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Sadiq E, Woodiwiss A, Norton G, Modi G. Cardioembolic stroke in an HIV endemic region: underdiagnosed and severe. BMJ Neurol Open 2024; 6:e000592. [PMID: 39104634 PMCID: PMC11298736 DOI: 10.1136/bmjno-2023-000592] [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: 11/21/2023] [Accepted: 07/11/2024] [Indexed: 08/07/2024] Open
Abstract
Background and objectives Cardioembolic stroke (CES) appears to be a rare cause of stroke (4%-9%) in people living with HIV (PLWH) in sub-Saharan Africa (SSA). However, due to limited access to diagnostic resources, this may be an underestimate. It is also unclear which cardiac pathologies are the major contributors to CES in this region. We sought to determine the prevalence and aetiology of CES in PLWH and to determine whether there are any differences compared with HIV negative stroke patients. Methods This cross-sectional study recruited PLWH with new-onset stroke at a quaternary-level hospital in Johannesburg, South Africa, from 2014 to 2017, and compared them to age-matched and sex-matched HIV negative stroke patients. Comprehensive investigations were performed to determine the underlying stroke aetiology, including electrocardiography, echocardiography, CT angiography and cerebrospinal fluid examination. Results 85 PLWH with ischaemic stroke were recruited and compared with 109 HIV negative controls. CES was identified in 17/85 (20.0%) of PLWH. These patients had more severe strokes than PLWH with non-CES (National Institutes of Health Stroke Scale score 14.9±6.7 vs 11.7±5.4, p=0.04). Cardiomyopathy was the predominant cardiac pathology in PLWH (76.4% vs 45.5% in HIV negative, p=0.04) while valvulopathy was more common in HIV negative patients (42.4% vs 11.8% in PLWH, p=0.03). Arrhythmia (n=1) and ischaemic heart disease (n=1) were uncommon in PLWH. Conclusion CES is underdiagnosed in SSA and is more severe than non-CES. The identification of cardiomyopathy as the predominant underlying cardiac pathology may assist to target resources towards its detection using accessible cost-effective biomarkers.
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Affiliation(s)
- Eitzaz Sadiq
- Division of Neurology, Department of Neurosciences, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Angela Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Gavin Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
| | - Girish Modi
- Division of Neurology, Department of Neurosciences, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
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2
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Lo S, Mbanze I, Orr JE, DeYoung P, Checkoway H, Govo V, Jessen N, Damasceno A, Malhotra A. The prevalence of sleep-disordered breathing and associated risk factors in patients with decompensated congestive heart failure in Mozambique. J Clin Sleep Med 2023; 19:1103-1110. [PMID: 36798985 PMCID: PMC10235722 DOI: 10.5664/jcsm.10510] [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: 05/27/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) is common in patients with congestive heart failure and has important implications regarding symptoms and prognosis. However, the burden of SDB on those with heart failure has not been well characterized in developing countries, including Mozambique in sub-Saharan Africa. Diagnosing SDB in individuals with congestive heart failure is important because treatment of SDB may improve outcomes. METHODS Between September 2014 and April 2017, patients hospitalized in a specialized cardiology unit in Maputo, Mozambique with decompensated congestive heart failure were recruited using convenience sampling. We determined the prevalence of SDB and associated risk factors. RESULTS A total of 165 patients were recruited, of which 145 had evaluable sleep study data. The overall prevalence of SDB in patients with decompensated congestive heart failure was 72%, and of these 46% had Cheyne-Stokes respirations. Male sex, higher body mass index, and lower left ventricular ejection fraction were all associated with a higher likelihood of SDB and more severe SDB. Cheyne-Stokes respirations were associated with male sex, lower ejection fraction, and larger left atrial size. CONCLUSIONS We conclude that in sub-Saharan Africa SDB is common in decompensated congestive heart failure and strongly predicted by demographic and echocardiographic parameters. This study highlights the need for the development of diagnostic tools and management strategies for patients with severe heart failure in resource-limited settings. CITATION Lo S, Mbanze I, Orr JE, et al. The prevalence of sleep-disordered breathing and associated risk factors in patients with decompensated congestive heart failure in Mozambique. J Clin Sleep Med. 2023;19(6):1103-1110.
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Affiliation(s)
- Shelton Lo
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California
| | - Irina Mbanze
- Nucleo de Investigação, Departamento de Medicina, Maputo Central Hospital, Maputo, Mozambique
| | - Jeremy E. Orr
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California San Diego, La Jolla, California
| | - Pamela DeYoung
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California San Diego, La Jolla, California
| | - Harvey Checkoway
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California
| | - Valerio Govo
- Nucleo de Investigação, Departamento de Medicina, Maputo Central Hospital, Maputo, Mozambique
| | - Neusa Jessen
- Nucleo de Investigação, Departamento de Medicina, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Albertino Damasceno
- Nucleo de Investigação, Departamento de Medicina, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, Sleep Medicine and Physiology, University of California San Diego, La Jolla, California
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3
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Shegena EA, Nigussie KA, Tamukong R, Lumori BAE, Yadesa TM. Prevalence and factors associated with adverse drug reactions among heart failure patients hospitalized at Mbarara Regional Referral Hospital, Uganda. BMC Cardiovasc Disord 2022; 22:480. [PMID: 36368954 PMCID: PMC9650824 DOI: 10.1186/s12872-022-02937-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adverse drug reaction (ADR) of medications remains an obstacle to achieving optimal disease outcomes. This study aimed to assess the prevalence and associated factors of ADR among Heart failure (HF) patients hospitalized at Mbarara Regional and Referral Hospital. METHOD A prospective observational study was conducted among hospitalized HF patients from November 2021 to January 2022. Univariate and multivariate logistic regression was employed to determine factors associated with the ADR. RESULT Overall, 118 HF patients were included in the study with a median age of 43 years. A total of 164 ADRs were identified during the follow-up period of 1011 days. The incidence of new ADRs was 106 ADRs/1000 person-days. The prevalence of ADR was 59.3%. Of the 164 ADRs, 118(71.9%) were probable. The gastrointestinal system was the most frequently (27.5%) affected system. Over half (86, 52.4%) of the ADRs were mild and 96(58.5%) were preventable. Age group 19-59(AOR 0.15[0.03-0.35] at 95%CI, p = 0.013), herbal use (AOR 3.07[1.01-9.32] at 95%CI, p = 0.048), poly-pharmacy (AOR 8.7[2.4-15.77] at 95%CI, p < 0.001) and drug-drug interaction (AOR 6.06[2.79-12.5] at 95%CI, p = 0.004) were significantly associated with ADRs among HF patients. CONCLUSION More than half of the hospitalized HF patients experienced at least one ADR during their hospital stay. The use of herbal medicines, poly-pharmacy, and drug-drug interaction were associated with a high risk of ARDs whereas the age group 19-59 years was less likely to experience ADRs.
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Affiliation(s)
- Efrata Ashuro Shegena
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Konjit Abebe Nigussie
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.,Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda.,Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda.,Department of Pharmacy, Ambo University, Ambo, Ethiopia
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4
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Tsige AW, Yikna BB, Altaye BM. Drug-Related Problems Among Ambulatory Heart Failure Patients on Follow-Up at Debre Berhan Comprehensive Specialized Hospital, Ethiopia. Ther Clin Risk Manag 2021; 17:1165-1175. [PMID: 34785901 PMCID: PMC8591109 DOI: 10.2147/tcrm.s337256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/27/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose The purpose of this study was to assess drug-related problems (DRPs) among ambulatory heart failure (HF) patients attending at medical referral clinic of Debre Berhan Comprehensive Specialized Hospital, Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted among 344 HF patients. Drug-related problems were classified using modified Cipolle’s DRP classification schemes and drug–drug interactions were assessed using Micromedex, up-to-date, and drug.com drug–drug interaction checkers. The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics were used to summarize patients’ characteristics. Univariable and multivariable binary logistic regression analysis was performed to identify associated factors with dependent variables. P < 0.05 was considered statistically significant. Results The mean age of the study participants was 53.38 ± 18.84 years and nearly half (45%) were in the age group of 31–60 years. Drug-related problems were found in 80.8% of HF patients. A total of 416 DRPs were identified. Adverse drug reaction (35.58%) was the top DRPs identified followed by the need for additional drug therapy (30.53%) and ineffective drug therapy (26.9%), respectively. Diuretics (45%), beta-blockers (BBs) (12.42%), and angiotensin-converting enzyme inhibitors (ACEIs) (10%) were the commonly used drug classes by study participants. The presence of comorbidity (p ˂ 0.001) and level of education of study participants (p = 0.03) had a significant association with the occurrence of DRPs. Conclusion The prevalence of DRPs among ambulatory HF patients was high. The presence of comorbidity and the educational level of study participants had a significant association with the occurrence of DRPs. Checking potential drug–drug interactions before starting a new therapy, monitoring adverse drug reactions, ensuring sustainable availability of medications, and regular education programs are recommended to minimize DRPs.
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Affiliation(s)
- Abate Wondesen Tsige
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Berhan Begashaw Yikna
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Birhanetensay Masresha Altaye
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
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5
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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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6
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Chillo P. Sensitivity and Specificity of an Electrocardiogram to Detect Echocardiographic Left Ventricular Hypertrophy in a Sample of 326 Tanzanian Adults: Differences in Men and Women. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2021. [DOI: 10.2147/rrcc.s313115] [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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7
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Henderson BD, Kinahan DJ, Rio J, Mishra R, King D, Torres-Delgado SM, Mager D, Korvink JG, Ducrée J. Siphon-Controlled Automation on a Lab-on-a-Disc Using Event-Triggered Dissolvable Film Valves. BIOSENSORS-BASEL 2021; 11:bios11030073. [PMID: 33800811 PMCID: PMC8000095 DOI: 10.3390/bios11030073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
Within microfluidic technologies, the centrifugal microfluidic “Lab-on-a-Disc” (LoaD) platform offers great potential for use at the PoC and in low-resource settings due to its robustness and the ability to port and miniaturize ‘wet bench’ laboratory protocols. We present the combination of ‘event-triggered dissolvable film valves’ with a centrifugo-pneumatic siphon structure to enable control and timing, through changes in disc spin-speed, of the release and incubations of eight samples/reagents/wash buffers. Based on these microfluidic techniques, we integrated and automated a chemiluminescent immunoassay for detection of the CVD risk factor marker C-reactive protein displaying a limit of detection (LOD) of 44.87 ng mL−1 and limit of quantitation (LoQ) of 135.87 ng mL−1.
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Affiliation(s)
- Brian D. Henderson
- School of Physical Sciences, Dublin City University, Dublin 9, Ireland; (B.D.H.); (J.R.)
| | - David J. Kinahan
- School of Mechanical Engineering, Dublin City University, Dublin 9, Ireland;
- National Center for Sensor Research, Dublin City University, Dublin 9, Ireland
- I-Form, the SFI Research Centre for Advanced Manufacturing, Dublin City University, Dublin 9, Ireland
- The Water Institute, Dublin City University, Dublin 9, Ireland
| | - Jeanne Rio
- School of Physical Sciences, Dublin City University, Dublin 9, Ireland; (B.D.H.); (J.R.)
| | - Rohit Mishra
- Fraunhofer Project Center, Dublin City University, Dublin 9, Ireland; (R.M.); (D.K.)
| | - Damien King
- Fraunhofer Project Center, Dublin City University, Dublin 9, Ireland; (R.M.); (D.K.)
| | - Sarai M. Torres-Delgado
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344 Karlsruhe, Germany; (S.M.T.-D.); (D.M.); (J.G.K.)
| | - Dario Mager
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344 Karlsruhe, Germany; (S.M.T.-D.); (D.M.); (J.G.K.)
| | - Jan G. Korvink
- Institute of Microstructure Technology, Karlsruhe Institute of Technology, 76344 Karlsruhe, Germany; (S.M.T.-D.); (D.M.); (J.G.K.)
| | - Jens Ducrée
- School of Physical Sciences, Dublin City University, Dublin 9, Ireland; (B.D.H.); (J.R.)
- Correspondence: ; Tel.: +353-1-700-5377
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8
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Blum A, Mudji J, Grize L, Burri C, Zellweger MJ, Blum J. Sleeping hearts: 12 years after a follow up study on cardiac findings due to sleeping sickness. One Health 2020; 11:100182. [PMID: 33392376 PMCID: PMC7772621 DOI: 10.1016/j.onehlt.2020.100182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022] Open
Abstract
Both American Trypanosomiasis (Chagas disease) and Human African Trypanosomiasis (HAT) are diseases caused by single-celled flagellate protozoan parasites. While cardiac complications such as conduction problems and heart failure are very common in Chagas disease there is little known about the long-term effects of Human African Trypanosomiasis (HAT) on cardiac sequelae in Sub-Saharan Africa, where heart failure has become an increasing problem and growing burden. In the context of clinical trials conducted between 2004 and 2005 in the Democratic Republic of the Congo (DRC), the prevalence of HAT related signs and symptoms and an ECG were evaluated prior to the initiation of treatment. The object of this follow-up study in 2017 was to assess the prevalence of cardiac sequelae in the same 51 first stage and 18 second stage HAT patients 12–13 years after their treatment by conducting a clinical examination and an ECG. A control group matched by age (± 5 years), sex and whenever possible form the same village was enrolled. There were no significant differences in the prevalence of cardiac symptoms and in ECG findings between patients and their controls at the time of the follow-up evaluation. Repolarization changes disappeared or improved in 24.7% of HAT patients and were even less frequent than in the control group. Peripheral low voltage was the only parameter that increased over time in HAT patients and in three patients, new conduction problems in the ECG (ventricular bigeminy, RBBB, and bifascicular block) could be found, although none of these findings was clinically significant. However, the appearance of these conduction problems might represent an early indication of a HAT related cardiomyopathy or ongoing subclinical infection. This hypothesis would be supported by the findings of an older study in which antibodies (IFAT) against trypanosomiasis in 27% of Cameroonian patients with dilated cardiomyopathy compared to 2% in normal controls had been observed. In American Trypanosomiasis (Chagas)cardiac complications are common, but no significant cardiac sequelae was found in African Trypanosomiasis. 12 years after treatment none of the patients developed cardiac failure and there was no sudden death due to arrhythmia. The appearance of cardiac conduction problems in the actual ECG could be an early indication of a HAT related cardiomyopathy. Overall, as compared to Chagas disease, HAT seems to have minimal influence on the heart even over a long follow-up time.
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Affiliation(s)
- Anna Blum
- Swiss Tropical and Public Health Institute, Medical Department, 4002 Basel, Switzerland
| | - Junior Mudji
- Hôpital Evangélique de Vanga, Vanga Mission, B.P. 4728, Kinshasa 2, Democratic Republic of the Congo
- Protestant University of Congo, Department of Family Medicine and Primary Care, B.P. 4745, Kinshasa 2, Democratic Republic of the Congo
| | - Leticia Grize
- Swiss Tropical and Public Health Institute, Medical Department, 4002 Basel, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Christian Burri
- Swiss Tropical and Public Health Institute, Medical Department, 4002 Basel, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Michael J. Zellweger
- University of Basel, 4001 Basel, Switzerland
- Cardiology Department, University Hospital, University of Basel, 4001 Basel, Switzerland
| | - Johannes Blum
- Swiss Tropical and Public Health Institute, Medical Department, 4002 Basel, Switzerland
- Hôpital Evangélique de Vanga, Vanga Mission, B.P. 4728, Kinshasa 2, Democratic Republic of the Congo
- University of Basel, 4001 Basel, Switzerland
- Corresponding author at: Swiss Tropical und Public Health Institute, Socinstrasse 57, BP 4002, Basel, Switzerland.
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9
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Godman B, Basu D, Pillay Y, Mwita JC, Rwegerera GM, Anand Paramadhas BD, Tiroyakgosi C, Okwen PM, Niba LL, Nonvignon J, Sefah I, Oluka M, Guantai AN, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Distiller LA, Rampamba EM, Wing J, Mueller D, Alfadl A, Amu AA, Matsebula Z, Kalungia A, Zaranyika T, Masuka N, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer JC. Review of Ongoing Activities and Challenges to Improve the Care of Patients With Type 2 Diabetes Across Africa and the Implications for the Future. Front Pharmacol 2020; 11:108. [PMID: 32265688 PMCID: PMC7098994 DOI: 10.3389/fphar.2020.00108] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background There has been an appreciable increase in the number of people in Africa with metabolic syndrome and Type 2 diabetes (T2DM) in recent years as a result of a number of factors. Factors include lifestyle changes, urbanisation, and the growing consumption of processed foods coupled with increasing levels of obesity. Currently there are 19 million adults in Africa with diabetes, mainly T2DM (95%), estimated to grow to 47 million people by 2045 unless controlled. This has a considerable impact on morbidity, mortality and costs in the region. There are a number of issues to address to reduce the impact of T2DM including improving detection rates and current access to services alongside addressing issues of adherence to prescribed medicines. There are also high rates of co-morbidities with infectious diseases such as HIV and tuberculosis in patients in Africa with T2DM that require attention. Objective Document ongoing activities across Africa to improve the care of patients with T2DM especially around issues of identification, access, and adherence to changing lifestyles and prescribed medicines. In addition, discussing potential ways forward to improve the care of patients with T2DM based on ongoing activities and experiences including addressing key issues associated with co-morbidities with infectious diseases. Our Approach Contextualise the findings from a wide range of publications including internet based publications of national approaches coupled with input from senior level government, academic and other professionals from across Africa to provide future guidance. Ongoing Activities A number of African countries are actively instigating programmes to improve the care of patients with T2DM starting with improved diagnosis. This recognises the growing burden of non-communicable diseases across Africa, which has been neglected in the past. Planned activities include programmes to improve detection rates and address key issues with diet and lifestyle changes, alongside improving monitoring of care and activities to enhance adherence to prescribed medicines. In addition, addressing potential complexities involving diabetes patients with infectious disease co-morbidities. It is too early to fully assess the impact of such activities. Conclusion There are a number of ongoing activities across Africa to improve the management of patients with diabetes including co-morbidities. However, more needs to be done considering the high and growing burden of T2DM in Africa. Ongoing research will help further benefit resource allocation and subsequent care.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom
| | - Debashis Basu
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Yogan Pillay
- HIV & AIDS, TB and Maternal, Child and Women's Health, National Department of Health, Pretoria, South Africa
| | - Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.,Department of Medicine, Princess Marina Hospital, Gaborone, Botswana
| | | | - Celda Tiroyakgosi
- Botswana Essential Drugs Action Program, Ministry of Health and Wellness, Gaborone, Botswana
| | - Patrick Mbah Okwen
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Bamenda, Cameroon.,Department of Public Health, University of Bamenda, Bambili, Cameroon
| | | | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Anastasia N Guantai
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mwangana Mubita
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria.,Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria.,Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Larry A Distiller
- Centre for Diabetes & Endocrinology (Pty) Ltd, Johannesburg, South Africa
| | - Enos M Rampamba
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Department Of Health, Shayandima, South Africa
| | - Jeffrey Wing
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Debjani Mueller
- Department of Public Health Medicine, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.,Charlotte Maxeke Medical Research Cluster, Johannesburg, South Africa
| | - Abubakr Alfadl
- National Medicines Board, Federal Ministry of Health, Khartoum, Sudan.,Unaizah College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | | | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Trust Zaranyika
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Nyasha Masuka
- Independent Health Systems Consultant, Harare, Zimbabwe
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Liverpool University, Liverpool, United Kingdom
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Angela Timoney
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,NHS Lothian Director of Pharmacy, NHS Lothian, Edinburgh, United Kingdom
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.,NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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10
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Abstract
PURPOSE OF REVIEW This review aims at highlighting the need to better understand the pathogenesis and natural history of endomyocardial fibrosis when set against its changing endemicity and disease burden, improvements in diagnosis, and new options for clinical management. RECENT FINDINGS Progress in imaging diagnostic techniques and availability of new targets for drug and surgical treatment of heart failure are contributing to earlier diagnosis and may lead to improvement in patient survival. Endomyocardial fibrosis was first described in Uganda by Davies more than 70 years ago (1948). Despite its poor prognosis, the etiology of this neglected tropical restrictive cardiomyopathy still remains enigmatic nowadays. Our review reflects on the journey of scientific discovery and construction of the current guiding concepts on this mysterious and fascinating condition, bringing to light the contemporary knowledge acquired over these years. Here we describe novel tools for diagnosis, give an overview of the improvement in clinical management, and finally, suggest research themes that can help improve patient outcomes focusing (whenever possible) on novel players coming into action.
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Affiliation(s)
- Ana Olga Mocumbi
- Division of Non-Communicable Diseases, Universidade Eduardo Mondlane, Faculdade de Medicina, Maputo, Mozambique. .,Instituto Nacional de Saúde, Marracuene, Mozambique.
| | | | - Paulo Correia-de-Sá
- Centro de Investigação Farmacológica e Inovação Medicamentosa, Porto, Portugal.,Instituto de Ciências Biomédicas de Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Magdi Yacoub
- Imperial College London, London, UK.,Aswan Heart Centre, Aswan, Egypt
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11
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Abstract
PURPOSE OF REVIEW Acute heart failure (AHF) is a common emergency presentation in Sub-Saharan Africa (SSA). In the current review, we present the most recent data on the epidemiology of AHF in SSA and discuss recommended approaches to management in resource-limited settings, with a particular focus on primary and secondary facilities (e.g., health centers and district hospitals), where these patients often present. RECENT FINDINGS AHF in SSA is most often due to hypertension, cardiomyopathies, and rheumatic heart disease. The etiology of AHF may be different in rural as compared with urban settings. Diagnostic tools for AHF are often lacking in SSA, especially at the first-level facilities. Point-of-care ultrasound (POCUS) and biomarker tests, such as brain natriuretic peptide (BNP), offer promise in helping to mitigate diagnostic challenges. POCUS can also help distinguish among types of heart failure and prompt the correct treatment strategy. Many of the drugs and equipment commonly used to treat AHF in resource-rich settings are lacking in SSA. However, some adaptations of commonly available materials may provide temporary alternatives. The epidemiology of AHF in SSA differs from that of high-income settings. Management of AHF at the first-level facility in SSA is an important and understudied problem. Simplified diagnostic and treatment algorithms rooted in knowledge of the local epidemiology should be developed and tested as part of broader efforts to combat cardiovascular disease in SSA.
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12
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Balmforth C, Simpson J, Shen L, Jhund PS, Lefkowitz M, Rizkala AR, Rouleau JL, Shi V, Solomon SD, Swedberg K, Zile MR, Packer M, McMurray JJV. Outcomes and Effect of Treatment According to Etiology in HFrEF: An Analysis of PARADIGM-HF. JACC-HEART FAILURE 2019; 7:457-465. [PMID: 31078482 DOI: 10.1016/j.jchf.2019.02.015] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The purpose of this study was to compare outcomes (and the effect of sacubitril/valsartan) according to etiology in the PARADIGM-HF (Prospective comparison of angiotensin-receptor-neprilysin inhibitor [ARNI] with angiotensin-converting-enzyme inhibitor [ACEI] to Determine Impact on Global Mortality and morbidity in Heart Failure) trial. BACKGROUND Etiology of heart failure (HF) has changed over time in more developed countries and is also evolving in non-Western societies. Outcomes may vary according to etiology, as may the effects of therapy. METHODS We examined outcomes and the effect of sacubtril/valsartan according to investigator-reported etiology in PARADIGM-HF. The outcomes analyzed were the primary composite of cardiovascular death or HF hospitalization, and components, and death from any cause. Outcomes were adjusted for known prognostic variables including N terminal pro-B type natriuretic peptide. RESULTS Among the 8,399 patients randomized, 5,036 patients (60.0%) had an ischemic etiology. Among the 3,363 patients (40.0%) with a nonischemic etiology, 1,595 (19.0% of all patients; 47% of nonischemic patients) had idiopathic dilated cardiomyopathy, 968 (11.5% of all patients; 28.8% of nonischemic patients) had a hypertensive cause, and 800 (9.5% of all patients, 23.8% of nonischemic patients) another cause (185 infective/viral, 158 alcoholic, 110 valvular, 66 diabetes, 30 drug-related, 14 peripartum-related, and 237 other). Whereas the unadjusted rates of all outcomes were highest in patients with an ischemic etiology, the adjusted hazard ratios (HRs) were not different from patients in the 2 major nonischemic etiology categories; for example, for the primary outcome, compared with ischemic (HR: 1.00), hypertensive 0.87 (95% confidence interval [CI]: 0.75 to 1.02), idiopathic 0.92 (95% CI: 0.82 to 1.04) and other 1.00 (95% CI: 0.85 to 1.17). The benefit of sacubitril/valsartan over enalapril was consistent across etiologic categories (interaction for primary outcome; p = 0.11). CONCLUSIONS Just under one-half of patients in this global trial had nonischemic HF with reduced ejection fraction, with idiopathic and hypertensive the most commonly ascribed etiologies. Adjusted outcomes were similar across etiologic categories, as was the benefit of sacubitril/valsartan over enalapril. (Efficacy and Safety of LCZ696 Compared to Enalapril on Morbidity and Mortality of Patients With Chronic Heart Failure; NCT01035255).
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Affiliation(s)
- Craig Balmforth
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Joanne Simpson
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Li Shen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | | | - Adel R Rizkala
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Jean L Rouleau
- Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
| | - Victor Shi
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | | | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina
| | | | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
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13
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Jingi AM, Hamadou B, Noubiap JJ, Mfeukeu-Kuate L, Boombhi J, Nganou CN, Ateba NA, Ndoadoumgue AL, Nyaga UF, Menanga A, Kingue S. Correlations of left ventricular systolic function indices with aortic root systolic excursion (ARSE): A cross-sectional echocardiographic study. PLoS One 2018; 13:e0206199. [PMID: 30399146 PMCID: PMC6219773 DOI: 10.1371/journal.pone.0206199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/09/2018] [Indexed: 12/02/2022] Open
Abstract
Background Heart failure (HF), is a major public health issue globally. Echocardiography is cost–effective in the diagnosis in expert hands. This study was conducted to estimate the usefulness of Aortic Root Systolic Excursion (ARSE) as a simple and accurate measure to estimate Left Ventricular (LV) function. Methods This was a cross-sectional echocardiographic study among adults aged ≥ 18 years, with or without heart failure, in sinus rhythm, and with no LV out–let obstruction. We studied the correlations of ARSE with some selected indices of LV Systolic Functions. We determined optimal cut–offs of ARSE in detecting LV dysfunction. We generated a simple regression equation to best estimate LV ejection fraction according to the modified Simpson method. Results Overall 213 echocardiograms were included from 106 males (49.8%), with mean age of the participants being 52.4 (SD: 18.3) years. The rate of LV systolic dysfunction was highest with Teicholz method (17.4%) and lowest with MAPSE method (5.2%). ARSE correlated with the LV functions. This was highest for the Simpson method (r = 0.619, p<0.001), and lowest for the ITV method (r = 0.319, p<0.001). Optimal cut-offs to detect LV systolic dysfunction was ≈ 6.6 mm. For an LV ejection fraction < 55%, the sensitivity was 82.9%, and the specificity was 97.2%, with an AUROC of 91.6%.The logarithmic regression equation was best in predicting LV ejection fraction (AUC: 60.2%), followed by the power model (AUC: 56.7%), and the linear model (AUC: 53.6%). Conclusion ARSE correlated well with LV systolic function. The cut–off ≤ 6.5 mm suggest LV systolic dysfunction. LV Ejection Fraction was best estimated with the generic equation: LVEF (%) = 29 x In [ARSE].
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Affiliation(s)
- Ahmadou M. Jingi
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Ba Hamadou
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Cardiology Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- * E-mail:
| | - Liliane Mfeukeu-Kuate
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Cardiology Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Jerome Boombhi
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Cardiology Unit, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Chris Nadege Nganou
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Cardiology Unit, Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Narcisse Assene Ateba
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Aude Laetitia Ndoadoumgue
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Ulrich Flore Nyaga
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Alain Menanga
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Cardiology Unit, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Samuel Kingue
- Department of Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Cardiology Unit, Yaoundé General Hospital, Yaoundé, Cameroon
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14
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Agbor VN, Essouma M, Ntusi NA, Nyaga UF, Bigna JJ, Noubiap JJ. Heart failure in sub-Saharan Africa: A contemporaneous systematic review and meta-analysis. Int J Cardiol 2018; 257:207-215. [DOI: 10.1016/j.ijcard.2017.12.048] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 01/13/2023]
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15
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Tsega TA, Demissei BG. A systematic review of epidemiology, treatment and prognosis of heart failure in adults in Ethiopia. J Cardiovasc Med (Hagerstown) 2018; 19:91-97. [PMID: 29324479 DOI: 10.2459/jcm.0000000000000617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Systematic characterization of heart failure in adults in Ethiopia is lacking currently. In this review, we sought to summarize the available scientific evidence on the epidemiology, treatment and prognosis of heart failure in adults in Ethiopia. METHODS A systematic review of PUBMED, EMBASE and SCOPUS was conducted for studies published between January 1990 and July 2017. Studies reporting on incidence, prevalence, treatment or prognosis of heart failure in individuals older than 14 years of age were included. RESULTS The search yielded 66 articles, out of which nine were found to be eligible for inclusion in this review. There are no studies reporting the incidence or prevalence of heart failure in the adult population in Ethiopia. There are, however, indications that heart failure might be a significant burden in the country, and typically affects middle-aged adults. Valvular heart disease, predominantly related to rheumatic heart disease, is the most commonly identified heart failure cause across the included studies. There are very limited data on treatment and prognosis. CONCLUSION There is limited scientific evidence on the epidemiology, treatment and prognosis of heart failure in adults in Ethiopia. Further studies are needed for the better understanding of the burden and treatment of heart failure in the adult population in Ethiopia.
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16
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Abstract
Heart failure is a growing problem in sub-Saharan Africa. This arises as the prevalence of risk factors for cardiovascular disease rises, life expectancy increases and causes of heart failure more common in Africa, such as rheumatic heart disease and endomyocardial fibrosis, continue to be a significant issue. Lack of access to diagnostics is an issue with the expense and technical expertise required for echocardiography limiting access. Biomarker strategies may play a role here. Access to essential medicines is also limited and requires a renewed focus by the international community to ensure that appropriate medications are readily available, similar to that which has been implemented for HIV and malaria.
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Affiliation(s)
| | | | | | - Chris J Watson
- Centre for Experimental Medicine, Queens University Belfast, Northern Ireland
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17
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Abstract
Patients with chronic heart failure (CHF) living in rural areas face an increased risk of adverse cardiovascular events. Even in countries with universal access to health care, rural areas are characteristically underserved, with reduced health care providers supply, greater distance to health care centers, decreased physician density with higher reliance on generalists, and high health care staff turnover. On the other hand, patient-related characteristics vary widely among published data. This review describes the epidemiology of CHF in rural or remote settings, organizational and patient-related factors involved in cardiovascular outcomes, and the role of interventions to improve rural health care.
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Affiliation(s)
- Hugo E Verdejo
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases FONDAP ACCDis, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, CP 8330024, Santiago, Chile.
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases FONDAP ACCDis, Division of Public Health and Family Medicine, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 434, CP 8330073, Santiago, Chile
| | - Pablo F Castro
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases FONDAP ACCDis, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, CP 8330024, Santiago, Chile
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