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van Hoogland-van Heerden M, Böhmer LH, Heyneke O, Lechaba T, Scott L, Norton G, Woodiwiss A, Mntla P, Majane OHI. Characteristics of heart failure with a preserved ejection fraction in black South African patients. IJC HEART & VASCULATURE 2024; 52:101408. [PMID: 38638536 PMCID: PMC11024654 DOI: 10.1016/j.ijcha.2024.101408] [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: 11/27/2023] [Revised: 03/14/2024] [Accepted: 04/06/2024] [Indexed: 04/20/2024]
Abstract
Background Heart failure with a preserved ejection fraction (HFpEF) is common in the elderly (≥75 years) and associated with arterial stiffness. The mean age of HFpEF presentation is lower (40-55 years) in sub-Saharan Africa. No clinical study has been conducted on HFpEF in identifying and characterising this phenotype at a younger age, moreover in a South African black population where the risk of HFpEF is two times higher than in other ethnic groups. This study investigated the characteristics of HFpEF in a black South African population, the biochemical markers that predict HFpEF and cardiac structural changes in this HF phenotype. Methods Sixty-six participants with HFpEF and 213 controls were enrolled. All participants gave informed consent and completed a standardised questionnaire. Echocardiographic, anthropometric, central haemodynamic measurements, pulse wave velocity (PWV) and biomarker analysis were done. Results The mean age of HFpEF participants was 54.88 ± 13.51 years. Most of the participants (76 %) were between 20 and 64 years, while only 24 % were older. HFpEF participants were hypertensive, and more obese with increased incidence of alcohol consumption. PWV was increased in HFpEF (9.97 ± 2.78 m/s) when compared to participants without HFpEF (6.11 ± 2.18 m/s), p < 0.0001. There were no significant associations between central haemodynamic parameters, N-terminal pro B-type natriuretic peptide (NT-proBNP) (p = 0.9746), and galectin-3 (p = 0.2166). NT-proBNP, but not galectin-3, was associated with left ventricular hypertrophy (p = 0.0002) and left atrial diameter (p = 0.0005). Conclusion HFpEF in South Africa is predominant in obese young to middle-age individuals with arterial stiffness and who consume alcohol regularly. NT-proBNP could be used to diagnose HFpEF, however, should be interpreted with caution in populations with a high prevalence of obesity.
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Affiliation(s)
| | - LH Böhmer
- Sefako Makgatho Health Sciences University, South Africa
| | - O Heyneke
- Sefako Makgatho Health Sciences University, South Africa
| | - T Lechaba
- Sefako Makgatho Health Sciences University, South Africa
| | - L Scott
- Sefako Makgatho Health Sciences University, South Africa
| | - G Norton
- University of the Witwatersrand, South Africa
| | - A Woodiwiss
- University of the Witwatersrand, South Africa
| | - P Mntla
- Sefako Makgatho Health Sciences University, Dr George Mukhari Academic Hospital, South Africa
| | - OHI Majane
- Sefako Makgatho Health Sciences University, South Africa
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Yogeswaran V, Hidano D, Diaz AE, Van Spall HGC, Mamas MA, Roth GA, Cheng RK. Regional variations in heart failure: a global perspective. Heart 2023; 110:11-18. [PMID: 37353316 DOI: 10.1136/heartjnl-2022-321295] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
Heart failure (HF) is a global public health concern that affects millions of people worldwide. While there have been significant therapeutic advancements in HF over the last few decades, there remain major disparities in risk factors, treatment patterns and outcomes across race, ethnicity, socioeconomic status, country and region. Recent research has provided insight into many of these disparities, but there remain large gaps in our understanding of worldwide variations in HF care. Although the majority of the global population resides across Asia, Africa and South America, these regions remain poorly represented in epidemiological studies and HF trials. Recent efforts and registries have provided insight into the clinical profiles and outcomes across HF patterns globally. The prevalence of HF and associated risk factors has been reported and varies by country and region ranges, with minimal data on regional variations in treatment patterns and long-term outcomes. It is critical to improve our understanding of the different factors that contribute to global disparities in HF care so we can build interventions that improve our general cardiovascular health and mitigate the social and economic cost of HF. In this narrative review, we hope to provide an overview of the global and regional variations in HF care and outcomes.
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Affiliation(s)
| | - Danelle Hidano
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andrea E Diaz
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Newcastle, UK
| | - Gregory A Roth
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington, USA
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3
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Kimeu R, Jeilan M, Ngunga M. Predictors of Coronary Artery Disease in Heart Failure with Reduced Ejection Fraction at the Aga Khan University Hospital in Nairobi. Glob Heart 2023; 18:56. [PMID: 37868128 PMCID: PMC10588509 DOI: 10.5334/gh.1271] [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: 01/30/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
There appears to be an epidemiological transition in the etiology of heart failure in sub-Saharan Africa (SSA) in parallel with a steady increase in risk factors for coronary artery disease (CAD). SSA has limited access to heart failure and CAD diagnostics, limiting the number of patients who receive optimal care. Our objectives were to study the predictors of coronary artery disease among patients with heart failure with reduced ejection fraction (HFrEF) and develop a model to assist clinicians in determining the likelihood of CAD before cardiac catheterization. Methodology This was a retrospective study at the Aga Khan University Hospital, Nairobi, which is equipped with diagnostic capabilities for heart failure and coronary artery assessment. We evaluated patients with HFrEF based on echocardiographic data over a 12-year period. Patients with coronary anatomical evaluation data were included. A multivariable model of CAD was generated using stepwise logistic regression. Results Of the 1329 patients screened, 514 met the inclusion criteria. The mean age was 61.0 ± 12.8 years. There were 381 male cases (75.2%), and the predominant race was African, numbering 386 (75.2%). Most patients, 97%, were evaluated through conventional coronary angiography. Further, 310 (60.3%) cases had significant CAD. The prevalence of CAD in HFrEF was 52.3% in Africans, 85% in Asians, and 79% in Caucasians. In the multivariable logistic regression, the odds of having significant CAD was higher among participants with diabetes mellitus (aOR: 1.86; 95%CI: 1.15-3.03), Q waves (aOR: 2.12; 95%CI: 1.12-4.10), significant ST segment deviation (aOR: 4.14; 95%CI: 2.23-8.03), and regional wall motion abnormalities on echocardiogram (aOR: 6.53; 95%CI: 3.94-11.06). Conclusion In this population, CAD was a major etiology in HFrEF among the African population. The most powerful predictors of CAD were type 2 diabetes, the presence of pathological Q waves, or ST segment shift on a 12-lead electrocardiogram, and regional wall motion abnormality on 2D echocardiogram. Highlights There is an epidemiological transition in the cause of heart failure in sub-Saharan Africa (SSA) in keeping with the steady increase in cardiovascular risk factors for coronary artery disease (CAD).The prevalence of CAD in African patients with heart failure with reduced ejection fraction (HFrEF) was 52.3%.In the multivariable logistic regression, diabetic mellitus, pathological Q waves, significant ST segment deviation, and regional wall motion abnormalities were significantly associated with CAD.
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Affiliation(s)
- Redemptar Kimeu
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Mohamed Jeilan
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Mzee Ngunga
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
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Raja Shariff RE, Soesanto AM, Scalia GM, Ewe SH, Izumo M, Liu L, Li WCW, Kam KKH, Fan Y, Hong GR, Kinsara AJ, Tucay ES, Oh JK, Lee APW. Echocardiographic Imaging in Transcatheter Structural Intervention: An AAE Review Paper. JACC. ASIA 2023; 3:556-579. [PMID: 37614546 PMCID: PMC10442887 DOI: 10.1016/j.jacasi.2023.05.012] [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: 03/01/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 08/25/2023]
Abstract
Transcatheter structural heart intervention (TSHI) has gained popularity over the past decade as a means of cardiac intervention in patients with prohibitive surgical risks. Following the exponential rise in cases and devices developed over the period, there has been increased focus on developing the role of "structural imagers" amongst cardiologists. This review, as part of a growing initiative to develop the field of interventional echocardiography, aims to highlight the role of echocardiography in myriad TSHIs available within Asia. We first discuss the various echocardiography-based imaging modalities, including 3-dimensional echocardiography, fusion imaging, and intracardiac echocardiography. We then highlight a selected list of structural interventions available in the region-a combination of established interventions alongside novel approaches-describing key anatomic and pathologic characteristics related to the relevant structural heart diseases, before delving into various aspects of echocardiography imaging for each TSHI.
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Affiliation(s)
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | | | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Miyamae Ward, Kawasaki, Kanagawa, Japan
| | - Liwen Liu
- Department of Ultrasound, Xijing Hypertrophic Cardiomyopathy Center, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Williams Ching-Wei Li
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kevin Ka-Ho Kam
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
| | - Yiting Fan
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Geu-Ru Hong
- Yonsei University College of Medicine, Sinchon-dong, Seodaemun-gu, Seoul, South Korea
| | - Abdulhalim Jamal Kinsara
- Ministry of National Guard—Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Edwin S. Tucay
- Philippine Heart Center, Diliman, Quezon City, Metro Manila, Philippines
| | - Jae K. Oh
- Mayo Clinic, Rochester, Minnesota, USA
| | - Alex Pui-Wai Lee
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
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James AS, Ugbaja RN, Ugwor EI, Thomas FC, Akamo AJ, Akinloye DI, Eteng OE, Salami SK, Emmanuel EA, Ugbaja VC. Lycopene abolishes palmitate-mediated myocardial inflammation in female Wistar rats via modulation of lipid metabolism, NF-κB signalling pathway, and augmenting the antioxidant systems. Nutr Metab Cardiovasc Dis 2023; 33:671-681. [PMID: 36646601 DOI: 10.1016/j.numecd.2022.11.026] [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: 03/26/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Obesity-related heart failure is exacerbated by excessive intake of saturated fats such as palmitate (PA). Lycopene (LYC) possesses anti-lipidemic, antioxidant, cytoprotective, and anti-inflammatory effects. This study, therefore, evaluated the impact of LYC against PA-invoked cardiotoxicity. METHODS AND RESULTS Thirty-six female rats were equally divided into six groups: control; PA (5 mM); PA + LYC (24 mg/kg); PA + LYC (48 mg/kg); LYC (24 mg/kg); and LYC (48 mg/kg). The PA was administered five times weekly for seven weeks, while the LYC was given for the last two weeks. Lipids in the blood and the heart were estimated, as were oxidative stress and antioxidant indices, cardiac function, inflammation, and histology. Palmitate overload occasioned a significant (p < 0.05) increase in cardiac cholesterol (50%), phospholipids (19%), and non-esterified fatty acids (40%). However, triglyceride levels decreased (38%). Furthermore, malondialdehyde (45%), hydrogen peroxide (33%) levels and myeloperoxidase activity increased (79%). Also, cardiac gamma-glutamyl transferase (50%), serum creatine kinase activities (1.34 folds), NF-kB, interleukin1β, and interleukin-6 mRNA expression increased in the PA group relative to the control. In contrast, reduced glutathione (13%) and nitric oxide levels (22%), interleukin-10 mRNA expression, cardiac creatine kinase (35%), lactate dehydrogenase (33%), aspartate, and alanine transaminase activities decreased markedly (15- and 10%, respectively). Also, PA caused hyperemia, congestion of the cardiac interstitium, and infiltration of inflammatory cells. However, treatment with LYC reversed the features of cardiotoxicity and histological complications caused by PA. These observations are likely because LYC has anti-inflammatory, antioxidant, and cytoprotective properties. CONCLUSION Thus, LYC might be an appropriate remedy to manage PA-induced cardiotoxicity in female rats.
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Affiliation(s)
- Adewale S James
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria; Department of Chemical Sciences (Biochemistry Program), Augustine University Ilara-Epe, P.M.B 1010, Lagos State Nigeria.
| | - Regina N Ugbaja
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria
| | - Emmanuel I Ugwor
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria
| | - Funmilola C Thomas
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria, PMB 2240
| | - Adio J Akamo
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria
| | - Dorcas I Akinloye
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria
| | - Ofem E Eteng
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria
| | - Shukurat K Salami
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria
| | - Esther A Emmanuel
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria
| | - Victory C Ugbaja
- Department of Biochemistry, College of Biosciences, Federal University of Agriculture, Abeokuta, Ogun State, PMB 2240, Nigeria
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Contemporary aetiology of acute heart failure in a teaching hospital in Ghana. BMC Cardiovasc Disord 2023; 23:82. [PMID: 36765294 PMCID: PMC9921595 DOI: 10.1186/s12872-023-03103-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Heart failure (HF) is recognized as a global public health disease associated with high morbidity and mortality. It is suggested that the main underlying causes of HF in developing countries differ from those identified in well-resourced countries. This study therefore presents the cardiovascular risk factors and the underlying aetiology of HF among admitted patients in a teaching Hospital in Ghana. METHOD The study prospectively recruited 140 consecutive patients admitted for heart failure at the Medical department of the Korle-Bu Teaching Hospital from March to October, 2014. The study evaluated the cardiovascular risk factors and the aetiologies of heart failure, and compared the risk factors and aetiologies with patient's age and gender. RESULTS The mean age of the study participants was 51.3 ± 16.8 years. The commonest cardiovascular risk factors observed were hypertension (46.5%), history of previous HF (40.7%), excessive alcohol use (38.6%), and family history of heart disease (29.3%); predominantly hypertension (68.3%). The major underlying aetiology of HF were dilated cardiomyopathy (38.6%), hypertensive heart disease (21.4%), ischaemic heart disease (13.6%) and valvular heart disease (12.9%). These underlying aetiology of HF were more common in patients aged 40 years and above (p = 0.004) and those presenting with multiple risk factors (p = 0.001). CONCLUSION The major underlying aetiology of heart failure in adults were dilated cardiomyopathy, hypertensive heart disease, ischaemic heart disease and valvular heart disease, which were significantly high among patients aged 40 years and above and those presenting multiple risk factors. Hypertension, excessive alcohol use, family history of heart disease and personal history of previous heart failure diagnosis are noted as the main cardiovascular risk factors among heart failure patients.
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7
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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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Hussen NM, Workie DL, Biresaw HB. Survival time to complications of congestive heart failure patients at Felege Hiwot comprehensive specialized referral hospital, Bahir Dar, Ethiopia. PLoS One 2022; 17:e0276440. [PMID: 36264946 PMCID: PMC9584442 DOI: 10.1371/journal.pone.0276440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUNDS Congestive heart failure is a serious chronic condition when the heart's muscles become too damaged and a condition in which one or both ventricles cannot pump sufficient blood to meet the metabolic needs of the body. This study aimed to identify factors affecting the complications time of congestive heart failure patients treated from January 2016 to December 2019 at Felege Hiwot comprehensive specialized referral hospital in Bahir Dar, Ethiopia. METHODS A hospital-based retrospective data collection was collected from the medical charts of 218 randomly selected congestive heart failure patients. The Kaplan-Meier curve and the Cox proportional hazards model were used to compare and identify the factors associated with time to complication in patients with congestive heart failure. RESULTS The median complication time of congestive heart failure patients was 22 months [95% CI: 21.98-28.01]. About 194 (88.99%) of the patients were complicated. The Kaplan-Meier curve depicts the survival probability of complicated patients decreasing as the complication time increases. The hazard ratios for serum sodium concentration, left ventricular ejection fraction, patients from rural areas, age of patients, serum hemoglobin concentration, and New York heart association classes I, II, and III were given 0.94 [95% CI: 0.90-1.00], 0.74 [95% CI: 0.65-0.85], 0.75 [95% CI: 0.68-0.84], 1.28 [95% CI: 1.12-1.46], 0.89 [95% CI: 0.85-0.94], 0.44 [95% CI: 0.36-0.53], 0.54 [95% CI: 0.47-0.62] and 0.73 [95% CI: 0.65-0.81] respectively, and they are statistically associated with the complication time of congestive heart failure patients. CONCLUSIONS The median complication time of congestive heart failure patients was 22 months. This study strongly suggests that healthcare awareness should be strengthened earlier about the potential complications for patients with lower serum sodium concentrations below the threshold and aged congestive heart failure patients to reduce the risk of developing complications.
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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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Farah Yusuf Mohamud M, Jeele MOO, Cetinkaya O, Goitom Sereke S, Bongomin F, AM Ahmed M. Baseline Characteristics, Risk Factors and Etiology of Heart Failure Among Patients Hospitalized at a Teaching Hospital in Somalia: Cross-Sectional Study. RESEARCH REPORTS IN CLINICAL CARDIOLOGY 2022. [DOI: 10.2147/rrcc.s380136] [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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Getachew A, Assefa T, Negash W. Self-care behavior and associated factors among patients with heart failure in public hospitals of Southeast Ethiopia. J Int Med Res 2022; 50:3000605221119367. [PMID: 36002989 PMCID: PMC9421238 DOI: 10.1177/03000605221119367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective This study was performed to assess self-care behavior and associated factors
among patients with heart failure attending public hospitals in Southeast
Ethiopia in 2021. Methods An institutional-based cross-sectional study was conducted among 420 patients
with heart failure from 15 May to 30 June 2021 using a simple random
sampling technique. A multivariable binary logistic model was used to
identify factors associated with self-care behavior. Statistical
significance was declared at p < 0.05. Results The magnitude of good self-care behavior among patients with heart failure
was 53.6% [95% confidence interval (CI), 48.9–58.3]. Factors associated with
self-care behavior were treatment with a beta blocker [adjusted odds ratio
(AOR), 0.49; 95% CI, 0.27–0.89], treatment with digitalis (AOR, 0.11; 95%
CI, 0.05–0.24), the level of social support (AOR, 0.07; 95% CI, 0.03–0.15),
and the presence of depressive symptoms (AOR, 0.21; 95% CI, 2.70–8.33). Conclusion Slightly more than half of the respondents had good self-care behavior.
Attention should be given to enhancing good self-care practice through
integration of health education as routine care.
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Affiliation(s)
- Almaz Getachew
- Nursing Department, Madda Walabu University Goba Referral Hospital
| | - Tesfaye Assefa
- Nursing Department, School of Health Science, Madda Walabu University Goba Referral Hospital
| | - Wogene Negash
- Nursing Department, School of Health Science, Madda Walabu University Goba Referral Hospital
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12
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Kaviarasan V, Mohammed V, Veerabathiran R. Genetic predisposition study of heart failure and its association with cardiomyopathy. Egypt Heart J 2022; 74:5. [PMID: 35061126 PMCID: PMC8782994 DOI: 10.1186/s43044-022-00240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Heart failure (HF) is a clinical condition distinguished by structural and functional defects in the myocardium, which genetic and environmental factors can induce. HF is caused by various genetic factors that are both heterogeneous and complex. The incidence of HF varies depending on the definition and area, but it is calculated to be between 1 and 2% in developed countries. There are several factors associated with the progression of HF, ranging from coronary artery disease to hypertension, of which observed the most common genetic cause to be cardiomyopathy. The main objective of this study is to investigate heart failure and its association with cardiomyopathy with their genetic variants. The selected novel genes that have been linked to human inherited cardiomyopathy play a critical role in the pathogenesis and progression of HF. Research sources collected from the human gene mutation and several databases revealed that numerous genes are linked to cardiomyopathy and thus explained the hereditary influence of such a condition. Our findings support the understanding of the genetics aspect of HF and will provide more accurate evidence of the role of changing disease accuracy. Furthermore, a better knowledge of the molecular pathophysiology of genetically caused HF could contribute to the emergence of personalized therapeutics in future.
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Affiliation(s)
- Vaishak Kaviarasan
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India
| | - Vajagathali Mohammed
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India
| | - Ramakrishnan Veerabathiran
- Human Cytogenetics and Genomics Laboratory, Faculty of Allied Health Sciences, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamilnadu, 603103, India.
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Ntusi NAB, Sliwa K. Impact of Racial and Ethnic Disparities on Patients With Dilated Cardiomyopathy: JACC Focus Seminar 7/9. J Am Coll Cardiol 2021; 78:2580-2588. [PMID: 34887144 DOI: 10.1016/j.jacc.2021.10.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 10/19/2022]
Abstract
Significant race- and ethnicity-based disparities among those diagnosed with dilated cardiomyopathy (DCM) exist and are deeply rooted in the history of many societies. The role of social determinants of racial disparities, including racism and bias, is often overlooked in cardiology. DCM incidence is higher in Black subjects; survival and other outcome measures are worse in Black patients with DCM, with fewer referrals for transplantation. DCM in Black patients is underrecognized and under-referred for effective therapies, a consequence of a complex interplay of social and socioeconomic factors. Strategies to manage social determinants of health must be multifaceted and consider changes in policy to expand access to equitable care; provision of insurance, education, and housing; and addressing racism and bias in health care workers. There is an urgent need to prioritize a social justice approach to health care and the pursuit of health equity to eliminate race and other disparities in the management of cardiovascular disease.
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Affiliation(s)
- Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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14
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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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15
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Peterson TE, Baker JV, Wong L, Rupert A, Ntusi NAB, Esmail H, Wilkinson R, Sereti I, Meintjes G, Ntsekhe M, Thienemann F. Elevated N-terminal prohormone of brain natriuretic peptide among persons living with HIV in a South African peri-urban township. ESC Heart Fail 2020; 7:3246-3251. [PMID: 32585776 PMCID: PMC7524119 DOI: 10.1002/ehf2.12849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/12/2020] [Accepted: 06/02/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Efforts to improve access to antiretroviral therapy (ART) have shifted morbidity and mortality among persons living with HIV (PLWH) from AIDS to non-communicable diseases, such as cardiovascular disease (CVD). However, contemporary data on CVD among PLWH in sub-Saharan Africa in the current ART era are lacking. The aim of this study was to assess the burden of cardiac stress among PLWH in South Africa via measurement of N-terminal prohormone of brain natriuretic peptide (NT-proBNP). METHODS AND RESULTS NT-proBNP was measured at baseline in 224 PLWH enrolled in a sub-study of a tuberculosis vaccine trial in Khayelitsha township near Cape Town, South Africa. Thresholds were applied at the assay's limit of detection (≥137 pg/mL) and a level indicative of symptomatic heart failure in the acute setting (>300 pg/mL). Mean (SD) age of participants was 39 (6) years, 86% were female, and 19% were hypertensive. Mean (SD) duration of HIV diagnosis was 8.3 (3.9) years and CD4 + count was 673 (267) with 79% prescribed ART for a duration of 5.6 (2.7) years. Thirty-one percent of participants had NT-proBNP > 300 pg/mL. Elevated vs. undetectable NT-proBNP level was associated with older age (P = 0.04), no ART (P = 0.03), and higher plasma tumour necrosis factor-α (P = 0.01). CONCLUSIONS Among South African PLWH largely free of known CVD and on ART with high CD4 + counts and few comorbidities, we observed a high proportion with elevated NT-proBNP levels, suggesting the burden of cardiac stress in this population may be high. This observation underscores the need for more in-depth research, including the current effect of HIV on heart failure risk among a growing ART-treated population in sub-Saharan Africa.
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Affiliation(s)
- Tess E. Peterson
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Jason V. Baker
- Infectious DiseasesHennepin Healthcare Research InstituteMinneapolisMNUSA
- Department of MedicineUniversity of MinnesotaMinneapolisMNUSA
| | - Lye‐Yeng Wong
- Department of SurgeryOregon Health Sciences UniversityPortlandORUSA
| | - Adam Rupert
- Leidos Biomedical Research IncFrederick National Laboratory for Cancer ResearchFrederickMDUSA
| | | | - Hanif Esmail
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of MedicineUniversity of Cape TownCape TownSouth Africa
- MRC Clinical Trials UnitUniversity College LondonLondonUK
- Institute for Global HealthUniversity College LondonLondonUK
| | - Robert Wilkinson
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Department of Infectious DiseaseImperial College LondonLondonUK
- Francis Crick InstituteLondonUK
| | - Irini Sereti
- Laboratory of Immunoregulation, National Institutes of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMDUSA
| | - Graeme Meintjes
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Mpiko Ntsekhe
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Friedrich Thienemann
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine and Department of MedicineUniversity of Cape TownCape TownSouth Africa
- Department of MedicineUniversity Hospital ZurichZurichSwitzerland
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Martin PV, Chataigneau A, Arnaud FX, Rozwadowski F, Cournac JM, Martin AC. Transthoracic Doppler echocardiography during a military mission in a French role II in Mali: is it useful to learn this practice? Mil Med 2020; 185:e1562-e1568. [DOI: 10.1093/milmed/usaa126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Ultrasound is now recognized as a key tool in the practice of medicine in isolated situations. This study aims to evaluate the impact of transthoracic echocardiography (TTE) in a military mission when performed by a trained military practitioner (MP).
Materials and Methods
We conducted a 2-month retrospective observational study on the use of TTE in a French medical complex in Mali with a mission that included providing a medical aid to the population. All patients were included. Every ultrasound performed by the MP was listed, and the epidemiologic data, indication for the exam and results were collected for each TTE.
Results
A total of 349 patients were included, 16 were war-wounded patients and 333 came for a general medical consultation. In all, 153 ultrasounds were performed, including 48 TTEs. Sixteen TTEs were performed to evaluate injuries in war-wounded patients. During the 333 medical consultations, 32 TTEs were realized. The indications were dyspnoea (10), heart murmur (7), acute chest pain (5) and assessment of heart disease (10). TTE permitted a direct positive diagnosis for 18 patients: 7 with acute heart failure and 11 with morphologic problems. The normality of the exam was a supplementary argument to exclude a cardiac implication for eight patients.
Conclusions
TTE can provide important information with a direct impact on the management of patients. Faced with cardiac emergencies, an adapted training can be proposed for the MP. Thereby, the transfer of conventional cardiac views could facilitate the advice of a cardiologist.
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Affiliation(s)
- Paul-Vincent Martin
- Emergency department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Anaïs Chataigneau
- Orthopedic and traumatology department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - François-Xavier Arnaud
- Radiology department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Faye Rozwadowski
- FAAFP, Primary Care Physician for U.S. Military Veterans, Tallahassee, Florida, 3231, USA
| | - Jean-Marie Cournac
- Internal Medecine department at the Percy Army training Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Anne-Céline Martin
- Department of Cardiology, European Hospital Georges Pompidou, Paris, France
- Université de Paris, Innovative Therapy in Haemostasis, INSERM 1140, Paris, France
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17
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Karagodin I, Singh A, Lang RM. Pathoanatomy of Mitral Regurgitation. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2020; 4:254-263. [PMID: 32885130 DOI: 10.1080/24748706.2020.1765055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ilya Karagodin
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL
| | - Amita Singh
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL
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18
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Seid E, Engidawork E, Alebachew M, Mekonnen D, Berha AB. Evaluation of drug therapy problems, medication adherence and treatment satisfaction among heart failure patients on follow-up at a tertiary care hospital in Ethiopia. PLoS One 2020; 15:e0237781. [PMID: 32857798 PMCID: PMC7454938 DOI: 10.1371/journal.pone.0237781] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Drug therapy problems (DTPs) are major concerns of healthcare and have been identified to contribute to negative clinical outcomes. The occurrence of DTPs in heart failure patients is associated with worsening of outcomes. The aim of this study was to assess DTPs, associated factors and patient satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialized Hospital (TASH). METHODS A hospital based prospective cross-sectional study was conducted on 423 heart failure patients on follow up at TASH. Data was collected through patient interview and chart review. Descriptive statistics, binary and multiple logistic regressions were used for analyses and P < 0.05 was used to declare association. RESULTS Majority of the patients were in NYHA class III (55.6%) and 66% of them had preserved systolic function. DTPs were identified in 291(68.8%) patients, with an average number of 2.51±1.07.per patient. The most common DTPs were drug interaction (27.3%) followed by noncompliance (26.2%), and ineffective drug use (13.7%). β blockers were the most frequent drug class involved in DTPs followed by angiotensin converting enzyme inhibitors. The global satisfaction was 78% and the overall mean score of treatment satisfaction was 60.5% (SD, 10.5). CONCLUSION Prevalence of DTPs as well as non-adherence among heart failure patients on follow up is relatively high. Detection and prevention of DTPs along with identifying patients at risk can save lives, help to adopt efficient strategies to closely monitor patients at risk, enhance patient's quality of life and optimize healthcare costs.
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Affiliation(s)
- Elham Seid
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desalew Mekonnen
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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19
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Clinical Characteristics and Factors Associated with Heart Failure Readmission at a Tertiary Hospital in North-Eastern Tanzania. Cardiol Res Pract 2020; 2020:2562593. [PMID: 32411443 PMCID: PMC7210553 DOI: 10.1155/2020/2562593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/20/2020] [Accepted: 04/18/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Heart failure (HF) is characterized by frequent episodes of decompensation, leading to a high hospitalization burden. More than 50% of index hospitalizations for HF patients return within 6 months of discharge. Once the patient is readmitted, the risk of further disease progression and the mortality rate are increased. A lot of patients are readmitted due to factors such as poor medication adherence, infections, or worsening comorbidities. The aim of our study was to identify the inpatient burden of HF readmission and to identify the factors associated with early readmission. METHODS A hospital-based cross-sectional analytical study was conducted from November 2018 to April 2019 within the medical wards at Kilimanjaro Christian Medical Centre (KCMC), which is a teaching and referral hospital in north-eastern Tanzania. The study population included all patients with HF admitted within the medical ward. Data were collected using questionnaires and blood and radiological investigations, and analysis was done using Statistical Package for Social Science (SPSS) version 25. Chi-square test was used to compare proportions of categorical variables. Logistic regression was used to determine the likelihood for readmission, and p-value of <0.05 was considered to be statistically significant. RESULTS A total of 353 patients were identified with HF, of whom 136 (38.5%) had a previous admission. Of the 136 patients analysed, the mean age was 62.8 years (SD 17.1), and 86 (63.2%) were females. Within 30 days after discharge, 34 (25.0%) of the patients were readmissions. Factors for early readmission were unemployment (OR = 2.38, 95% CI = 1.02-5.54, p = 0.043), poor medication adherence (OR = 3.87, 95% CI = 1.67-8.97, p = 0.002), absence of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR = 2.40, 95% CI = 1.09-5.31, p = 0.030), and pleural effusion (OR 3.25, 95% CI = 1.44-7.32, p = 0.004). CONCLUSION Heart failure is a burden due to a large number of admissions and readmissions. Factors such as poor medication adherence and absence of adequate HF therapy, especially the absence of regimes containing ACEI or ARB, need to be targeted to reduce the number of readmissions. This will help reduce the risk of further decompensations, disease progression, and mortality rate.
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20
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Shaboodien G, Spracklen TF, Kamuli S, Ndibangwi P, Van Niekerk C, Ntusi NAB. Genetics of inherited cardiomyopathies in Africa. Cardiovasc Diagn Ther 2020; 10:262-278. [PMID: 32420109 DOI: 10.21037/cdt.2019.10.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCDs) is rising disproportionately in comparison to the rest of the world, affecting urban, semi-urban and rural dwellers alike. NCDs are predicted to surpass infections like human immunodeficiency virus, tuberculosis and malaria as the leading cause of mortality in SSA over the next decade. Heart failure (HF) is the dominant form of cardiovascular disease (CVD), and a leading cause of NCD in SSA. The main causes of HF in SSA are hypertension, cardiomyopathies, rheumatic heart disease, pericardial disease, and to a lesser extent, coronary heart disease. Of these, the cardiomyopathies deserve greater attention because of the relatively poor understanding of mechanisms of disease, poor outcomes and the disproportionate impact they have on young, economically active individuals. Morphofunctionally, cardiomyopathies are classified as dilated, hypertrophic, restrictive and arrhythmogenic; regardless of classification, at least half of these are inherited forms of CVD. In this review, we summarise all studies that have investigated the incidence of cardiomyopathy across Africa, with a focus on the inherited cardiomyopathies. We also review data on the molecular genetic underpinnings of cardiomyopathy in Africa, where there is a striking lack of studies reporting on the genetics of cardiomyopathy. We highlight the impact that genetic testing, through candidate gene screening, association studies and next generation sequencing technologies such as whole exome sequencing and targeted resequencing has had on the understanding of cardiomyopathy in Africa. Finally, we emphasise the need for future studies to fill large gaps in our knowledge in relation to the genetics of inherited cardiomyopathies in Africa.
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Affiliation(s)
- Gasnat Shaboodien
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Timothy F Spracklen
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen Kamuli
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Polycarp Ndibangwi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carla Van Niekerk
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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21
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Agbor VN, Ntusi NAB, Noubiap JJ. An overview of heart failure in low- and middle-income countries. Cardiovasc Diagn Ther 2020; 10:244-251. [PMID: 32420107 PMCID: PMC7225422 DOI: 10.21037/cdt.2019.08.03] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) is a global public health concern with disproportionate socioeconomic, morbidity and mortality burden on low- and middle-income countries (LMICs). This review summarises contemporary data on the demographic and clinical characteristics, aetiologies, treatment, economic burden and outcomes of HF in LMICs. Patients with HF in LMICs are younger than those from high-income countries (HICs) and present at advanced stages of the disease. Hypertension, ischaemic heart disease (IHD), cardiomyopathy (CMO), and rheumatic heart disease (RHD) are the leading causes of HF in LMICs. The contribution of infectious diseases to HF remains prominent in many LMICs. Most health facilities in LMICs lack adequate diagnostic tools for HF, and the use of evidence-based medical and device therapies is suboptimal. Further, HF in LMICs is associated with prolonged hospital stay and high in-hospital and one-year mortality. Finally, HF has profound economic impact on individual patients who, mostly, have no health insurance, and on societies where patients are young, comprising those who have the greatest potential to contribute to economic productivity.
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Affiliation(s)
- Valirie N Agbor
- Ibal Sub-Divisional Hospital, Oku, Northwest Region, Cameroon
- Department of Clinical Research, Health Education and Research Organization (HERO), Buea, Cameroon
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Cape Universities Body Imaging Center, University of Cape Town, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Pallangyo P, Millinga J, Bhalia S, Mkojera Z, Misidai N, Swai HJ, Hemed NR, Kaijage A, Janabi M. Medication adherence and survival among hospitalized heart failure patients in a tertiary hospital in Tanzania: a prospective cohort study. BMC Res Notes 2020; 13:89. [PMID: 32085803 PMCID: PMC7035643 DOI: 10.1186/s13104-020-04959-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023] Open
Abstract
Objective Management of heart failure is complex and multifaceted but adherence to medications remains the cornerstone of preventing avoidable readmissions, premature deaths, and unnecessary healthcare expenses. Despite of evidence-based efficacy on anti-failure drugs, poor adherence is pervasive and remains a significant barrier to improving clinical outcomes in heart failure population. Results We enrolled 459 patients with diagnosis of heart failure admitted at a tertiary cardiovascular hospital in Dar es Salaam, Tanzania. The mean age was 46.4 years, there was a female predominance (56.5%), 67.5% resided in urban areas and 74.2% had primary education. Of the 419 participants eligible for assessment of medication adherence, 313 (74.7%) had poor adherence and 106 (25.3%) had good adherence. Possession of a health insurance was found to be the strongest associated factor for adherence (adjusted OR 8.7, 95% CI 4.7–16.0, p < 0.001). Participants with poor adherence displayed a 70% increased risk for rehospitalization compared to their counterparts with good adherence (adjusted RR 1.7, 95% CI 1.2–2.9, p = 0.04). Poor adherence was found to be the strongest predictor of early mortality (HR 2.5, 95% CI 1.3–4.6, p < 0.01). In conclusion, Poor medication adherence in patients with heart failure is associated with increased readmissions and mortality.
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Affiliation(s)
- Pedro Pallangyo
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania. .,Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Jalack Millinga
- Department of Nursing, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Smita Bhalia
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Zabella Mkojera
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Nsajigwa Misidai
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Happiness J Swai
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Naairah R Hemed
- Unit of Research, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Alice Kaijage
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Zühlke L, Sliwa K, Naidoo P, Ntsinjana H, Ntsekhe M, Hellig F, Smit F, Jankelow D, Subahi S, Dyer R, Dau E, Ntusi NAB. Cardiovascular medicine and research in sub-Saharan Africa: challenges and opportunities. Nat Rev Cardiol 2019; 16:642-644. [PMID: 31551590 DOI: 10.1038/s41569-019-0269-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Pamela Naidoo
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Heart and Stroke Foundation South Africa, Cape Town, South Africa
- African Heart Network, Cape Town, South Africa
| | - Hopewell Ntsinjana
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Witwatersrand and Nelson Mandela Children's Hospital, Johannesburg, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- AfricaPCR, Cape Town, South Africa
| | - Farrel Hellig
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- AfricaPCR, Cape Town, South Africa
- Sunninghill Hospital, Johannesburg, South Africa
| | - Francis Smit
- Division of Cardiothoracic Surgery, Department of Surgery, University of the Free State, Bloemfontein, South Africa
| | - David Jankelow
- Linksfield Park Clinic, Johannesburg, South Africa
- SA Heart, Cape Town, South Africa
| | - Saad Subahi
- Ribat University Hospital, Khartoum, Sudan
- College of Medicine, Alribat National University, Khartoum, Sudan
- Pan-African Society of Cardiology, Khartoum, Sudan
| | - Rob Dyer
- SA Heart, Cape Town, South Africa
- Busamed Gateway Private Hospital, Durban, South Africa
| | | | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
- Cardiovascular Magnetic Resonance Congress of South Africa, Cape Town, South Africa.
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24
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Myers VD, Gerhard GS, McNamara DM, Tomar D, Madesh M, Kaniper S, Ramsey FV, Fisher SG, Ingersoll RG, Kasch-Semenza L, Wang J, Hanley-Yanez K, Lemster B, Schwisow JA, Ambardekar AV, Degann SH, Bristow MR, Sheppard R, Alexis JD, Tilley DG, Kontos CD, McClung JM, Taylor AL, Yancy CW, Khalili K, Seidman JG, Seidman CE, McTiernan CF, Cheung JY, Feldman AM. Association of Variants in BAG3 With Cardiomyopathy Outcomes in African American Individuals. JAMA Cardiol 2019; 3:929-938. [PMID: 30140897 DOI: 10.1001/jamacardio.2018.2541] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance The prevalence of nonischemic dilated cardiomyopathy (DCM) is greater in individuals of African ancestry than in individuals of European ancestry. However, little is known about whether the difference in prevalence or outcomes is associated with functional genetic variants. Objective We hypothesized that Bcl2-associated anthanogene 3 (BAG3) genetic variants were associated with outcomes in individuals of African ancestry with DCM. Design This multicohort study of the BAG3 genotype in patients of African ancestry with dilated cardiomyopathy uses DNA obtained from African American individuals enrolled in 3 clinical studies: the Genetic Risk Assessment of African Americans With Heart Failure (GRAHF) study; the Intervention in Myocarditis and Acute Cardiomyopathy Trial-2 (IMAC-2) study; and the Genetic Risk Assessment of Cardiac Events (GRACE) study. Samples of DNA were also acquired from the left ventricular myocardium of patients of African ancestry who underwent heart transplant at the University of Colorado and University of Pittsburgh. Main Outcomes and Measures The primary end points were the prevalence of BAG3 mutations in African American individuals and event-free survival in participants harboring functional BAG3 mutations. Results Four BAG3 genetic variants were identified; these were expressed in 42 of 402 African American individuals (10.4%) with nonischemic heart failure and 9 of 107 African American individuals (8.4%) with ischemic heart failure but were not present in a reference population of European ancestry (P < .001). The variants included 2 nonsynonymous single-nucleotide variants; 1 three-nucleotide in-frame insertion; and 2 single-nucleotide variants that were linked in cis. The presence of BAG3 variants was associated with a nearly 2-fold (hazard ratio, 1.97 [95% CI, 1.19-3.24]; P = .01) increase in cardiac events in carriers compared with noncarriers. Transfection of transformed adult human ventricular myocytes with plasmids expressing the 4 variants demonstrated that each variant caused an increase in apoptosis and a decrease in autophagy when samples were subjected to the stress of hypoxia-reoxygenation. Conclusions and Relevance This study demonstrates that genetic variants in BAG3 found almost exclusively in individuals of African ancestry were not causative of disease but were associated with a negative outcome in patients with a dilated cardiomyopathy through modulation of the function of BAG3. The results emphasize the importance of biological differences in causing phenotypic variance across diverse patient populations, the need to include diverse populations in genetic cohorts, and the importance of determining the pathogenicity of genetic variants.
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Affiliation(s)
- Valerie D Myers
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Glenn S Gerhard
- Department of Human Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Dennis M McNamara
- The Heart and Vascular Institute, the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dhanendra Tomar
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Muniswamy Madesh
- The Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Scott Kaniper
- Department of Human Genetics and Molecular Biochemistry, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Frederick V Ramsey
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Susan G Fisher
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Roxann G Ingersoll
- The McKusick-Nathans Institute for Genetic Medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura Kasch-Semenza
- The McKusick-Nathans Institute for Genetic Medicine, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - JuFang Wang
- The Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Karen Hanley-Yanez
- The Heart and Vascular Institute, the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bonnie Lemster
- The Heart and Vascular Institute, the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jessica A Schwisow
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Amrut V Ambardekar
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Seta H Degann
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Michael R Bristow
- Department of Medicine, University of Colorado School of Medicine, Denver
| | - Richard Sheppard
- Department of Medicine, McGill University and the Jewish General Hospital, Montreal, Quebec, Canada
| | - Jeffrey D Alexis
- Department of Medicine, the University of Rochester, Rochester, New York
| | - Douglas G Tilley
- The Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Christopher D Kontos
- Division of Cardiology, Department of Medicine and the Department of Pharmacology and Cancer, Duke University School of Medicine, Durham, North Carolina
| | - Joseph M McClung
- Department of Physiology and Cardiovascular Sciences, East Carolina Diabetes and Obesity Institute, Brody School of Medicine, Greenville, North Carolina
| | - Anne L Taylor
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Deputy Editor
| | - Kamel Khalili
- Department of Neuroscience, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Christine E Seidman
- Department of Genetics, Harvard Medical School, Boston, Massachusetts.,Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,The Howard Hughes Medical Institute, Chevy Chase, Maryland
| | - Charles F McTiernan
- The Heart and Vascular Institute, the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph Y Cheung
- The Center for Translational Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Arthur M Feldman
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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Ifeoluwa AA, Adewole AA, Abiodun AM, Akinyemi A. Right ventricular systolic function in Nigerians with heart failure secondary to hypertensive heart disease. Afr Health Sci 2019; 19:2130-2139. [PMID: 31656497 PMCID: PMC6794531 DOI: 10.4314/ahs.v19i2.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Right ventricular (RV) dysfunction has been shown to be a major contributor to the adverse outcomes in subjects with heart failure. Few studies evaluating the right ventricle in heart failure subjectshave been carried out in Sub-Saharan Africa. This studywas therefore designed to evaluate the right ventricular systolic function in subjects with heart failure secondary to hypertensive heart disease presenting to the University College Hospital, Ibadan Nigeria. Methodology Seventy-six subjects with heart failure secondary to hypertension and 92 normal controls underwent clinical, electrocardiographic and echocardiographic evaluation. Indices of right ventricular systolic function that were measured include tricuspid annular plane systolic excursion (TAPSE), tissue Doppler derived tricuspid peak systolic lateral annulus velocity(S′) and right ventricular fractional areachange(RVFAC). Results Sixty-two (81.6%) heart failure subjects had right ventricular systolic dysfunction, 31(40.8%) had abnormal TAPSE, 42(55.5%) had abnormal S′ while 49(64.5%) had abnormal RVFAC. Elevated pulmonary artery systolic pressure was found in 25(32.9%) of the subjects. There was no relationship between the indices of right ventricular systolic function and the estimated systolic pulmonary artery pressures. The independent predictor of right ventricular systolic dysfunction was the right atrial size. Conclusion Right ventricular systolic function is impaired in patients with heart failure secondary to hypertensive heart disease. There is no relationship between the indices of right ventricular systolic function and systolic pulmonary artery pressure. Further studies are needed to assess right ventricular systolic function in Nigerians.
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Affiliation(s)
| | - Adesoji Adebiyi Adewole
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adeoye M Abiodun
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Aje Akinyemi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
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26
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Tefera YG, Abebe TB, Mekuria AB, Kelkay MS, Abegaz TM. Prescribing trend in cardiovascular patients at Ethiopian university hospital: The number of medications and implication on the clinical improvement. Pharmacol Res Perspect 2019; 7:e00474. [PMID: 31024733 PMCID: PMC6475640 DOI: 10.1002/prp2.474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 12/04/2022] Open
Abstract
Investigating the prescribing trend is important to improve rational prescribing. This study aimed at assessing the cardiovascular drug use, pattern, and its impact on clinical outcome. A cross-sectional study was employed in the outpatient department of chronic illness clinic of Gondar University specialized hospital, Ethiopia from 15 January 2017 to 15 March 2017. The independent variables were sociodemographic, medication, and other clinical information while cardiovascular disease improvement is the outcome variable. Binary logistic regression was used to test the association between the independent variables and the outcome variable. Kaplan Meier curve was used to analyze the clinical improvement while the Log-rank test was employed to compare the clinical outcome with the number of medications. Eight hundred thirty-three cardiovascular patient medical records were included in the final analysis. The majority (62.5%) of patients were females and more than 61% were above 50 years of age. Diuretics monotherapy accounted for a third (33.6%) of cardiovascular drug use, followed by combination therapy of angiotensin convertase enzyme inhibitors with Diuretics (21.8%) and calcium channel blockers with diuretics (8.3%). Cardiovascular patients followed for 72 months found to have a good level of clinical improvement on combination medication (Log Rank of 28.9, P = 0.000). In this study, diuretics monotherapy or in combination with angiotensin convertase enzyme inhibitors were found to be the frequently prescribed drugs in cardiovascular patients. Combination therapy has an implication for good cardiovascular improvement on long term follow-up. It seems clinicians were restricted to certain cardiovascular medications while plenty of choices are available from the diverse classes of cardiovascular drugs.
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Affiliation(s)
- Yonas G. Tefera
- Department of Clinical PharmacySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Tamrat B. Abebe
- Department of Clinical PharmacySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
- Master's program in Health Economics, Policy and ManagementDepartment of Learning Informatics, Management and Ethics LIMEKarolinska InstitutetSolnaSweden
| | - Abebe B. Mekuria
- Department of PharmacologySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Misganaw S. Kelkay
- Hospital Pharmacy DepartmentGondar University Specialized HospitalGondarEthiopia
| | - Tadesse M. Abegaz
- Department of Clinical PharmacySchool of PharmacyCollege of Medicine and Health SciencesUniversity of GondarGondarEthiopia
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Herrey AS, Francis JM, Hughes M, Ntusi NAB. Cardiovascular magnetic resonance can be undertaken in pregnancy and guide clinical decision-making in this patient population. Eur Heart J Cardiovasc Imaging 2018; 20:291-297. [PMID: 30462196 DOI: 10.1093/ehjci/jey162] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/13/2018] [Accepted: 10/05/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Anna S Herrey
- St. Bartholomew’s Hospital/Barts Heart Centre, West Smithfield, London, UK
- Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond Street, London, UK
| | - Jane M Francis
- Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, John Radcliffe Hospital, Headington, Oxford, UK
| | - Marina Hughes
- Cardiorespiratory Unit, Great Ormond Street Hospital, Great Ormond St, London, UK
| | - Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Main Rd, Observatory, Cape Town, South Africa
- The Hatter Institute, Faculty of Health Sciences, University of Cape Town, 4th Floor Chris Barnard Building, Private Bag, Observatory, South Africa
- Cape Universities Body Imaging Centre, University of Cape Town, UCT MRI Unit 10, J Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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28
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Murray M, King C, Sorensen C, Bunick E, King R. Community awareness of stroke, hypertension and modifiable risk factors for cardiovascular disease in Nkonya-Wurupong, Ghana. J Public Health Afr 2018; 9:783. [PMID: 30687476 PMCID: PMC6325415 DOI: 10.4081/jphia.2018.783] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 07/10/2018] [Indexed: 11/23/2022] Open
Abstract
Hypertension and other non-communicable diseases are growing risk factors for cardiovascular disease and stroke in lowand middle-income countries like Ghana who are experiencing the effects of rapid urbanization and globalization. Awareness and education may help reduce the population’s exposure to modifiable risk-factors. A survey from a central clinic outside the city of Ho, in the Volta region investigates participants’ level of awareness and education surrounding hypertension and stroke. It provides important information about the approach to education and preventing modifiable risk factors. A central clinic in Nkonya-Wurupong, Ghana, evaluated 1671 patients in July 2016, and a group of 302 adults over the age of 18 provided a convenience sampling. The survey examined three main areas: demographics, medical history, and evaluation of knowledge with respect to stroke and cardiovascular risk factors. 18.5% of participants demonstrated hypertension (BP ³ 140/90). 30% of those with hypertension were female. Thirty-five percent believed hypertension was a risk factor for stroke, and only 26% were currently medicated for hypertension. Poor diet, obesity and alcohol were the most frequently identified risk factors for stroke and 86% of participants felt that it was preventable. However, diet, heart disease, smoking, obesity, diabetes, sedentary lifestyle or alcohol were not uniformly identified as stroke risk factors. One-sided weakness was the only symptom the group associated with stroke. Other symptoms included in the survey were headache, slurred speech, visual changes, dizziness, and facial droop. Educational resources included TV, school, internet, radio, medical books and health professionals and 7% responded that they had never been educated about stroke and its risk-factors. Knowledge of hypertensive consequences including cardiovascular disease and stroke varies significantly along with stroke identification and educational sources. However, many indicated that stroke is due to lifestyle and can be prevented. It is unclear what respondents believe these lifestyle choices are. This data suggests there are major areas where healthcare education is needed. Discerning baseline health in developing countries will become increasingly important when evaluating an area for health resource allocation including patient health education programs.
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Affiliation(s)
- Melissa Murray
- University of Kentucky College of Medicine, Rotary Club of Oak Ridge Tennessee, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carol King
- University of Kentucky College of Medicine, Rotary Club of Oak Ridge Tennessee, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cecilia Sorensen
- University of Kentucky College of Medicine, Rotary Club of Oak Ridge Tennessee, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elaine Bunick
- University of Kentucky College of Medicine, Rotary Club of Oak Ridge Tennessee, University of Colorado School of Medicine, Aurora, CO, USA
| | - Renee King
- University of Kentucky College of Medicine, Rotary Club of Oak Ridge Tennessee, University of Colorado School of Medicine, Aurora, CO, USA
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29
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Raafat SS, Ramzy AA, El-Hadidy AF, Abd Allah MA, Hanna HF. Mitral leaflet separation index. An easy two dimensional echocardiography technique for assessment of mitral valve area before and after percutaneous balloon mitral valvuloplasty. Egypt Heart J 2018; 70:195-201. [PMID: 30190646 PMCID: PMC6123234 DOI: 10.1016/j.ehj.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/19/2018] [Indexed: 12/01/2022] Open
Abstract
AIM To evaluate the reliability of the mitral leaflet separation (MLS) index against the traditional echocardiographic methods in measuring mitral valve area (MVA) pre and post percutaneous balloon mitral valvuloplasty (PBMV). METHODS Ninety patients suffering symptomatic moderate to severe MS underwent PBMV at Ain Shams University Hospital in cardiology department. Seventy of the patients were females representing 77.8% and 20 were males representing 22.2%. Their age ranged from 22 to 56 years. All patients were subjected to full transthoracic echocardiography (TTE) examination pre and post PBMV. MLS index was introduced as a comparative parameter with traditional echocardiographic methods for assessment of MVA, measuring average of distance between tips of MV leaflets in parasternal long axis and four chamber two dimensional echocardiographic views. RESULTS MVA increased from 0.95 ± 0.28 to 2.21 ± 0.41 cm2 (P=0.001) using 2D planimetry; and increased from 0.93 ± 0.23 to 2.21 ± 0.46 cm2 (P= 0.0011) by pressure half time method (PHT). MLS index was correlated with MVA by 2D planimetry pre and post PBMV (r=0.453) and (r=0.668) respectively (p=0.0001) and strongly correlated with MVA using PHT post PBMV (r=0.768) (p=0.0001). Post PBMV 14 patients suffered significant mitral regurgitation 3 of them were transferred to surgery. MLS index above 11.75 mm and below 9.15 mm had excellent positive predictive value for detecting mild and severe MS respectively. CONCLUSION The MLS index it is a simple and effective method for assessment of the MVA, it has an excellent correlation with MVA with an excellent sensitivity and specificity for the prediction of effective MVA. The MLS index cannot evaluate outcome of PBMV because it is an anatomical parameter and not flow dependent thus does not correlate with grades of mitral regurgitation.
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Affiliation(s)
| | - Ali A. Ramzy
- Cardiology Department, Al-Azhar University, Egypt
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The Prevalence and Associated Distress of Physical and Psychological Symptoms in Patients With Advanced Heart Failure Attending a South African Medical Center. J Cardiovasc Nurs 2018; 31:313-22. [PMID: 25829136 DOI: 10.1097/jcn.0000000000000256] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. OBJECTIVE The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. METHODS Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. RESULTS A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017). CONCLUSIONS Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients.
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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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Epstein D, Petersiel N, Klein E, Marcusohn E, Aviran E, Harel R, Azzam ZS, Neuberger A, Fuchs L. Pocket-size point-of-care ultrasound in rural Uganda - A unique opportunity "to see", where no imaging facilities are available. Travel Med Infect Dis 2018; 23:87-93. [PMID: 29317333 DOI: 10.1016/j.tmaid.2018.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/24/2017] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the developing world, only a small minority of patients have access to radiological services. Over the past decade, technological developments of ultrasound equipment have led to the emergence of point-of-care ultrasonography (POCUS), which is widely used by healthcare professionals of nearly all specialties. We hypothesized that physicians with only basic POCUS training, but with telemedicine support, can use POCUS successfully in rural hospitals in sub-Saharan Africa. METHOD During a 14-day voluntary clinical work session in a rural hospital in central Uganda, bedside ultrasound scans were performed by use of a pocket-size portable machine by a physician who underwent a five-day training period. All the POCUS studies were reviewed by radiologists and cardiologists abroad with the use of telemedicine. RESULTS During the study period, 30% of patients received a POCUS-augmented physical examination. 16 out of 23 patients (70%) had positive findings; in 20 of them (87%), the management was changed. The technique was successfully used on trauma casualties, patients suffering from shock, patients with cardiorespiratory symptoms, and patients undergoing invasive procedures. CONCLUSIONS In a very resource-limited environment, POCUS conducted by basically trained primary care physicians with telemedicine support is a powerful diagnostic tool in a variety of medical conditions.
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Affiliation(s)
- Danny Epstein
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel.
| | - Neta Petersiel
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Erez Klein
- Department of Diagnostic Imaging, Rambam Health Care Center, Haifa, Israel
| | - Erez Marcusohn
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel
| | - Eyal Aviran
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Reut Harel
- Department of Internal Medicine "C", Emek Medical Center, Afula, Israel
| | - Zaher S Azzam
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel; The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel
| | - Ami Neuberger
- Department of Internal Medicine "B", Rambam Health Care Campus, Haifa, Israel; The Rappaport's Faculty of Medicine, The Technion Institute, Haifa, Israel; Division of Infectious Diseases, Rambam Health Care Center, Haifa, Israel
| | - Lior Fuchs
- Medical Intensive Care Unit, Soroka Medical Center, Beer Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Ukpabi OJ, Uwanurochi K. Comparing indications for cardiovascular admissions into a Nigerian and an Israeli Hospital. Ann Afr Med 2017; 16:70-73. [PMID: 28469120 PMCID: PMC5452706 DOI: 10.4103/aam.aam_30_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Changing epidemiologic profile with increase in cardiovascular risk factors is well documented in literature. Our study sought to see how this is reflected in cardiovascular admissions into medical wards of a Nigerian and an Israeli hospital. Objective: To compare the range and pattern of cardiovascular admissions encountered in a Nigerian hospital and an Israel hospital. Methods: This was a retrospective study of admission records of patients admitted into both Federal Medical Centre (FMC), Umuahia, Abia State, Nigeria, and Sheba Medical Centre, Israel. Results: Ischemic heart disease (IHD) was the most prevalent among the Israeli hospital's admissions but ranks very low as an indication for admission in Nigeria. The most common causes of admission in Nigeria were hypertension and heart failure (HF). The spectrum of cardiovascular diseases (CVDs) was very limited in the Nigerian hospital, indicating disparity in diagnostic capacity. Conclusion: There were more patients with CVD as a cause of medical admission in the Israel hospital as compared to the Nigerian hospital. Hypertension and HF were prevalent indications for CVD in FMC, Umuahia, Nigeria, while hypertension and IHD were the prevalent indications for admission in Sheba Medical Centre, Israel. Future studies are needed to monitor spectrum and frequency of cardiovascular admissions in view of evolving epidemiological transition in developing countries.
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Affiliation(s)
- Ogba Joseph Ukpabi
- Department of Internal Medicine, Cardiology Unit, Federal Medical Centre, Umuahia, Abia State, Nigeria
| | - Kelechukwu Uwanurochi
- Department of Internal Medicine, Cardiology Unit, Federal Medical Centre, Umuahia, Abia State, Nigeria
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Appiah LT, Sarfo FS, Agyemang C, Tweneboah HO, Appiah NABA, Bedu-Addo G, Opare-Sem O. Current trends in admissions and outcomes of cardiac diseases in Ghana. Clin Cardiol 2017; 40:783-788. [PMID: 28692760 DOI: 10.1002/clc.22753] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular diseases (CVDs) pose a major burden in Africa, but data on temporal trends in disease burden are lacking. We assessed trends in CVD admissions and outcomes in central Ghana using a retrospective analysis of data from January 2004 to December 2015 among patients admitted to the medical wards of a tertiary medical center in Kumasi, Ghana. Rates of admissions and mortality were expressed as CVD admissions and deaths divided by the total number of medical admissions and deaths, respectively. Case fatality rates per specific cardiac disease diagnosis were also computed. Over the period, there were 4226 CVD admissions, with a male-to-female ratio of 1.1 to 1. There was a progressive increase in percentage of CVD admissions from 4.6% to 8.2%, representing an 78% increase, between 2004 and 2014. Of the 2170 CVD cases whose data were available, the top 3 causes of CVD admissions were heart failure (HF; 88.3%), ischemic heart disease (IHD; 7.2%), and dysrhythmias (1.9%). Of all HF admissions, 52% were associated with hypertension. IHD prevalence rose by 250% between 2005 and 2015. There were 976 deaths (23%), with an increase in percentage of hospital deaths that were cardiovascular in nature from 3.6% to 7.3% between 2004 and 2014, representing a 102% increase. Cardiac disease admissions and mortality have increased progressively over the past decade, with HF as the most common cause of admission. Once rare, IHD is emerging as a significant contributor to the CVD burden in sub-Saharan Africa.
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Affiliation(s)
- Lambert T Appiah
- Department of Cardiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fred S Sarfo
- Department of Cardiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | | | - George Bedu-Addo
- Department of Cardiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ohene Opare-Sem
- Department of Cardiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Namukwaya E, Grant L, Downing J, Leng M, Murray SA. Improving care for people with heart failure in Uganda: serial in-depth interviews with patients' and their health care professionals. BMC Res Notes 2017; 10:184. [PMID: 28545502 PMCID: PMC5445313 DOI: 10.1186/s13104-017-2505-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/11/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The short prognosis of patients with advanced heart failure (HF) and the associated multidimensional distress as illustrated in literature from high income countries necessitates the integration of palliative care into the care of advanced HF patients to address these needs and improve their quality of life. These needs, which are subjective, have not been described from the patients' and health care professionals'(HPs) view point in the Ugandan setting, a low income country with a different socio-cultural context. This study aimed at bridging this gap in knowledge by eliciting patients' and HPs' views of HF patients' needs over the course of their illness to enable generalists, cardiologists and palliative care clinicians to develop guidelines to provide patient-centred realistic care in Uganda. METHODS Serial qualitative in-depth interviews were conducted with HF patients who were purposively sampled and recruited in Mulago National Referral Hospital (MNRH) until thematic saturation. In-depth interviews were conducted at three time points with intervals of 3 month between interviews over the course of their illness in the hospital and their home context. One-off interviews were conducted with HPs that manage HF in MNRH. We used a grounded theory approach in data analysis. The Uganda National Council of science and technology approved the research. RESULTS Forty-eight interviews were conducted with 21 patients and their carers and eight interviews with their HPs. Multidimensional needs including physical, psychological, social, spiritual and information needs were identified. These highlighted the underpinning need to have normal functioning, control, to cope and adapt to a changed life and to find meaning. Spiritual needs were less recognised by HPs than the other multidimensional needs. Information needs were commonly unmet. Patients and HPs suggested improvements in care that were congruent with the recommendations in chronic disease care and the six pillars of the WHO health systems strengthening approach. CONCLUSION Management of HF in Uganda requires an approach that targets multidimensional needs, embraces multidisciplinary care and strengthens health systems which are all important tenets of palliative care.
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Affiliation(s)
- Elizabeth Namukwaya
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Liz Grant
- Global Health Academy, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Julia Downing
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Mhoira Leng
- Makerere University College of Health Sciences, P.O BOX 7072, Kampala, Uganda
| | - Scott A. Murray
- Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
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Bonsu KO, Owusu IK, Buabeng KO, Reidpath DD, Kadirvelu A. Statin Treatment and Clinical Outcomes of Heart Failure Among Africans: An Inverse Probability Treatment Weighted Analysis. J Am Heart Assoc 2017; 6:JAHA.116.004706. [PMID: 28365564 PMCID: PMC5532994 DOI: 10.1161/jaha.116.004706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Randomized control trials of statins have not demonstrated significant benefits in outcomes of heart failure (HF). However, randomized control trials may not always be generalizable. The aim was to determine whether statin and statin type–lipophilic or –hydrophilic improve long‐term outcomes in Africans with HF. Methods and Results This was a retrospective longitudinal study of HF patients aged ≥18 years hospitalized at a tertiary healthcare center between January 1, 2009 and December 31, 2013 in Ghana. Patients were eligible if they were discharged from first admission for HF (index admission) and followed up to time of all‐cause, cardiovascular, and HF mortality or end of study. Multivariable time‐dependent Cox model and inverse‐probability‐of‐treatment weighting of marginal structural model were used to estimate associations between statin treatment and outcomes. Adjusted hazard ratios were also estimated for lipophilic and hydrophilic statin compared with no statin use. The study included 1488 patients (mean age 60.3±14.2 years) with 9306 person‐years of observation. Using the time‐dependent Cox model, the 5‐year adjusted hazard ratios with 95% CI for statin treatment on all‐cause, cardiovascular, and HF mortality were 0.68 (0.55–0.83), 0.67 (0.54–0.82), and 0.63 (0.51–0.79), respectively. Use of inverse‐probability‐of‐treatment weighting resulted in estimates of 0.79 (0.65–0.96), 0.77 (0.63–0.96), and 0.77 (0.61–0.95) for statin treatment on all‐cause, cardiovascular, and HF mortality, respectively, compared with no statin use. Conclusions Among Africans with HF, statin treatment was associated with significant reduction in mortality.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia .,Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Isaac Kofi Owusu
- Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Department of Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel D Reidpath
- School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
| | - Amudha Kadirvelu
- School of Medicine and Health Sciences, Monash University, Bandar Sunway, Malaysia
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Bonsu KO, Owusu IK, Buabeng KO, Reidpath DD, Kadirvelu A. Clinical characteristics and prognosis of patients admitted for heart failure: A 5-year retrospective study of African patients. Int J Cardiol 2017; 238:128-135. [PMID: 28318656 DOI: 10.1016/j.ijcard.2017.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 02/28/2017] [Accepted: 03/04/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mortality associated with heart failure (HF) remains high. There are limited clinical data on mortality among HF patients from African populations. We examined the clinical characteristics, long-term outcomes, and prognostic factors of African HF patients with preserved, mid-range or reduced left ventricular ejection fraction (LVEF). METHODS AND RESULTS We conducted a retrospective longitudinal cohort study of individuals aged ≥18years discharged from first HF admission between January 1, 2009 and December 31, 2013 from the Cardiac Clinic, Directorate of Medicine of the Komfo Anokye Teaching Hospital, Ghana. A total of 1488 patients diagnosed of HF were included in the analysis. Of these, 345 patients (23.2%) had reduced LVEF (LVEF<40%) [HFrEF], 265(17.8%) with mid-range LVEF (40%≥LVEF<50%) [HFmEF] and 878 (59.0%) had preserved LVEF (LVEF≥50%) [HFpEF]. Kaplan-Meier curves and log-rank test demonstrated better prognosis for HFpEF compared to HFrEF and HFmEF patients. An adjusted Cox analysis showed a significantly lower risk of mortality for HFpEF (hazard ratio (HR); 0.74; 95% confidence interval (CI) 0.57-0.94) p=0.015). Multivariate analyses showed that age, higher New York Heart Association (NYHA) functional class, lower LVEF, chronic kidney disease, atrial fibrillation, anemia, diabetes mellitus and absence of statin and aldosterone antagonist treatment were independent predictors of mortality in HF. Although, prognostic factors varied across the three groups, age was a common predictor of mortality in HFpEF and HFmEF. CONCLUSIONS This study identified the clinical characteristics, long-term mortality and prognostic factors of African HF patients with reduced, mid-range and preserved ejection fractions in a clinical setting.
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Affiliation(s)
- Kwadwo Osei Bonsu
- School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia; Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana.
| | - Isaac Kofi Owusu
- Directorate of Medicine, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana; Department of Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology.
| | - Daniel D Reidpath
- School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia.
| | - Amudha Kadirvelu
- School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia.
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Bloomfield GS, DeLong AK, Akwanalo CO, Hogan JW, Carter EJ, Aswa DF, Binanay C, Koech M, Kimaiyo S, Velazquez EJ. Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns in Heart Failure: A Case-Control Study of Middle-Aged Adult Heart Failure Patients in Rural Kenya. Glob Heart 2017; 11:97-107. [PMID: 27102027 DOI: 10.1016/j.gheart.2015.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although risk factors for heart failure are increasingly common worldwide, the contribution of atherosclerosis to heart failure in sub-Saharan Africa is largely unknown. OBJECTIVE This study assessed the association between atherosclerotic risk factors and heart failure in a developing country. METHODS We performed a case-control study of heart failure in rural Kenya. We assessed the risk factors for heart failure by using international criteria based on electrocardiogram (ECG), echocardiogram, physical examination findings, and laboratory testing. Atherosclerotic risk factors were determined by ECG, echocardiogram, ankle-brachial index (ABI), and lipid testing. We described the relationship of wall motion abnormalities on echocardiogram, ABI <0.9, and ischemic pattern on ECG with the presence of heart failure with multivariable logistic regression adjusting for age and sex and using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS There were 125 cases and 191 controls (n = 316); 49% were male. The mean age was 60 (SD = 13) years. Most patients had hypertension (53%), and 16% had human immunodeficiency virus infection. Lipids were in the normal range for all. Cases were older than controls (62 years vs. 58 years, respectively). The most common abnormality associated with heart failure was dilated cardiomyopathy. Ischemic heart failure was the second most common cause in men. Cases were more likely to have an ABI <0.9 (46% vs. 31%; AOR: 1.99; 95% CI: 1.19 to 3.32), ischemia or infarct on ECG (68% vs. 43%; AOR: 3.01; 95% CI: 1.43 to 6.34), and wall motion abnormalities on echocardiogram (54% vs. 15%; AOR: 7.00; 95% CI: 3.95 to 12.39). CONCLUSIONS Ischemic heart failure is more common in Kenya than previously recognized. Noninvasive markers of atherosclerosis are routinely found among patients with heart failure. Treatment and prevention of heart failure in sub-Saharan Africa must consider many causes including those related to atherosclerosis.
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Affiliation(s)
- Gerald S Bloomfield
- Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Allison K DeLong
- Center for Statistical Science, School of Public Health, Brown University, Providence, RI, USA
| | | | - Joseph W Hogan
- Department of Biostatistics and Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - E Jane Carter
- Division of Infectious Diseases, Alpert School of Medicine at Brown University, Providence, RI, USA; Division of Pulmonary Medicine, Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Daniel F Aswa
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Cynthia Binanay
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Myra Koech
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
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Abstract
Heart failure (HF) is a global pandemic affecting at least 26 million people worldwide and is increasing in prevalence. HF health expenditures are considerable and will increase dramatically with an ageing population. Despite the significant advances in therapies and prevention, mortality and morbidity are still high and quality of life poor. The prevalence, incidence, mortality and morbidity rates reported show geographic variations, depending on the different aetiologies and clinical characteristics observed among patients with HF. In this review we focus on the global epidemiology of HF, providing data about prevalence, incidence, mortality and morbidity worldwide.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine,Karolinska Insitutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital,Stockholm, Sweden
| | - Lars H Lund
- Division of Cardiology, Department of Medicine,Karolinska Insitutet, Stockholm, Sweden.,Department of Cardiology, Karolinska University Hospital,Stockholm, Sweden
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Abebe TB, Gebreyohannes EA, Tefera YG, Abegaz TM. Patients with HFpEF and HFrEF have different clinical characteristics but similar prognosis: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:232. [PMID: 27871223 PMCID: PMC5117494 DOI: 10.1186/s12872-016-0418-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/16/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Globally, heart failure (HF) has been recognized as one of the major cardiovascular disorder with high morbidity, mortality and considerable social impact. In Sub Saharan African countries, HF has turned out as a leading form of cardiovascular diseases, and has considerable socioeconomic impact. However, there are differences in clinical characteristics and survival status among patients with preserved (HFpEF) and reduced (HFrEF) ejection fraction. The aim of this study is to outline the clinical characteristics and medication profile, assess the survival status and prognostic factors of Ethiopian HF patients with HFrEF and HFpEF. METHODS A retrospective cohort study was carried out and we employed medical records of patient's, admitted as a result of HF to the University of Gondar Referral Hospital in the period between December 02, 2010 and December 01, 2015 due to HF. Kaplan Meier curve was used to analyze the survival status and log rank test was used to compare the curves. Cox regression was used to analyze independent predictors of mortality in all HF patients. RESULTS Of the 850 patients who were admitted due to HF, 311 patients met the inclusion criteria. Majority of the patients had HFpEF (52.73%) and tend to be women (76.22%). They predominantly had etiologies of valvular and hypertensive heart diseases, and took calcium channel blockers and anticoagulants. Conversely, patients with HFrEF had etiologies of ischemic heart disease and dilated cardiomyopathy and were prescribed angiotensine converting inhibitors (ACEI) and beta blockers. Kaplan Meier curves and Log rank test (p = 0.807) showed that there was no statistically significant difference in the mortality difference among patients with HFpEF and HFrEF. On the other hand, Cox regression analysis showed advanced age, lower sodium level, higher creatinine level and absence of medications like ACEI, spironolactone and statins independently predicted mortality in all HF patients. CONCLUSIONS Different clinical characteristics were found in both groups of HF patients. There was no difference in survival outcome between patients with HFrEF and HFpEF.
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Affiliation(s)
- Tamrat Befekadu Abebe
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Eyob Alemayehu Gebreyohannes
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yonas Getaye Tefera
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tadesse Melaku Abegaz
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Mwita JC, Dewhurst MJ, Magafu MG, Goepamang M, Omech B, Majuta KL, Gaenamong M, Palai TB, Mosepele M, Mashalla Y. Presentation and mortality of patients hospitalised with acute heart failure in Botswana. Cardiovasc J Afr 2016; 28:112-117. [PMID: 27701482 PMCID: PMC5488055 DOI: 10.5830/cvja-2016-067] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/19/2016] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana. METHODS Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed. RESULTS The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay. CONCLUSIONS AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV.
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Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana.
| | - Matthew J Dewhurst
- Department of Cardiology, North Tees and Hartlepool NHS Foundation Trust, UK
| | - Mgaywa G Magafu
- Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Monkgogi Goepamang
- Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana
| | - Bernard Omech
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana
| | | | - Marea Gaenamong
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Tommy Baboloki Palai
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana
| | - Mosepele Mosepele
- Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana
| | - Yohana Mashalla
- Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana
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Malebranche R, Tabou Moyo C, Morisset PH, Raphael NA, Wilentz JR. Clinical and echocardiographic characteristics and outcomes in congestive heart failure at the Hospital of The State University of Haiti. Am Heart J 2016; 178:151-60. [PMID: 27502863 DOI: 10.1016/j.ahj.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to evaluate the clinical and epidemiologic profile of congestive heart failure at the principal free-care hospital in Haiti. Cardiovascular disease represents the most prevalent cause of admissions to the medical service of the University Hospital of the State of Haiti. No previous study has examined the demographics of congestive heart failure in urban Haiti. METHODS Two hundred forty-seven patients presented to the inpatient service between May 2011 and May 2013. Evaluation included history and physical, CBC, renal/metabolic profile, serum glucose, anti-HIV antibody, ECG, chest radiograph and echocardiogram. Treatment included angiotensin converting enzyme inhibitors, furosemide and spironolactone, carvedilol, digoxin and anticoagulation. RESULTS Women (62.4%) outnumbered men; patients were relatively young (mean age 50.1) and from the lowest socio-economic levels of the population. Nearly all (98.8%) presented with NYHA III-IV status, with correspondingly high mortality (23.3%). Echocardiography showed 73% dilated cardiomyopathy; 83% showed moderate to severe LV systolic dysfunction (mean EF 36.5 +/- 15%) and 17% preserved LV systolic function. The three principal etiologies were dilated cardiomyopathy (29%) hypertensive cardiomyopathy (27%) and peripartum cardiomyopathy (20%). Ischemic cardiomyopathy was rare (3.4%). At 27 months follow-up, 76.7% of the patients were alive and well. Among those who died, mean survival time was 113 days. Readmission carried a poor prognosis. CONCLUSIONS This congestive heart failure study from Haiti shows an unusually high proportion of young women, primarily due to peripartum cardiomyopathy. Ischemic cardiomyopathy is rare, as in Africa. Further study is warranted to address the particular problem of the high frequency of peripartum cardiomyopathy in this population.
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MESH Headings
- Adolescent
- Adrenergic beta-Antagonists/therapeutic use
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Anticoagulants/therapeutic use
- Carbazoles/therapeutic use
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/drug therapy
- Cardiomyopathy, Dilated/epidemiology
- Cardiomyopathy, Dilated/physiopathology
- Cardiotonic Agents/therapeutic use
- Carvedilol
- Cohort Studies
- Digoxin/therapeutic use
- Diuretics/therapeutic use
- Echocardiography
- Electrocardiography
- Female
- Furosemide/therapeutic use
- Haiti
- Heart Failure/diagnostic imaging
- Heart Failure/drug therapy
- Heart Failure/epidemiology
- Heart Failure/physiopathology
- Hospitalization
- Hospitals, University
- Hospitals, Urban
- Humans
- Hypertension/epidemiology
- Male
- Middle Aged
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnostic imaging
- Pregnancy Complications, Cardiovascular/drug therapy
- Pregnancy Complications, Cardiovascular/epidemiology
- Pregnancy Complications, Cardiovascular/physiopathology
- Propanolamines/therapeutic use
- Prospective Studies
- Puerperal Disorders/diagnostic imaging
- Puerperal Disorders/drug therapy
- Puerperal Disorders/epidemiology
- Puerperal Disorders/physiopathology
- Sex Distribution
- Spironolactone/therapeutic use
- Stroke Volume
- Young Adult
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Affiliation(s)
- Rodolphe Malebranche
- Cardiology Unit, Department of Medicine, Hospital of the University of the State of Haiti, Port-au-Prince, Haiti; Faculty of Medicine and Pharmacy of the University of the State of Haiti, Port-au-Prince, Haiti
| | - Christian Tabou Moyo
- Cardiology Unit, Department of Medicine, Hospital of the University of the State of Haiti, Port-au-Prince, Haiti
| | - Paul-Henry Morisset
- Cardiology Unit, Department of Medicine, Hospital of the University of the State of Haiti, Port-au-Prince, Haiti
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Makubi A, Hage C, Sartipy U, Lwakatare J, Janabi M, Kisenge P, Dahlström U, Rydén L, Makani J, Lund LH. Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF). Int J Cardiol 2016; 220:750-8. [PMID: 27393861 DOI: 10.1016/j.ijcard.2016.06.239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden. METHODS A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after matching 1:3 by gender and age±5years (n 411 vs. 1232). The association between cohort and all-cause mortality was assessed with multivariable Cox regression. RESULTS In the unmatched cohorts, TaHeF (as compared to SwedeHF) patients were younger (median age [interquartile range] 55 [40-68] vs. 77 [64-84] years, p<0.001) and more commonly women (51% vs. 40%, p<0.001). The three-year survival was 61% in both cohorts. In the matched cohorts, TaHeF patients had more hypertension (47% vs. 37%, p<0.001), more anemia (57% vs. 9%), more preserved EF, more advanced HF, longer duration of HF, and less use of beta-blockers. Crude mortality was worse in TaHeF (HR 2.25 [95% CI 1.78-2.85], p<0.001), with three-year survival 61% vs. 83%. However, covariate-adjusted risk was similar (HR 1.07, 95% CI 0.69-1.66; p=0.760). In both cohorts, preserved EF was associated with higher mortality in crude but not adjusted analysis. CONCLUSIONS Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis.
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Affiliation(s)
- Abel Makubi
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania.
| | - Camilla Hage
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johnson Lwakatare
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania
| | - Mohammed Janabi
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania
| | - Peter Kisenge
- Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania
| | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, 58191 Linköping, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden
| | - Julie Makani
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Nuffield Department of Clinical Medicine, University of Oxford, OX3 7BN Oxford, London, United Kingdom; Muhimbili Wellcome Programme, PO Box 65001, Dar es Salaam, Tanzania
| | - Lars H Lund
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden
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Hoeper MM, Humbert M, Souza R, Idrees M, Kawut SM, Sliwa-Hahnle K, Jing ZC, Gibbs JSR. A global view of pulmonary hypertension. THE LANCET RESPIRATORY MEDICINE 2016; 4:306-22. [DOI: 10.1016/s2213-2600(15)00543-3] [Citation(s) in RCA: 242] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
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Heart Failure in Africa, Asia, the Middle East and South America: The INTER-CHF study. Int J Cardiol 2015; 204:133-41. [PMID: 26657608 DOI: 10.1016/j.ijcard.2015.11.183] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 11/24/2015] [Accepted: 11/27/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are few data on heart failure (HF) patients from Africa, Asia, the Middle East and South America. METHODS INTER-CHF is a prospective study that enrolled HF patients in 108 centers in 16 countries from 2012 to 2014. Consecutive ambulatory or hospitalized adult patients with HF were enrolled. Baseline data were recorded on sociodemographics, clinical characteristics, HF etiology and treatments. Age- and sex-adjusted results are reported. RESULTS We recruited 5813 HF patients: mean(SE) age=59(0.2)years, 39% female, 65% outpatients, 31% from rural areas, 26% with HF with preserved ejection fraction, with 1294 from Africa, 2661 from Asia, 1000 from the Middle-East, and 858 from South America. Participants from Africa-closely followed by Asians-were younger, had lower literacy levels, and were less likely to have health or medication insurance or be on beta-blockers compared with participants from other regions, but were most likely to be in NYHA class IV. Participants from South America were older, had higher insurance and literacy levels, and, along with Middle Eastern participants, were more likely to be on beta-blockers, but had the lowest proportion in NYHA IV. Ischemic heart disease was the most common HF etiology in all regions except Africa where hypertensive heart disease was most common. CONCLUSIONS INTER-CHF describes significant regional variability in socioeconomic and clinical factors, etiologies and treatments in HF patients from Africa, Asia, the Middle East and South America. Opportunities exist for improvement in health/medication insurance rates and proportions of patients on beta blockers, particularly in Africa and Asia.
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Ngaïdé AA, Mbaye A, Kane A, Ndiaye MB, Jobe M, Bodian M, Dioum M, Sarr SA, Aw F, Mbakop PS, Ba FG, Gaye ND, Tabane A, Bah MB, Coly SM, Diagne D, Diack B, Diao M, Kane A. Prevalence of rheumatic heart disease in Senegalese school children: a clinical and echocardiographic screening. HEART ASIA 2015; 7:40-5. [PMID: 27326219 DOI: 10.1136/heartasia-2015-010664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/01/2015] [Accepted: 11/03/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the prevalence of rheumatic heart disease (RHD) in schools (locally referred to as 'daaras') located in the city of Dakar and its suburbs using both clinical examination and echocardiography. METHODS This is a cross-sectional study conducted from 9 August to 24 December 2011 involving 2019 pupils, aged between 5 and 18 years selected from the 16 'daaras' of the Academic Inspectorate (Inspection d'Académie) of the city of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were collected and entered into a questionnaire designed for the study. The World Heart Federation criteria for echocardiographic diagnosis were used to diagnose RHD. p<0.05 was considered statistically significant in bivariate analysis. RESULTS About 60.1% of the pupils were men and the mean age was 9.7±3.3 years. 10 cases of definite RHD were detected, prevalence being 4.96 per 1000 (95% CI 2.4 to 9.1). This prevalence was five times higher with echocardiographic screening compared with clinical screening. 23 cases (11.4 per 1000) of borderline forms were detected. The populations at risk of definite RHD identified in our study were children over 14 years (p<0.001), those with recurrent sore throat (p=0.003) and those residing in the suburbs of the city of Dakar (p<0.001). CONCLUSION Our study shows a relatively high prevalence of RHD. Reducing its prevalence should focus on the implementation of appropriate policies, targeting at-risk populations and focusing on raising awareness and early detection.
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Affiliation(s)
| | - Alassane Mbaye
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
| | - Adama Kane
- Cardiology Department of Aristide Le Dantec Teaching Hospital, Dakar, Senegal; Unités de Formation et de Recherche (UFR), Santé Université Gaston Berger de Saint-Louis, Saint Louis, Sénégal
| | | | - Modou Jobe
- Cardiology Department of Aristide Le Dantec Teaching Hospital, Dakar, Senegal; Medical Research Council Unit, Atlantic Boulevard, Fajara, The Gambia
| | - Malick Bodian
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Momar Dioum
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Simon Antoine Sarr
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Fatou Aw
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | | | - Fatimata Gatta Ba
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Ngoné Diaba Gaye
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
| | - Alioune Tabane
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | | | - Sarah Mouna Coly
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Dior Diagne
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
| | - Bouna Diack
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
| | - Maboury Diao
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Abdoul Kane
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
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Heart failure in low- and middle-income countries: background, rationale, and design of the INTERnational Congestive Heart Failure Study (INTER-CHF). Am Heart J 2015; 170:627-634.e1. [PMID: 26386785 DOI: 10.1016/j.ahj.2015.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although heart failure (HF) has been referred to as a global epidemic, most HF information comes from high-income countries, with little information about low-income countries (LIC) and middle-income countries (MIC) in Africa, Asia, the Middle East, and South America, which make up the majority of the world's population. METHODS The INTERnational Congestive Heart Failure Study is a cohort study of 5,813 HF patients enrolled in 108 centers in 16 LIC and MIC. At baseline, data were recorded on sociodemographic and clinical risk factors, HF etiology, laboratory variables, management, and barriers to evidence-based HF care at the patient, physician, and system levels. We sought to enroll consecutive and consenting patients ≥18 years of age with a clinical diagnosis of HF seen in outpatient clinics (2/3 of patients) or inpatient hospital wards (1/3 of patients). Patients were followed up at 6 and 12 months post-enrollment to record clinical status, treatments, and clinical outcomes such as death and hospitalizations. In the 5,813 enrolled HF patients, the mean age was 59 ± 15 years, 40% were female, 62% had a history of hypertension, 30% had diabetes, 21% had prior myocardial infarction, 64% were recruited from outpatient clinics, 36% lived in rural areas, and 29% had HF with preserved left ventricular ejection fraction. CONCLUSIONS This unique HF registry aims to systematically gather information on sociodemographic and clinical risk factors, etiologies, treatments, barriers to evidence-based care, and outcomes of HF in LIC and MIC. This information will help improve the management of HF globally.
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Kavishe B, Biraro S, Baisley K, Vanobberghen F, Kapiga S, Munderi P, Smeeth L, Peck R, Mghamba J, Mutungi G, Ikoona E, Levin J, Bou Monclús MA, Katende D, Kisanga E, Hayes R, Grosskurth H. High prevalence of hypertension and of risk factors for non-communicable diseases (NCDs): a population based cross-sectional survey of NCDS and HIV infection in Northwestern Tanzania and Southern Uganda. BMC Med 2015; 13:126. [PMID: 26021319 PMCID: PMC4476208 DOI: 10.1186/s12916-015-0357-9] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/30/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is increasing in sub-Saharan Africa, but data available for intervention planning are inadequate. We determined the prevalence of selected NCDs and HIV infection, and NCD risk factors in northwestern Tanzania and southern Uganda. METHODS A population-based cross-sectional survey was conducted, enrolling households using multistage sampling with five strata per country (one municipality, two towns, two rural areas). Consenting adults (≥18 years) were interviewed using the WHO STEPS survey instrument, examined, and tested for HIV and diabetes mellitus (DM). Adjusting for survey design, we estimated population prevalences of hypertension, DM, obstructive pulmonary disease, cardiac failure, epilepsy and HIV, and investigated factors associated with hypertension using logistic regression. RESULTS Across strata, hypertension prevalence ranged from 16 % (95 % confidence interval (CI): 12 % to 22 %) to 17 % (CI: 14 % to 22 %) in Tanzania, and from 19 % (CI: 14 % to 26 %) to 26 % (CI: 23 % to 30 %) in Uganda. It was high in both urban and rural areas, affecting many young participants. The prevalence of DM (1 % to 4 %) and other NCDs was generally low. HIV prevalence ranged from 6 % to 10 % in Tanzania, and 6 % to 12 % in Uganda. Current smoking was reported by 12 % to 23 % of men in different strata, and 1 % to 3 % of women. Problem drinking (defined by Alcohol Use Disorder Identification Test criteria) affected 6 % to 15 % men and 1 % to 6 % women. Up to 46 % of participants were overweight, affecting women more than men and urban more than rural areas. Most patients with hypertension and other NCDs were unaware of their condition, and hypertension in treated patients was mostly uncontrolled. Hypertension was associated with older age, male sex, being divorced/widowed, lower education, higher BMI and, inversely, with smoking. CONCLUSIONS The high prevalence of NCD risk factors and unrecognized and untreated hypertension represent major problems. The low prevalence of DM and other preventable NCDs provides an opportunity for prevention. HIV prevalence was in line with national data. In Tanzania, Uganda and probably elsewhere in Africa, major efforts are needed to strengthen health services for the PREVENTION, early detection and treatment of chronic diseases.
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Affiliation(s)
- Bazil Kavishe
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania.
| | - Samuel Biraro
- MRC/UVRI Uganda Research Unit on AIDS / Uganda Virus Research Institute, Entebbe, Uganda.
| | - Kathy Baisley
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Fiona Vanobberghen
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania.
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania.
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Paula Munderi
- MRC/UVRI Uganda Research Unit on AIDS / Uganda Virus Research Institute, Entebbe, Uganda.
| | - Liam Smeeth
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Robert Peck
- Weill Bugando School of Medicine, Mwanza, Tanzania.
- Weill Cornell Medical College, New York, USA.
| | - Janneth Mghamba
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
| | | | | | - Jonathan Levin
- MRC/UVRI Uganda Research Unit on AIDS / Uganda Virus Research Institute, Entebbe, Uganda.
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | | | - David Katende
- MRC/UVRI Uganda Research Unit on AIDS / Uganda Virus Research Institute, Entebbe, Uganda.
| | - Edmund Kisanga
- Mwanza Intervention Trials Unit, National Institute for Medical Research, PO 11936, Mwanza, Tanzania.
| | - Richard Hayes
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Heiner Grosskurth
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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Ajayi OE, Abiodun OO, Akintomide AO, Adebayo RA, Ogunyemi SA, Balogun MO, Bamikole OJ, Ajibare AO, Ajayi AA. Pattern of arrhythmias among Nigerians with congestive heart failure. Int J Gen Med 2015; 8:125-30. [PMID: 25870514 PMCID: PMC4381882 DOI: 10.2147/ijgm.s73216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background In patients with heart failure, death is often sudden due to life-threatening arrhythmias. This work was carried out to evaluate the pattern of arrhythmias in Nigerians with heart failure. Materials and methods Thirty subjects with congestive heart failure (CHF), 30 subjects with hypertensive heart disease, and 15 normal subjects with no obvious features of heart disease were evaluated with resting and 24-hour electrocardiographic monitoring and transthoracic echocardiography. Data were analyzed with one-way analysis of variance with post hoc Duncan’s analysis, Fisher’s exact test, and linear regression analysis using SPSS version 16. Results CHF subjects had more instances of supraventricular tachycardia (P=0.005), ventricular extrasystoles (P<0.001), bigeminy (P<0.001), trigeminy (P<0.001), couplets (P<0.001), triplets (P<0.001), and nonsustained ventricular tachycardia (VT) (P=0.003) than the other two control groups. They also showed a significantly longer VT duration (4.6±5.6 seconds) compared with the other groups (P<0.001). Linear regression analysis showed a significant direct relationship between VT and the maximum number of ventricular extrasystoles per hour (P=0.001). Conclusion Cardiac arrhythmias are common in subjects with CHF and are more frequent when compared with patients with hypertensive heart disease and normal subjects.
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Affiliation(s)
- Olufemi E Ajayi
- Cardiac care unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, USA
| | - Olugbenga O Abiodun
- Cardiac care unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, USA
| | - Anthony O Akintomide
- Cardiac care unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, USA
| | - Rasaaq A Adebayo
- Cardiac care unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, USA
| | - Suraj A Ogunyemi
- Cardiac care unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, USA
| | - Michael O Balogun
- Cardiac care unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, USA
| | - Olaniyi J Bamikole
- Cardiac care unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, USA
| | - Adeola O Ajibare
- Cardiac care unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria, USA
| | - Adesuyi A Ajayi
- Texas Southern University, Houston, TX, USA ; The Saba University School of Medicine, The Bottom, Saba, Dutch Caribbean
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Abstract
Heart failure with preserved ejection fraction (HFPEF) is a common condition, and the prevalence is projected to increase further. Studies differ in the reported incidence and mortality associated with this condition, although there is agreement that between a third and one-half of all patients with heart failure have HFPEF. Although several consensus statements and guidelines have been published, some recent randomized clinical trials have reported low mortality, raising doubts about whether all patients diagnosed with HFPEF have HFPEF or whether the condition is heterogeneous in its cause and prognosis. The overall reported prognosis of patients with HFPEF remains poor.
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Affiliation(s)
- Charlotte Andersson
- Framingham Heart Study, Mt Wayte Avenue 73, Suite 2, Framingham, MA 01702-5827, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA; Department of Cardiology, Gentofte Hospital, Niels Andersens vej 65, Hellerup 2900, Denmark.
| | - Ramachandran S Vasan
- Framingham Heart Study, Mt Wayte Avenue 73, Suite 2, Framingham, MA 01702-5827, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue, Suite 470, Boston, MA 02118, USA; Section of Cardiology, Boston University School of Medicine, 801 Massachussetts Avenue, Suite 470, Boston, MA 02118, USA
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