraction. Front Cardiovasc Med 2022; 9:1017673. [DOI: 10.3389/fcvm.2022.1017673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundCurrent predictive models based on biomarkers reflective of different pathways of heart failure with reduced ejection fraction (HFrEF) pathogenesis constitute a useful tool for predicting death risk among HFrEF patients. The purpose of the study was to develop a new predictive model for post-discharge mortality risk among HFrEF patients, based on a combination of clinical patients’ characteristics, N-terminal pro-B-type Natriuretic peptide (NT-proBNP) and oxidative stress markers as a potentially valuable tool for routine clinical practice.Methods116 patients with stable HFrEF were recruited in a prospective single-center study. Plasma levels of NT-proBNP and oxidative stress markers [superoxide dismutase (SOD), glutathione peroxidase (GPX), uric acid (UA), total bilirubin (TB), gamma-glutamyl transferase (GGT) and total antioxidant capacity (TAC)] were measured in the stable predischarge condition. Generalized linear model (GLM), random forest and extreme gradient boosting models were developed to predict post-discharge mortality risk using clinical and laboratory data. Through comprehensive evaluation, the most performant model was selected.ResultsDuring a median follow-up of 525 days (7–930), 33 (28%) patients died. Among the three created models, the GLM presented the best performance for post-discharge death prediction in HFrEF. The predictors included in the GLM model were age, female sex, beta blockers, NT-proBNP, left ventricular ejection fraction (LVEF), TAC levels, admission systolic blood pressure (SBP), angiotensin-converting enzyme inhibitors/angiotensin receptor II blockers (ACEI/ARBs) and UA levels. Our model had a good discriminatory power for post-discharge mortality [The area under the curve (AUC) = 74.5%]. Based on the retained model, an online calculator was developed to allow the identification of patients with heightened post-discharge death risk.ConclusionIn conclusion, we created a new and simple tool that may allow the identification of patients at heightened post-discharge mortality risk and could assist the treatment decision-making.
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Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: A Systematic Review. Glob Heart 2022; 17:76. [DOI: 10.5334/gh.1166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/30/2022] [Indexed: 01/17/2023] Open
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Agbor VN, Tianyi FL, Aminde LN, Mbanga CM, Petnga SJN, Simo LP, Dzudie A, Chobufo MD, Noubiap JJ. Burden of atrial fibrillation among adults with heart failure in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2022; 12:e061618. [PMID: 36223967 PMCID: PMC9562316 DOI: 10.1136/bmjopen-2022-061618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of atrial fibrillation (AF) in adults with heart failure (HF) and summarise the all-cause mortality ratio among adult patients with coexisting HF and AF in sub-Saharan Africa (SSA). SETTING This was a systematic review and meta-analysis of cross-sectional and cohort studies with primary data on the prevalence and incidence of AF among patients with HF and the all-cause mortality ratio among patients with HF and AF in SSA. We combined text words and MeSH terms to search MEDLINE, PubMed and Global Health Library through Ovid SP, African Journals Online and African Index Medicus from database inception to 10 November 2021. Random-effects meta-analysis was used to estimate pooled prevalence. PRIMARY OUTCOME MEASURES The prevalence and incidence of AF among patients with HF, and the all-cause mortality ratio among patients with HF and AF. RESULTS Twenty-seven of the 1902 records retrieved from database searches were included in the review, totalling 9987 patients with HF. The pooled prevalence of AF among patients with HF was 15.6% (95% CI 12.0% to 19.6%). At six months, the all-cause mortality was 18.4% (95% CI 13.1% to 23.6%) in a multinational registry and 67.7% (95% CI 51.1% to 74.3%) in one study in Tanzania. The one-year mortality was 48.6% (95% CI 32.5% to 64.7%) in a study in the Democratic Republic of Congo. We did not find any study reporting the incidence of AF in HF. CONCLUSION AF is common among patients with HF in SSA, and patients with AF and HF have poor survival. There is an urgent need for large-scale population-based prospective data to reliably estimate the prevalence, incidence and risk of mortality of AF among HF patients in SSA to better understand the burden of AF in patients with HF in the region. PROSPERO REGISTRATION NUMBER CRD42018087564.
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Affiliation(s)
- Valirie Ndip Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Population Health Research, Health Education and Research Organisation, Buea, Southwest, Cameroon
| | | | - Leopold Ndemnge Aminde
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | | | - Saint Just N Petnga
- Kousseri Regional Hospital, Far-North Regional Delegation for Health, Kousseri, Cameroon
| | - Larissa Pone Simo
- General Practice, Dzeng Sub-divisional Hospital, Dzeng, Centre Region, Cameroon
| | - Anastase Dzudie
- Cardiology and Cardiac Pacing Unit, Department of Medicine, Douala General Hospital, Douala, Cameroon
| | - Muchi Ditah Chobufo
- Department of Cardiovascular Diseases Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia, University of Adelaide CHRD, Adelaide, South Australia, Australia
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Badianyama M, Mpanya D, Adamu U, Sigauke F, Nel S, Tsabedze N. New Biomarkers and Their Potential Role in Heart Failure Treatment Optimisation-An African Perspective. J Cardiovasc Dev Dis 2022; 9:jcdd9100335. [PMID: 36286287 PMCID: PMC9604249 DOI: 10.3390/jcdd9100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Heart failure is a clinical syndrome resulting from various cardiovascular diseases of different aetiologies and pathophysiology. These varying pathologies involve several complex mechanisms that lead to the activation of the neurohumoral system, inflammation, angiogenesis, apoptosis, fibrosis, and eventually adverse cardiac remodelling associated with a progressive decline in cardiac function. Once a diagnosis is made, the cardiac function has a gradual decline characterised by multiple hospital admissions. It is therefore imperative to identify patients at different stages of the heart failure continuum to better risk stratify and initiate optimal management strategies. Biomarkers may play a role in the diagnosis, prognostication, and monitoring response to treatment. This review discusses the epidemiology of heart failure and biomarkers commonly used in clinical practice such as natriuretic peptides and cardiac troponins. In addition, we provide a brief overview of novel biomarkers and genetic coding and non-coding biomarkers used in the management of patients with heart failure. We also discuss barriers that hinder the clinical application of novel biomarkers. Finally, we appraise the value of polygenic risk scoring, focusing on sub-Saharan Africa.
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Błaziak M, Urban S, Wietrzyk W, Jura M, Iwanek G, Stańczykiewicz B, Kuliczkowski W, Zymliński R, Pondel M, Berka P, Danel D, Biegus J, Siennicka A. An Artificial Intelligence Approach to Guiding the Management of Heart Failure Patients Using Predictive Models: A Systematic Review. Biomedicines 2022; 10:biomedicines10092188. [PMID: 36140289 PMCID: PMC9496386 DOI: 10.3390/biomedicines10092188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/19/2022] [Accepted: 08/27/2022] [Indexed: 11/23/2022] Open
Abstract
Heart failure (HF) is one of the leading causes of mortality and hospitalization worldwide. The accurate prediction of mortality and readmission risk provides crucial information for guiding decision making. Unfortunately, traditional predictive models reached modest accuracy in HF populations. We therefore aimed to present predictive models based on machine learning (ML) techniques in HF patients that were externally validated. We searched four databases and the reference lists of the included papers to identify studies in which HF patient data were used to create a predictive model. Literature screening was conducted in Academic Search Ultimate, ERIC, Health Source Nursing/Academic Edition and MEDLINE. The protocol of the current systematic review was registered in the PROSPERO database with the registration number CRD42022344855. We considered all types of outcomes: mortality, rehospitalization, response to treatment and medication adherence. The area under the receiver operating characteristic curve (AUC) was used as the comparator parameter. The literature search yielded 1649 studies, of which 9 were included in the final analysis. The AUCs for the machine learning models ranged from 0.6494 to 0.913 in independent datasets, whereas the AUCs for statistical predictive scores ranged from 0.622 to 0.806. Our study showed an increasing number of ML predictive models concerning HF populations, although external validation remains infrequent. However, our findings revealed that ML approaches can outperform conventional risk scores and may play important role in HF management.
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Affiliation(s)
- Mikołaj Błaziak
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence: (M.B.); (W.K.); Tel.: +48-71-733-11-12 (M.B.)
| | - Szymon Urban
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Weronika Wietrzyk
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maksym Jura
- Department of Physiology and Pathophysiology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Gracjan Iwanek
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Wiktor Kuliczkowski
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Correspondence: (M.B.); (W.K.); Tel.: +48-71-733-11-12 (M.B.)
| | - Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maciej Pondel
- Institute of Information Systems in Economics, Wroclaw University of Economics and Business, 53-345 Wroclaw, Poland
| | - Petr Berka
- Department of Information and Knowledge Engineering, Prague University of Economics and Business, W. Churchill Sq. 1938/4, 130 67 Prague, Czech Republic
| | - Dariusz Danel
- Department of Anthropology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Agnieszka Siennicka
- Department of Physiology and Pathophysiology, Wroclaw Medical University, 50-368 Wroclaw, Poland
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Gelaye AT, Seid MA, Baffa LD. Angiotensin-Converting Enzyme Inhibitor Dose Optimization and Its Associated Factors at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia. Vasc Health Risk Manag 2022; 18:481-493. [PMID: 35832662 PMCID: PMC9272845 DOI: 10.2147/vhrm.s363051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Angiotensin-converting enzyme inhibitors dose optimizations (ACEIs) are essential to boost the treatment outcome in heart failure patients (HF) with reduced ejection fraction. Therefore, the main purpose of this study was to evaluate dose optimization and associated factors of ACEIs among HF patients. METHOD An institutional-based retrospective study was conducted on 256 study participants from May 20 to August 30, 2020 in ambulatory care clinic at Felege Hiwot Comprehensive Specialized Hospital. A systematic random sampling method was carried out to select study participants. Data were collected from the patient interview and the review of medical records. Epidata and SPSS version 22 were used for data entry and analysis. A bivariate logistic regression analysis was done to determine the association of independent variables with a dose optimization of ACEIs. RESULTS The mean age of the subjects in the study was 53.82 years with a standard deviation (SD) of 17.067 and more than half of (60.9%) the patients were unable to read and write. Among participants who were receiving ACEIs, only 30.6% were taking an optimal dose. Age ≥65 years (AOR 5.04 (2.81-12.56)) and a dose of furosemide ≥40 mg (AOR, 2.62 (1.28-16.74)) were significantly associated with the suboptimal dose of ACEIs. CONCLUSION Only one-third of patients received the optimum dose of ACEIs. Older age and dose of furosemide greater >40 mg were significantly associated with suboptimal dosing of ACEIs. Therefore, more attention must be given to older patients with HF in order to optimize the dose of ACEIs administered.
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Affiliation(s)
- Abebech Tewabe Gelaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Correspondence: Abebech Tewabe Gelaye, Email
| | - Mohammed Assen Seid
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemlem Daniel Baffa
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Agbor VN, Chen Y, Clarke R, Guo Y, Pei P, Lv J, Yu C, Li L, Chen Z, Bennett D. Resting heart rate and risk of left and right heart failure in 0.5 million Chinese adults. Open Heart 2022; 9:e001963. [PMID: 35649571 PMCID: PMC9161067 DOI: 10.1136/openhrt-2022-001963] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the shape and strength of the associations of resting heart rate (RHR) with incident heart failure (HF) and pulmonary heart disease (PHD) in Chinese adults. METHODS The prospective China Kadoorie Biobank recruited >0.5 million adults from 10 geographically diverse regions (5 urban, 5 rural) of China during 2004-2008. After an 11-year follow-up, 6082 incident cases of HF and 5572 cases of PHD, were recorded among 491 785 participants with no prior history of heart disease or use of beta-blockers at baseline. Cox regression yielded HRs for each disease associated with usual RHR after adjustment for confounding factors. RESULTS The mean (SD) baseline RHR was 79 (12) (men 78 (12); women 80 (11)) bpm, and these decreased with increasing age (by about 1 bpm per 10 years). Usual RHR showed J-shaped associations with HF and log-linear associations PHD. For HF, each 10 bpm higher usual RHR was associated with an adjusted HR of 1.25 (95% CI 1.17 to 1.34) for RHR>75 bpm. For PHD, each 10 bpm higher RHR was associated with HR of 1.74 (1.67-1.81) across the full range of usual RHR. For HF at RHR>75 bpm but not PHD, the HRs per 10 bpm higher RHR were approximately halved by further adjustment for diabetes and hypertension. CONCLUSIONS RHR was strongly positively associated with PHD throughout the range studied, but was only associated with HF at RHR>75 bpm, and the strength of the associations with HF were only one-third of those with PHD.
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Affiliation(s)
- Valirie Ndip Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council, Population Health Research Unit (PHRU), University of Oxford, Oxford, UK
| | - Robert Clarke
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council, Population Health Research Unit (PHRU), University of Oxford, Oxford, UK
| | - Yu Guo
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Pei Pei
- National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Centre for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Centre for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Centre for Public Health and Epidemic Preparedness and Response, Peking University, Beijing, China
| | - Zhengming Chen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council, Population Health Research Unit (PHRU), University of Oxford, Oxford, UK
| | - Derrick Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council, Population Health Research Unit (PHRU), University of Oxford, Oxford, UK
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Abebaw Moyehodie Y, Wale Muluneh M. Determinants of Longitudinal Measure Pulse Rate of Chronic Heart Failure Patients at Felege Hiwot Referral Hospital, Ethiopia: A Longitudinal Modeling Data Analysis. Int J Gen Med 2022; 15:3483-3496. [PMID: 35378913 PMCID: PMC8976500 DOI: 10.2147/ijgm.s355377] [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: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Heart rate is a significant modifiable factor in lowering mortality in heart failure patients. The heart rate, often known as the pulse rate, is the number of times the heart beats in a given amount of time. Irregular pulse rate or heart block are all measured using heart rate data. A higher heart rate has been associated with worse clinical outcomes. The main purpose of this study was to identify factors associated with the longitudinal pulse rate of congestive heart failure patients. Methods Hospital-based retrospective studies were conducted among 249 congestive heart failure patients who were 18 years old or older and who were on treatment follow-up from first February 2016 to thirty-one December 2017 in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. Results Data were explored using descriptive statistics, individual and mean profile plots, and analyzed using linear mixed models. Out of the total 249 patients, 139 (55.8%) were females. The majority 179 (71.9%) of the CHF patients were rural residents. 65 (26.1%) patients had Hypertension, 30 (12.5%) patients had Diabetes Mellitus, 58 (23.3%) patients had Pneumonia. Thus age, LVEF, follow-up time in a month had a negative significant effect whereas NYHA class, male gender, pneumonia had a positive significant effect on the average evaluation of pulse rate of patients. The time interaction effect of NYHA Class (Time* NYHA Class), and LVEF (Time*LVEF) had a significant effect on average pulse rate evolution. Conclusion The variables age, LVEF, and follow-up time were negatively associated whereas, male gender, NYHA class, and presence of pneumonia were positively associated with the progression change of pulse rate of patients rate of progression of pulse rate decreases over time. Furthermore, health professionals give more attention to patients who are NYHA class IV, had low LVEF, pneumonic patients to reduce pulse rate during the follow-up time.
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Chen Y, Alphonce E, Mujuni E, Kisigo GA, Kingery JR, Makubi A, Peck RN, Kalokola F. Atrial fibrillation and mortality in outpatients with heart failure in Tanzania: a prospective cohort study. BMJ Open 2022; 12:e058200. [PMID: 35046009 PMCID: PMC8772409 DOI: 10.1136/bmjopen-2021-058200] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/25/2022] Open
Abstract
OBJECTIVE In recent years, the prevalence and mortality of heart failure (HF) and other associated cardiovascular diseases have doubled in sub-Saharan Africa (SSA). Studies in high-income countries indicate that HF with concurrent atrial fibrillation (AF) is linked to increased mortality. Our objective was to determine the incidence and clinical outcomes of AF among patients with HF in SSA. DESIGN A prospective cohort study using data collected between October 2018 and May 2020. SETTING Outpatient clinic at a tertiary hospital in Mwanza, Tanzania. PARTICIPANTS 303 adult participants (aged ≥18 years) with HF as defined by the European Society of Cardiology guidelines (2016) and 100 adults with HF as defined by clinical criteria alone were enrolled into the study. Patients with comorbid medical condition that had prognosis of <3 months (ie, advance solid tumours, advance haematological malignancies) were excluded. METHODS Participants were screened for AF, and their medical history, physical examinations and sociodemographic information were obtained. Multivariable logistic regression models were used to examine factors associated with AF incidence. Cox regression models were used to analyse 3-month mortality and its associated risk factors. RESULTS We enrolled 403 participants with HF (mean age 60±19 years, 234 (58%) female). The AF prevalence was 17%. In multivariable models, factors associated with AF were low income, alcohol consumption and longer duration of HF. At the end of the 3-month follow-up, 120 out of 403 (30%) participants died, including 44% (31/70) of those with AF. Higher heart rate on ECG, more severe New York Heart Association HF class, rural residence and anaemia were significantly correlated with mortality. CONCLUSION AF is common, underdiagnosed and is associated with significant mortality among outpatients with HF in Tanzania (HR 1.749, 95% CI 1.162 to 2.633, p=0.007). Our findings additionally identify tachycardia (>110 bpm, HR 1.879, 95% CI 1.508 to 2.340, p<0.001) as an easily measurable, high-impact physical examination finding for adverse outcomes in patients with HF.
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Affiliation(s)
- Yunchan Chen
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Emmanuel Alphonce
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Eva Mujuni
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Godfrey A Kisigo
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Justin R Kingery
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Abel Makubi
- Ministry of Health Community Development Gender Elderly and Children, Dar es Salaam, Dar es Salaam, Tanzania, United Republic of
| | - R N Peck
- Weill Cornell Medicine, New York, New York, USA
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
| | - Fredrick Kalokola
- Department of Internal Medicine, Catholic University of Health And Allied Sciences Weill Bugando School of Medicine, Mwanza, Mwanza, Tanzania, United Republic of
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Emmons-Bell S, Johnson C, Roth G. Prevalence, incidence and survival of heart failure: a systematic review. Heart 2022; 108:1351-1360. [PMID: 35042750 PMCID: PMC9380485 DOI: 10.1136/heartjnl-2021-320131] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022] Open
Abstract
Studies of the epidemiology of heart failure in the general population can inform assessments of disease burden, research, public health policy and health system care delivery. We performed a systematic review of prevalence, incidence and survival for all available population-representative studies to inform the Global Burden of Disease 2020. We examined population-based studies published between 1990 and 2020 using structured review methods and database search strings. Studies were sought in which heart failure was defined by clinical diagnosis using structured criteria such as the Framingham or European Society of Cardiology criteria, with studies using alternate case definitions identified for comparison. Study results were extracted with descriptive characteristics including age range, location and case definition. Search strings identified 42 360 studies over a 30-year period, of which 790 were selected for full-text review and 125 met criteria for inclusion. 45 sources reported estimates of prevalence, 41 of incidence and 58 of mortality. Prevalence ranged from 0.2%, in a Hong Kong study of hospitalised heart failure patients in 1997, to 17.7%, in a US study of Medicare beneficiaries aged 65+ from 2002 to 2013. Collapsed estimates of incidence ranged from 0.1%, in the EPidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine (EPICAL) study of acute heart failure in France among those aged 20-80 years in 1994, to 4.3%, in a US study of Medicare beneficiaries 65+ from 1994 to 2003. One-year heart failure case fatality ranged from 4% to 45% with an average of 33% overall and 24% for studies across all adult ages. Diagnostic criteria, case ascertainment strategy and demographic breakdown varied widely between studies. Prevalence, incidence and survival for heart failure varied widely across countries and studies, reflecting a range of study design. Heart failure remains a high prevalence disease among older adults with a high risk of death at 1 year.
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Affiliation(s)
- Sophia Emmons-Bell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Catherine Johnson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Gregory Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA .,Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
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Jingi AM, Nkoke C, Noubiap JJ, Teuwafeu D, Mambap AT, Nkouonlack C, Gobina R, Njume D, Dzudie A, Ashuntantang G. Prevalence, correlates and in-hospital outcomes of kidney dysfunction in hospitalized patients with heart failure in Buea-Cameroon. BMC Nephrol 2022; 23:8. [PMID: 34979971 PMCID: PMC8722319 DOI: 10.1186/s12882-021-02641-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background Kidney dysfunction is common in patients with heart failure (HF) and has been associated with poor outcomes. This study aimed to determine the prevalence, correlates, and prognosis of kidney dysfunction in patients with HF in Cameroon, an understudied population. Methods We conducted a cross-sectional study in consecutive patients hospitalized with HF between June 2016 and November 2017 in the Buea Regional Hospital, Cameroon. Kidney dysfunction was defined as an estimated glomerular filtration rate < 60 ml/min/1.73m2. Prognostic outcomes included death and prolonged hospital stay (> 7 days). We also performed a sensitivity analysis excluding racial considerations. Results Seventy four patients (86.1% of those eligible) were included. Their median age was 60 (interquartile range: 44–72) years and 46.0% (n = 34) were males. Half of patients (n = 37) had kidney dysfunction. Correlates of kidney dysfunction included previous diagnosis of HF (adjusted odds ratio [aOR]4.3, 95% CI: 1.1–17.5) and left ventricular hypertrophy (aOR3.4, 95% CI: 1.1–9.9). Thirty-six (48.9%) had prolonged hospital stay, and seven (9.5%) patients died in hospital. Kidney dysfunction was not associated with in-hospital death (aOR 0.4, 95% CI: 0.1–2) nor prolonged hospital stay (aOR 2.04, 0.8–5.3). In sensitivity analysis (excluding racial consideration), factors associated with Kidney dysfunction in HF were; anemia (aOR: 3.0, 95% CI: 1.1–8.5), chronic heart failure (aOR: 4.7, 95% CI: 0.9–24.6), heart rate on admission < 90 bpm (aOR: 3.4, 95% CI: 1.1–9.1), left atrial dilation (aOR: 3.2, 95% CI: 1.04–10), and hypertensive heart disease (aOR: 3.1, 95% CI: 1.2–8.4). Kidney dysfunction in HF was associated with hospital stay > 7 days (OR: 2.6, 95% CI: 1–6.8). Conclusion Moderate-to-severe kidney dysfunction was seen in half of the patients hospitalized with HF in our setting, and this was associated with a previous diagnosis of HF and left ventricular hypertrophy. Kidney dysfunction might not be the main driver of poor HF outcomes in this population. In sensitivity analysis, this was associated with anemia, chronic heart failure, heart rate on admission less than 90 bpm, left atrial dilatation, and hypertensive heart disease. Kidney dysfunction was associated with hospital stay > 7 days. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02641-2.
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Affiliation(s)
| | - Clovis Nkoke
- Buea Regional Hospital, Buea, Cameroon. .,Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.
| | - Jean Jacques Noubiap
- Center for Heart Rhythm Disorders, University of Adelaide, Adelaide, SA, Australia
| | - Denis Teuwafeu
- Buea Regional Hospital, Buea, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Alex T Mambap
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Cyrille Nkouonlack
- Buea Regional Hospital, Buea, Cameroon.,Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | | | - Debimeh Njume
- Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaoundé, Cameroon
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaoundé, Cameroon
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Boudreaux C, Barango P, Adler A, Kabore P, McLaughlin A, Mohamed MOS, Park PH, Shongwe S, Dangou JM, Bukhman G. Addressing Severe Chronic NCDs Across Africa: Measuring Demand for the Package of Essential Noncommunicable Disease Interventions-Plus (PEN-Plus). Health Policy Plan 2022; 37:452-460. [PMID: 34977932 PMCID: PMC9006066 DOI: 10.1093/heapol/czab142] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/07/2021] [Accepted: 12/31/2021] [Indexed: 12/30/2022] Open
Abstract
Severe chronic non-communicable diseases (NCDs) pose important challenges for health systems across Africa. This study explores the current availability of and demand for decentralization of services for four high-priority conditions: insulin-dependent diabetes, heart failure, sickle cell disease, and chronic pain. Ministry of Health NCD Programme Managers from across Africa (N = 47) were invited to participate in an online survey. Respondents were asked to report the status of clinical care across the health system. A care package including diagnostics and treatment was described for each condition. Respondents were asked whether the described services are currently available at primary, secondary and tertiary levels, and whether making the service generally available at that level is expected to be a priority in the coming 5 years. Thirty-seven (79%) countries responded. Countries reported widespread gaps in service availability at all levels. We found that just under half (49%) of respondents report that services for insulin-dependent diabetes are generally available at the secondary level (district hospital); 32% report the same for heart failure, 27% for chronic pain and 14% for sickle cell disease. Reported gaps are smaller at tertiary level (referral hospital) and larger at primary care level (health centres). Respondents report ambitious plans to introduce and decentralize these services in the coming 5 years. Respondents from 32 countries (86%) hope to make all services available at tertiary hospitals, and 21 countries (57%) expect to make all services available at secondary facilities. These priorities align with the Package of Essential NCD Interventions-Plus. Efforts will require strengthened infrastructure and supply chains, capacity building for staff and new monitoring and evaluation systems for efficient implementation. Many countries will need targeted financial assistance in order to realize these goals. Nearly all (36/37) respondents request technical assistance to organize services for severe chronic NCDs.
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Affiliation(s)
| | | | - Alma Adler
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital
| | | | | | | | - Paul H Park
- Harvard Medical School, Department of Global Health and Social Medicine.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital.,NCD Synergies Project, Partners in Health
| | | | | | - Gene Bukhman
- Harvard Medical School, Department of Global Health and Social Medicine.,WHO Regional Office for Africa.,Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital.,Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital
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38
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Epidemiology of infective endocarditis in Africa: a systematic review and meta-analysis. THE LANCET GLOBAL HEALTH 2022; 10:e77-e86. [DOI: 10.1016/s2214-109x(21)00400-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
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Edwards JG, Barry M, Essam D, Elsayed M, Abdulkarim M, Elhossein BMA, Mohammed ZHA, Elnogomi A, Elfaki ASE, Elsayed A, Chang AY. Health system and patient-level factors serving as facilitators and barriers to rheumatic heart disease care in Sudan. Glob Health Res Policy 2021; 6:35. [PMID: 34598719 PMCID: PMC8486630 DOI: 10.1186/s41256-021-00222-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/15/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains a leading cause of morbidity and mortality in Sub-Saharan Africa despite widely available preventive therapies such as prophylactic benzathine penicillin G (BPG). In this study, we sought to characterize facilitators and barriers to optimal RHD treatment with BPG in Sudan. METHODS We conducted a mixed-methods study, collecting survey data from 397 patients who were enrolled in a national RHD registry between July and November 2017. The cross-sectional surveys included information on demographics, healthcare access, and patient perspectives on treatment barriers and facilitators. Factors associated with increased likelihood of RHD treatment adherence to prophylactic BPG were assessed by using adjusted logistic regression. These data were enhanced by focus group discussions with 20 participants, to further explore health system factors impacting RHD care. RESULTS Our quantitative analysis revealed that only 32% of the study cohort reported optimal prophylaxis adherence. Younger age, reduced primary RHD healthcare facility wait time, perception of adequate health facility staffing, increased treatment costs, and high patient knowledge about RHD were significantly associated with increased odds of treatment adherence. Qualitative data revealed significant barriers to RHD treatment arising from health services factors at the health system level, including lack of access due to inadequate healthcare staffing, lack of faith in local healthcare systems, poor ancillary services, and patient lack of understanding of disease. Facilitators of RHD treatment included strong interpersonal support. CONCLUSIONS Multiple patient and system-level barriers to RHD prophylaxis adherence were identified in Khartoum, Sudan. These included patient self-efficacy and participant perception of healthcare facility quality. Strengthening local health system infrastructure, while enhancing RHD patient education, may help to improve treatment adherence in this vulnerable population.
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Affiliation(s)
- Jeffrey G. Edwards
- Stanford University School of Medicine, Stanford, CA USA
- Present Address: Boston Medical Center, Department of Pediatrics, Boston University School of Medicine, Residency Program Coordinator, c/o Jeffrey Edwards, 801 Albany, St Boston, MA 02119-2598 USA
- Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Michele Barry
- Department of Medicine, Stanford University, Stanford, CA USA
- Center for Innovation in Global Health, Stanford University, Stanford, CA USA
| | - Dary Essam
- Alazhari Health Research Center, Alzaeim Alazhari University, Khartoum, Sudan
| | - Mohammed Elsayed
- Alazhari Health Research Center, Alzaeim Alazhari University, Khartoum, Sudan
| | | | | | - Zahia H. A. Mohammed
- Faculty of Medicine, Alzaeim Alazhari University, Khartoum, Sudan
- Department of Psychiatry, Alzaeim Alazhari University Khartoum, Khartoum, Sudan
| | | | - Amna S. E. Elfaki
- Alazhari Health Research Center, Alzaeim Alazhari University, Khartoum, Sudan
| | - Ahmed Elsayed
- Alazhari Health Research Center, Alzaeim Alazhari University, Khartoum, Sudan
| | - Andrew Y. Chang
- Department of Medicine, Stanford University, Stanford, CA USA
- Center for Innovation in Global Health, Stanford University, Stanford, CA USA
- Cardiovascular Institute, Stanford University, Stanford, CA USA
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Abebaw Y, Yusuf K, Aragaw A, Melese B. Joint Modeling of Longitudinal Pulse Rate and Time-to-Default from Treatment of Congestive Heart Failure Patients. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2021. [DOI: 10.2147/rrcc.s326229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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41
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Gtif I, Bouzid F, Charfeddine S, Abid L, Kharrat N. Heart failure disease: An African perspective. Arch Cardiovasc Dis 2021; 114:680-690. [PMID: 34563468 DOI: 10.1016/j.acvd.2021.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality. The current review aims to summarize the most recent data on the epidemiology, aetiology, risk factors and management of heart failure, comparing countries in North Africa and sub-Saharan Africa. There is a paucity of data on heart failure epidemiology, aetiology and management, and on the sociodemographic characteristics of African patients with heart failure. Heart failure prevalence has been evaluated among all medical admissions or admissions to cardiac units or emergency departments in a few hospital-based studies conducted in countries in North Africa and sub-Saharan Africa. Common causes of heart failure in Africa include ischaemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. The aetiology of heart failure differs between countries in North Africa and sub-Saharan Africa. Diagnosing heart failure proves challenging in Africa because of a lack of basic tools and the necessary human resources. The principal drugs used frequently for heart failure therapy are lacking in sub-Saharan Africa. The clinical profile of heart failure in sub-Saharan Africa differs from that in North African countries; this is related to aetiological factors, socioeconomic status and availability of diagnostic tools. There is an evident need to establish a large multicentre registry to evaluate the heart failure burden in almost all African countries, and to highlight the major cardiovascular risk factors and co-morbidities. The present review highlights the importance of this syndrome in Africa, and calls for improvements in its early diagnosis, treatment and, possibly, prevention.
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Affiliation(s)
- Imen Gtif
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia.
| | - Fériel Bouzid
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
| | - Salma Charfeddine
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Leila Abid
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Najla Kharrat
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
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Nkoke C, Damasceno A, Edwards C, Davison B, Cotter G, Sani M, Gaeta L, Ogah OS, Mondo C, Ojji D, Suliman A, Yonga G, Ba SA, Dzudie A, Sliwa K. Differences in socio-demographic and risk factor profile, clinical presentation, and outcomes between patients with and without RHD heart failure in Sub-Saharan Africa: results from the THESUS-HF registry. Cardiovasc Diagn Ther 2021; 11:980-990. [PMID: 34527521 DOI: 10.21037/cdt-21-112] [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: 02/24/2021] [Accepted: 06/20/2021] [Indexed: 11/06/2022]
Abstract
Background Rheumatic heart disease (RHD) was found in the THESUS-HF registry to be the third most common cause of acute heart failure (AHF) in Sub-Saharan Africa. Methods One thousand six patients with AHF from 9 Sub-Saharan African countries were recruited in THESUS-HF, of which 143 (14.3%) had RHD-AHF. Clinical characteristics and outcomes in patients with RHD-AHF and non-RHD-AHF were compared. Kaplan-Meier plots for time to all-cause death and/or HF readmission according to the presence of RHD-AHF and non-RHD-AHF were performed and survival distributions compared using the log-rank test. Cox regression was used to determine the hazard ratio of death to day 180 and death or readmission to day 60 after adjusting for confounders. Results Patients with RHD-AHF were younger, more often females, had higher rates of atrial fibrillation, had less hypertension, hyperlipidemia and diabetes, had lower BP, and higher pulse rate and better kidney function and echocardiographic higher ejection fraction larger left atria and more diastolic dysfunction. Patients with RHD-AHF had a numerically longer mean stay in the hospital (10.5 vs. 8.8 days) and significantly higher initial hospitalization mortality (9.1% vs. 3.4%). Conclusions In conclusion, patients with HF related to RHD were younger, have higher rate of atrial fibrillation and have a worse short-term outcome compared to HF related to other etiologies in Sub-Saharan Africa.
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Affiliation(s)
- Clovis Nkoke
- Department of Internal Medicine, Buea Regional Hospital, Buea, Cameroon.,Clinical Research Education, Networking and Consultancy, Douala, Cameroon
| | | | | | - Beth Davison
- Momentum Research Inc., Durham, North Carolina, USA.,U 942 Inserm-MASCOT, Paris, France
| | - Gad Cotter
- Momentum Research Inc., Durham, North Carolina, USA.,U 942 Inserm-MASCOT, Paris, France
| | - Mahmoud Sani
- Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Lauren Gaeta
- Momentum Research Inc., Durham, North Carolina, USA
| | - Okechukwu S Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State
| | | | - Dike Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Ahmed Suliman
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Gerald Yonga
- Department of Medicine, Aga Khan University, Nairobi, Kenya
| | - Serigne Abdou Ba
- Service de cardiologie, Faculte de medecine de Dakar, Dakar, Senegal
| | - Anastase Dzudie
- Clinical Research Education, Networking and Consultancy, Douala, Cameroon.,Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaoundé, Cameroon
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
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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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44
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Nganou-Gnindjio CN, Awah Epoupa RA, Wafeu Sadeu G, Tchapmi Njeunje DP, Endomba Angong FT, Menanga AP. Seasonal variation of decompensated heart failure admissions and mortality rates in sub-Saharan Africa, Cameroon. Ann Cardiol Angeiol (Paris) 2021; 70:148-152. [PMID: 33962785 DOI: 10.1016/j.ancard.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Epidemiological data of heart failure (HF) decompensation from the northern hemisphere suggests higher rates during winter. OBJECTIVES We aimed to explore the seasonal variation in decompensated HF admission and mortality rates in a country with equatorial climate. METHODS We conducted a retrospective cross-sectional study by chart review of the admission, discharge registries and patient files from 2016 to 2018 in the cardiology unit of the Yaoundé Central Hospital, Cameroon. Data was collected on HF morbidity and mortality from the registers and patients' files. Corresponding seasonal climatic data was obtained from the meteorology office of the Cameroonian ministry of transports. Analysis of variance and Chi-square test were respectively used to compare the continuous and categorical data between across seasons. Correlation between continuous data was assess with the Spearman correlation. RESULTS Decompensated HF accounted for 636 (36.2%) out 1755 cardiology unit admission and an 18% lethality rate. Decompensated HF admission, mortality and lethality rates were respectively 38.2%, 6.7% and 17.9% higher during the long rainy season (all P values>0.05). We observed a borderline-to-significant inverse linear continuous correlation between monthly temperatures and admission rate (r=-0.301; P=0.070), lethality rate (r=-0.361; P=0.030) and mortality rate (r=-0.385; P=0.020). There was no significant difference of the distribution of precipitating factors between seasons. CONCLUSION Although statistically insignificant, decompensated HF admissions and mortality increase in rainy season where the temperature is lower in an equatorial climate.
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Affiliation(s)
- C N Nganou-Gnindjio
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; Cardiology department, Yaoundé Central Hospital, Yaoundé, Cameroon.
| | - R A Awah Epoupa
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - G Wafeu Sadeu
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - D P Tchapmi Njeunje
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - F T Endomba Angong
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - A P Menanga
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon; Internal medicine department, Yaoundé General Hospital, Yaoundé, Cameroon
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Predicting mortality and hospitalization in heart failure using machine learning: A systematic literature review. IJC HEART & VASCULATURE 2021; 34:100773. [PMID: 33912652 PMCID: PMC8065274 DOI: 10.1016/j.ijcha.2021.100773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/11/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022]
Abstract
Objective The partnership between humans and machines can enhance clinical decisions accuracy, leading to improved patient outcomes. Despite this, the application of machine learning techniques in the healthcare sector, particularly in guiding heart failure patient management, remains unpopular. This systematic review aims to identify factors restricting the integration of machine learning derived risk scores into clinical practice when treating adults with acute and chronic heart failure. Methods Four academic research databases and Google Scholar were searched to identify original research studies where heart failure patient data was used to build models predicting all-cause mortality, cardiac death, all-cause and heart failure-related hospitalization. Results Thirty studies met the inclusion criteria. The selected studies' sample size ranged between 71 and 716 790 patients, and the median age was 72.1 (interquartile range: 61.1–76.8) years. The minimum and maximum area under the receiver operating characteristic curve (AUC) for models predicting mortality were 0.48 and 0.92, respectively. Models predicting hospitalization had an AUC of 0.47 to 0.84. Nineteen studies (63%) used logistic regression, 53% random forests, and 37% of studies used decision trees to build predictive models. None of the models were built or externally validated using data originating from Africa or the Middle-East. Conclusions The variation in the aetiologies of heart failure, limited access to structured health data, distrust in machine learning techniques among clinicians and the modest accuracy of existing predictive models are some of the factors precluding the widespread use of machine learning derived risk calculators.
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Bimerew M, Beletew B, Getie A, Wondmieneh A, Gedefaw G, Demis A. Prevalence of rheumatic heart disease among school children in East Africa: a systematic review and meta-analysis. Pan Afr Med J 2021; 38:242. [PMID: 34104290 PMCID: PMC8164427 DOI: 10.11604/pamj.2021.38.242.26058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 02/08/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction conducting researches and estimating the prevalence of rheumatic heart disease in school children is crucial to develop school-based strategies targeted to decrease the prevalence of this disease. Therefore, this systematic review and meta-analysis were aimed to estimate the overall prevalence of rheumatic heart disease (RHD) among school children in East Africa. Methods PubMed/MEDLINE, Google Scholar, Cochrane review, African Journals Online and African Index Medicus databases were searched to identify relevant research articles. The overall prevalence of rheumatic heart disease was pooled based on the weighted inverse variance random-effects model at a 95% confidence interval. The presence of heterogeneity, sensitivity analysis and presence of publication bias was tested. Results were presented with narrative synthesis, tables and forest plots. Results a total of thirteen research articles were included in the final analysis. The pooled prevalence of rheumatic heart disease in East African school children was 1.79% (17.9 cases per 1000 children (95% CI=11.6, 24.2; I2=95.1%; p<0.001)). From the subgroup analysis conducted by publication year, a lower prevalence of RHD in school children was reported among studies published after 2015 (six studies; overall prevalence=1.17% (11.7 cases per 1000 school children); with 95% CI=0.60, 1.73%; I2=88.8%; p<0.001). Additionally, the horn of Africa was found to have the lowest prevalence of RHD in school children among East African countries (six studies; overall prevalence=1.59% (15.9 cases per 1000 school children); with 95% CI=0.68, 2.51%; I2=94.2%; p<0.001). Conclusion the prevalence of rheumatic heart disease (RHD) among school children in East Africa was considerably higher than the results from high-income countries. Therefore, community education on strep throat and its complications should be implemented through mass media. Rheumatic heart disease preventive strategies should be integrated with schools to reduce the prevalence of RHD among school children.
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Affiliation(s)
- Melaku Bimerew
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Biruk Beletew
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Addisu Getie
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Adam Wondmieneh
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Getnet Gedefaw
- Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3166] [Impact Index Per Article: 1055.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Bragazzi NL, Zhong W, Shu J, Abu Much A, Lotan D, Grupper A, Younis A, Dai H. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. Eur J Prev Cardiol 2021; 28:1682-1690. [PMID: 33571994 DOI: 10.1093/eurjpc/zwaa147] [Citation(s) in RCA: 259] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/26/2022]
Abstract
AIMS To provide the first systematic analysis of the burden and underlying causes of heart failure (HF) in 195 countries and territories from 1990 to 2017. METHODS AND RESULTS We collected detailed information on prevalence, years lived with disability (YLDs), and underlying causes of HF from the Global Burden of Disease study 2017. Numbers and age-standardized rates of HF prevalence and YLDs were compared by age, sex, socio-demographic index (SDI), and location. The proportions of HF age-standardized prevalence rates due to 23 underlying causes were also presented. Globally, the age-standardized prevalence and YLD rates of HF in 2017 were 831.0 and 128.2 per 100 000 people, a decrease of -7.2% and -0.9% from 1990, respectively. Nevertheless, the absolute numbers of HF prevalent cases and YLDs have increased by 91.9% and 106.0% from 1990, respectively. There is significant geographic and socio-demographic variation in the levels and trends of HF burden from 1990 to 2017. Among all causes of HF, ischaemic heart disease accounted for the highest proportion (26.5%) of age-standardized prevalence rate of HF in 2017, followed by hypertensive heart disease (26.2%), chronic obstructive pulmonary disease (23.4%). CONCLUSION HF remains a serious public health problem worldwide, with increasing age-standardized prevalence and YLD rates in countries with relatively low SDI. More geo-specific strategies aimed at preventing underlying causes and improving medical care for HF are warranted to reduce the future burden of this condition.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Department of General Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China.,Centre for Disease Modelling, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada.,Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Via Balbi 5, Genova 16126, Italy
| | - Wen Zhong
- Department of General Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China
| | - Jingxian Shu
- Department of Pharmacy, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 Mei Hua East Road, Zhuhai, Guangdong 519000, China
| | - Arsalan Abu Much
- Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dor Lotan
- Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avishay Grupper
- Leviev Heart Center, Sheba Medical Center, Tel HaShomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arwa Younis
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, 265 Crittenden Boulevard, Rochester, NY 14620, USA
| | - Haijiang Dai
- Centre for Disease Modelling, York University, 4700 Keele St, Toronto, ON M3J 1P3, Canada
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49
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Fundikira LS, Chillo P, van Laake LW, Mutagaywa RK, Schmidt AF, Kamuhabwa A, Kwesigabo G, Asselbergs FW. Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: Protocol for a Systematic Review. JMIR Res Protoc 2021; 10:e18229. [PMID: 33475522 PMCID: PMC7862000 DOI: 10.2196/18229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022] Open
Abstract
Background Cardiomyopathies, defined as diseases involving mainly the heart muscles, are linked to an estimated 5.9 of 100,000 deaths globally. In sub-Saharan Africa, cardiomyopathies constitute 21.4% of heart failure cases, with dilated cardiomyopathy (DCM) being the most common form. The etiology of DCM is heterogeneous and is broadly categorized as genetic or nongenetic, as well as a mixed disease in which genetics interact with intrinsic and environmental factors. Factors such as age, gender, family history, and ethnicity are nonmodifiable, whereas modifiable risk factors include poor nutrition, physical inactivity, and excessive alcohol consumption, among others. However, the relative contribution of the different risk factors to the etiology of DCM is not known in sub-Saharan Africa, and the prevalence of DCM among heart failure patients has not been systematically studied in the region. Objective The aim of this review is to synthesize available literature from sub-Saharan Africa on the prevalence of DCM among patients with heart failure, as well as the literature on factors associated with DCM. This paper outlines the protocol that will be followed to conduct the systematic review. Methods A limited search of the PubMed database will be performed to identify relevant keywords contained in the title, abstract, and subject descriptors using initial search terms “heart failure,” “cardiomyopathy,” and “sub-Saharan Africa.” These search terms and their synonyms will then be used in an extensive search in PubMed, and will address the first research question on prevalence. To address the second research question on risk factors, the terms “heart failure,” “cardiomyopathy,” and “cardiovascular risk factors” in “Sub-Saharan Africa” will be used, listing them one by one. Articles published from 2000 and in the English language will be included. Indexed articles in PubMed and Embase will be included, as well as the first 300 articles retrieved from a Google Scholar search. Collected data will be organized in Endnote and then uploaded to the Rayyan web app for systematic reviews. Two reviewers will independently select articles against the inclusion criteria. Discrepancies in reviewer selections will be resolved by an arbitrator. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting systematic reviews will be applied. A map of sub-Saharan Africa with colors to show disease prevalence in each country will be included. For quantitative data, where possible, odds ratios (for categorical outcome data) or standardized mean differences (for continuous data) and their 95% CIs will be calculated. Results The primary outcomes will be the prevalence of DCM among patients with heart failure and cardiovascular risk factors associated with DCM in sub-Saharan Africa. The literature search will begin on January 1, 2021, and data analysis is expected to be completed by April 30, 2021. Conclusions This review will provide information on the current status of the prevalence and associated factors of DCM, and possibly identify gaps, including paucity of data or conflicting results that need to be addressed to improve our understanding of DCM in sub-Saharan Africa. International Registered Report Identifier (IRRID) PRR1-10.2196/18229
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Affiliation(s)
- Lulu Said Fundikira
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Pilly Chillo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Linda W van Laake
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Reuben Kato Mutagaywa
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Amand Floriaan Schmidt
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom.,Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
| | - Appolinary Kamuhabwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Gideon Kwesigabo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Folkert W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom.,Health Data Research UK and Institute of Health Informatics, University College London, London, United Kingdom
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50
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Chobufo MD, Rahman EU, Farah F, Suliman M, Mansoor K, Elhamdani A, El-Hamdani M, Balla S. 10-Year community prevalence and trends of severe asymptomatic hypertension among patients with hypertension in the USA: 2007-2016. Int J Cardiol Hypertens 2020; 7:100066. [PMID: 33447787 PMCID: PMC7803022 DOI: 10.1016/j.ijchy.2020.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Severe asymptomatic hypertension (SAH) is associated with significant health cost, morbidity and mortality. AIM Establish the nationwide prevalence, trends and associated sociodemographic characteristics of SAH among patients with hypertension in the USA. METHODS We utilized the National Health and Nutrition Examination data collected over five survey cycles (2007-2016). Included were participants aged 20-80 years with self-reported diagnosis of hypertension. SAH was defined as having a mean systolic blood pressure (SBP) ≥180 mmHg and/or mean diastolic blood pressure (DBP) ≥120 mmHg at the time of examination. The Chi square test was used to compare prevalence across different categories. Associations between sociodemographic variables and SAH were assessed using multivariate binary logistic regression. RESULTS The prevalence of SAH among patients with hypertension is 2.15% (95% CI 1.80-2.56), mainly explained by isolated mean SBP≥180 mmHg (86% of all cases), with no statistically significant change between 2007: 2.66% (95% CI 2.10-3.36) and 2016:2.61% [95% CI 1.73-3.94), p-trend = 0.17. Increasing age (OR 1.07, 95% CI 1.04-1.09), NH Blacks (OR 2.20, 95% CI 1.37-3.54), BMI< 25 (OR 2.52, 95% CI 1.48-4.28), lack of health insurance OR 4.92% (95% CI 2.53-9.54) and never married individuals (OR = 2.59%, 95% CI 1.20-5.60) were more likely to have SAH, comparatively. There was no significant association between duration of hypertension and SAH. CONCLUSION The prevalence of SAH in the USA is 2.15% and has been stable over the past decade. Our study underscores the importance of identifying barriers to screening and treatment of hypertension which is a major treatable risk factor for cardiovascular disease.
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Affiliation(s)
- Muchi Ditah Chobufo
- Department of Internal Medicine, Interfaith Medical Ctr, Brooklyn, NY, 11213, USA
| | - Ebad Ur Rahman
- Department of Internal Medicine, St Mary's Medical Ctr, Huntington, WV, 25701, USA
| | - Fatima Farah
- Deccan College of Medical Sciences, Hyderabad, India
| | - Mohamed Suliman
- Department of Cardiology, Marshall University, Huntington, WV, 25701, USA
| | - Kanaan Mansoor
- Department of Cardiology, Marshall University, Huntington, WV, 25701, USA
| | - Adee Elhamdani
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, USA
| | - Mehiar El-Hamdani
- Department of Cardiology, Marshall University, Huntington, WV, 25701, USA
| | - Sudarshan Balla
- Department of Cardiology and Cardiothoracic Surgery, West Virginia University, Morgantown, WV, 26505, USA
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