1
|
Shehu MN, Adamu UG, Ojji DB, Ogah OS, Sani MU. The Pandemic of Coronary Artery Disease in the Sub-Saharan Africa: What Clinicians Need to Know. Curr Atheroscler Rep 2023; 25:571-578. [PMID: 37606811 DOI: 10.1007/s11883-023-01136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally with an accelerated increase in CVD‑related death in Africa and other low‑middle‑income countries. This review is aimed at highlighting the burden of coronary artery disease CAD, its peculiarities as well as challenges of management in sub-Saharan Africa. RECENT FINDINGS Recent data revealed a shift from high incidence of CVDs associated with poverty and malnutrition (such as rheumatic heart disease) initially, which are now falling, to rising incidence of other non-communicable CVDs (such as hypertension, coronary artery disease (CAD), and heart failure). Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide, which is projected to supersede communicable diseases in the future. Previous studies have shown that CAD was rare among Africans. Those studies conducted in Africa in the 1940s-1960s reported that Black Africans were almost immune to developing CAD and were even thought to have specific genetic make-up protecting them from CAD. However, the continent is now experiencing a steady rise in the prevalence of CAD associated with severe disease burden, compared to other regions of the world. The changes seen have been attributed to the current epidemiological transition with increase in CVD risk factors that are poorly controlled, lack of awareness as well as the poor health facilities to tackle the menace of the disease. The Global Burden of Disease (GBD) estimates have also shown that over the past three decades the highest contribution to CVD burden in Africa is attributed to atherosclerotic diseases, with 71.4, 37.7, and 154% increases in the burden of ischemic heart disease, stroke, and peripheral artery disease respectively. There is a steady increase of CAD prevalence in Africa as a result of increase in CV risk factors. Hypertension, obesity, diabetes, dyslipidemia, and cigarette smoking are the rapidly rising risk factors for CAD on the continent. Africa also faces challenges in diagnosis and management of CAD. There is need for increased public and health personnel awareness on prevention and control of commonly identifiable risk factors, provision of prehospital emergency services, and provision of modern therapeutic facilities for treatment of CAD including reperfusion therapy. These are priority areas where efforts could be intensified in the future with potential to improve the current rate of progress of the disease on the continent.
Collapse
Affiliation(s)
- Muhammad N Shehu
- Department of Internal Medicine, General Amadi Rimi Specialist Hospital Katsina, Batagarawa, Nigeria
| | - Umar G Adamu
- Department of Internal Medicine, Federal Medical Centre, Bida, Niger State, Nigeria
| | - Dike B Ojji
- Department of Internal Medicine, University of Abuja, Teaching Hospital, Abuja, Nigeria
| | - Okechukwu S Ogah
- Department of Internal Medicine, University College Hospital, Ibadan, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria.
| |
Collapse
|
2
|
Amaechi UM, Chukwudum E, Aiwuyo HO, Ilerhunmwuwa N, Osarenkhoe JO, Kweki AG, Onuwaje OE, Obilahi JO, Irabor GI, Attuquayefio S. Clinical and Echocardiographic Correlates of Iron Status in Chronic Heart Failure Patients: A Cross-Sectional Descriptive Study. Cureus 2023; 15:e39998. [PMID: 37415988 PMCID: PMC10321567 DOI: 10.7759/cureus.39998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Chronic heart failure (HF) is one of the conditions commonly seen in the medical outpatient departments, and iron deficiency (ID) has been reported as the commonest nutritional deficiency in these patients. The presence of ID may interfere with the clinical parameters of chronic HF. The relationship between iron status and chronic HF needs more attention and should be given more consideration in the evaluation of patients with chronic HF. AIM The aim of the study was to determine the relationship, if any, between iron status and clinical/echocardiographic variables in chronic HF. METHODS AND MATERIALS A cross-sectional descriptive study was carried out at the Lagos University Teaching Hospital (LUTH), Nigeria, where 88 patients with chronic HF were recruited to participate in this study. The participants underwent clinical and laboratory assessments. Iron status was assessed with full blood count parameters; serum ferritin and transferrin saturation (Tsat) and its relationship with clinical parameters among these participants were also studied. RESULTS No correlations existed between the duration of chronic HF and iron status when compared using Tsat. However, a significant weak negative correlation was observed between the duration of HF and the serum ferritin levels. The clinical characteristics of the HF participants with and without ID were compared. There was no significant difference in the frequency of prior hospitalization in both groups. However, a higher proportion of participants with severe HF (New York Heart Association (NYHA) classes III/IV) (n = 14; 46.7%) were iron-deficient compared to those with moderate chronic HF (NYHA II) (n = 11; 36.7%). This relationship was statistically significant. Left ventricular ejection fraction (LVEF) was similar in the iron-deficient and iron-replete groups (using serum ferritin or Tsat) both when compared as means and when compared after categorizing LVEF as HF with preserved ejection fraction (HFpEF) vs HF with reduced ejection fraction (HFrEF). There was no statistically significant correlation between the severity of ID and LVEF. Conclusion: A spectrum of clinical changes occurs in patients with chronic HF. ID can make these changes more profound and the condition less amenable to standard HF treatments. These patients may therefore benefit from further evaluation for this nutritional deficiency. Laboratory measurements including Tsat and serum ferritin may help in further assessment of select patients with worse and/or non-responsive clinical parameters.
Collapse
Affiliation(s)
| | | | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital and Medical Center, New York, USA
| | | | - John O Osarenkhoe
- Medicine and Surgery, Igbinedion University Teaching Hospital, Benin City, NGA
| | - Anthony G Kweki
- Internal Medicine and Cardiology, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, GBR
| | | | | | | | | |
Collapse
|
3
|
Akintunde A, Aworanti O. PATTERN OF ANAEMIA AND ITS CORRELATES IN NIGERIANS WITH HEART FAILURE. Ann Ib Postgrad Med 2020; 18:51-59. [PMID: 33623494 PMCID: PMC7893304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Heart failure often coexists with many comorbidities, including anaemia. However, the pattern of anaemia in heart failure and its clinical and echocardiographic associations have not been adequately studied among Nigerians. OBJECTIVE To describe the pattern of anaemia, its clinical characteristics, and its echocardiographic associations among heart failure subjects in Nigeria. METHODOS One hundred and forty subjects with heart failure were recruited from the cardiology clinics of two teaching hospitals in southwest Nigeria: Ladoke Akintola University of Technology and Bowen University Teaching Hospitals, Ogbomoso. Complete blood analyses, among other tests, were done. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) 20.0. P <0.05 was taken as statistically significant. RESULTS Anaemia, as defined by the World Health Organisation, occurred in 106 (75.7%) of the heart failure patients. The patterns of anaemia among participants include combined anaemia of chronic diseases (ACD) with iron deficiency in 64 (45.7%) patients, and ACD alone in 40 (28.6%). Anaemia was more significantly associated with previous diagnosis of diabetes mellitus, presence of pulmonary hypertension, and heart failure with reduced ejection fraction. Mean systolic and diastolic blood pressures, ejection fraction, and fractional shortening were significantly lower among heart failure subjects with anaemia, while serum creatinine, left atrial dimension, left ventricular end diastolic dimension, and left ventricular mass index were significantly higher among heart failure subjects with anaemia compared to those without anaemia. CONCLUSION Anaemia occurs very frequently among heart failure patients in southwest Nigeria. It is associated with many poor prognostic factors, including diabetes mellitus, pulmonary hypertension, and kidney failure.
Collapse
Affiliation(s)
- A.A. Akintunde
- Cardiology Unit, Department of Medicine, LAUTECH Teaching Hospital, Ogbomoso & Department of Medicine, Faculty of Clinical Sciences, LAUTECH, Osogbo, Nigeria.,Goshen Heart Clinic, Osogbo, Nigeria
| | - O.W. Aworanti
- Department of Haematology & Blood Transfusion, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Huson MAM, Kaminstein D, Kahn D, Belard S, Ganesh P, Kandoole-Kabwere V, Wallrauch C, Phiri S, Kreuels B, Heller T. Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa. Ultrasound J 2019; 11:34. [PMID: 31883027 PMCID: PMC6934640 DOI: 10.1186/s13089-019-0149-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background Point-of-care ultrasound is increasingly being used as a diagnostic tool in resource-limited settings. The majority of existing ultrasound protocols have been developed and implemented in high-resource settings. In sub-Saharan Africa (SSA), patients with heart failure of various etiologies commonly present late in the disease process, with a similar syndrome of dyspnea, edema and cardiomegaly on chest X-ray. The causes of heart failure in SSA differ from those in high-resource settings. Point-of-care ultrasound has the potential to identify the underlying etiology of heart failure, and lead to targeted therapy. Based on a literature review and weighted score of disease prevalence, diagnostic impact and difficulty in performing the ultrasound, we propose a context-specific cardiac ultrasound protocol to help differentiate patients presenting with heart failure in SSA. Results Pericardial effusion, dilated cardiomyopathy, cor pulmonale, mitral valve disease, and left ventricular hypertrophy were identified as target conditions for a focused ultrasound protocol in patients with cardiac failure and cardiomegaly in SSA. By utilizing a simplified 5-question approach with all images obtained from the subxiphoid view, the protocol is suitable for use by health care professionals with limited ultrasound experience. Conclusions The “Cardiac ultrasound for resource-limited settings (CURLS)” protocol is a context-specific algorithm designed to aid the clinician in diagnosing the five most clinically relevant etiologies of heart failure and cardiomegaly in SSA. The protocol has the potential to influence treatment decisions in patients who present with clinical signs of heart failure in resource-limited settings outside of the traditional referral institutions.
Collapse
Affiliation(s)
- Michaëla A M Huson
- Department of Microbiology and Infectious Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Dan Kaminstein
- Department of Emergency Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Daniel Kahn
- Department of Internal Medicine, University of California, Los Angeles, CA, USA
| | - Sabine Belard
- Department of Paediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Prakash Ganesh
- Lighthouse Clinic, Kamuzu Central Hospital, Lilongwe, Malawi.,International Training and Education Centre for Health, University of Washington, Seattle, WA, USA
| | | | - Claudia Wallrauch
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany
| | - Sam Phiri
- Lighthouse Clinic, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.,Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Lilongwe, Malawi
| | - Benno Kreuels
- Department of Internal Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.,Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tom Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Lilongwe, Malawi.
| |
Collapse
|
6
|
Hertz JT, Sakita FM, Limkakeng AT, Mmbaga BT, Appiah LT, Bartlett JA, Galson SW. The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study. Afr J Emerg Med 2019; 9:180-184. [PMID: 31890481 PMCID: PMC6933214 DOI: 10.1016/j.afjem.2019.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/26/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction The prevalence of cardiovascular disease in sub-Saharan Africa is substantial and growing. Much remains to be learned about the relative burden of acute coronary syndrome (ACS), heart failure, and stroke on emergency departments and hospital admissions. Methods A retrospective chart review of admissions from September 2017 through March 2018 was conducted at the emergency department of a tertiary care center in northern Tanzania. Stroke admission volume was compared to previously published data from the same hospital and adjusted for population growth. Results Of 2418 adult admissions, heart failure and stroke were the two most common admission diagnoses, accounting for 294 (12.2%) and 204 (8.4%) admissions, respectively. ACS was uncommon, accounting for 9 (0.3%) admissions. Of patients admitted for heart failure, uncontrolled hypertension was the most commonly identified etiology of heart failure, cited in 124 (42.2%) cases. Ischemic heart disease was cited as the etiology in only 1 (0.3%) case. Adjusting for population growth, the annual volume of stroke admissions increased 70-fold in 43 years, from 2.9 admissions per 100,000 population in 1974 to 202.2 admissions per 100,000 in 2017. Conclusions The burden of heart failure and stroke on hospital admissions in Tanzania is substantial, and the volume of stroke admissions is rising precipitously. ACS is a rare diagnosis, and the distribution of cardiovascular disease phenotypes in Tanzania differs from what has been observed outside of Africa. Further research is needed to ascertain the reasons for these differences. In northern Tanzania, acute coronary syndrome is a rare admission diagnosis Heart failure and stroke are the most common admission diagnoses The burden of stroke admissions in this community is rising rapidly
Collapse
Affiliation(s)
- Julian T. Hertz
- Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Durham, NC 27710, United States of America
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, United States of America
- Corresponding author at: Duke Global Health Institute, Box 102359, Duke University, Durham, NC 27710, United States of America.
| | - Francis M. Sakita
- Department of Emergency Medicine, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania
| | - Alexander T. Limkakeng
- Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Durham, NC 27710, United States of America
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Research Institute, Kilimanjaro Christian Medical University, PO Box 3010, Moshi, Tanzania
| | - Lambert T. Appiah
- Department of Cardiology, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
| | - John A. Bartlett
- Duke Global Health Institute, 310 Trent Drive, Durham, NC 27710, United States of America
| | - Sophie W. Galson
- Division of Emergency Medicine, Duke University, 2301 Erwin Rd, Durham, NC 27710, United States of America
| |
Collapse
|
7
|
Faduyile FA, Soyemi SS, Sanni DA, Wright KO. Hypertension and Sudden Unexpected Deaths: An Autopsy Study of Four Hundred and Seventy-Seven Brought-in-Dead in a Tertiary Health Center. Niger Med J 2019; 60:13-16. [PMID: 31413429 PMCID: PMC6676999 DOI: 10.4103/nmj.nmj_6_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Hypertension is an important and major public health concern globally. One of the major causes of sudden death worldwide is hypertension. This study is to present the morphological pattern of deaths at autopsy of those patients who were brought-in-dead (BID) and who had hypertensive heart disease (HHD) as the underlying illness. Materials and Methods This is a 6-year retrospective autopsy study of BID patients as a result of HHD seen at our department between January 1, 2010, and December 31, 2015. The autopsy findings and data retrieved were analyzed using IBM Statistical Package for Social Sciences version 20. Test for statistical significance was set at P < 0.05. Results A total of 477 deaths (44%) as a result of HHD were recorded out of the 1016 BID during the period under study. The age ranged from 21 to 92 years with a mean age of 52 ± 14.0 years and a male to female ratio of 1.8:1. The 5th decade of life was the most common age group encountered. The most common cause of death was acute left ventricular failure (67.8%), and myocardial infarction was the least common (1.7%). Conclusions Acute left ventricular heart failure was the most common cause of sudden death as a result of hypertension and was followed by intracerebral hemorrhage. In the female gender, sudden deaths were most common in the 6th decade and in the male gender most sudden deaths were seen in the 5th decade.
Collapse
Affiliation(s)
- Francis Adedayo Faduyile
- Department of Pathology and Forensic Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Sunday Sokunle Soyemi
- Department of Pathology and Forensic Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Daniel Ayodele Sanni
- Department of Pathology and Forensic Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Kikelomo Ololade Wright
- Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| |
Collapse
|
8
|
Adeloye D, Ezejimofor M, Auta A, Mpazanje RG, Ezeigwe N, Ngige EN, Harhay MO, Alemu W, Adewole IF. Estimating morbidity due to stroke in Nigeria: a systematic review and meta-analysis. J Neurol Sci 2019; 402:136-144. [PMID: 31151064 DOI: 10.1016/j.jns.2019.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/15/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The response to stroke in Nigeria is impaired by inadequate epidemiologic information. We sought to collate available evidence and estimate the incidence of stroke and prevalence of stroke survivors in Nigeria. METHODS Using random effects meta-analysis, we pooled nationwide and regional incidence and prevalence of stroke from the estimates reported in each study. RESULTS Eleven studies met our selection criteria. The pooled crude incidence of stroke in Nigeria was 26.0 (12.8-39.0) /100,000 person-years, with this higher among men at 34.1 (9.7-58.4) /100,000, compared to women at 21.2 (7.4-35.0) /100,000. The pooled crude prevalence of stroke survivors in Nigeria was 6.7 (5.8-7.7) /1000 population, with this also higher among men at 6.4 (5.1-7.6) /1000, compared to women at 4.4 (3.4-5.5) /1000. In the period 2000-2009, the incidence of stroke in Nigeria was 24.3 (95% CI: 11.9-36.8) per 100,000, with this increasing to 27.4 (95% CI: 2.2-52.7) per 100,000 from 2010 upwards. The prevalence of stroke survivors increased minimally from 6.0 (95% CI: 4.6-7.5) per 1000 to 7.5 (95% CI: 5.8-9.1) per 1000 over the same period. The prevalence of stroke survivors was highest in the South-south region at 13.4 (9.1-17.8) /100,000 and among rural dwellers at 10.8 (7.5-14.1) /100,000. CONCLUSION Although study period does not appear to contribute substantially to variations in stroke morbidity in Nigeria, an increasing number of new cases compared to survivors may be due in part to limited door-door surveys, or possibly reflects an increasing mortality from stroke in the country.
Collapse
Affiliation(s)
- Davies Adeloye
- Centre for Global Health Research, Usher Institute, University of Edinburgh, UK; RcDavies Evidence-based Medicine, Lagos, Nigeria.
| | | | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Fylde Road, Preston, UK
| | | | | | | | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA; Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Odunaiya NA, Akinpelu AO, Ogwu S, Aje A. Healthcare professionals' perception of quality of care of patients with cardiac disease in Nigeria: Implication for clinical guideline, inter-professional education and team work. Malawi Med J 2019; 31:31-38. [PMID: 31143394 PMCID: PMC6526338 DOI: 10.4314/mmj.v31i1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Heart disease is one of the leading chronic conditions posing a major and growing threat to the public. Studies on quality of care given to patients with heart diseases in Nigeria are not available. The purpose of this study was to explore healthcare professionals' perception of quality of care of patients with heart disease at a tertiary hospital in Nigeria. Methods A mixed method design was utilized in this study. Twenty eight healthcare professionals consisting of cardiologists, nurses, physiotherapists and dieticians were recruited into the study through purposive sampling technique. A questionnaire developed and validated from existing questionnaire was used to survey the health care professionals' perception of care and qualitative design was further used to explore their perceptions of care. The data were analyzed using descriptive statistics of percentages and graphs. The qualitative data were analyzed using thematic analysis. Quality of care was assessed through structure, process and outcome of care indices. Results The mean age of the healthcare professionals was 38.46±8.988 years. 19 (66.7%) reported that there were treatment guidelines for cardiac disease management but there was no system for internal quality assurance. 18 (95%) out of these 19 healthcare professionals reported that the treatment guidelines were either never applied or not applied regularly during treatment. Other areas that were perceived as poor were poor teamwork, poor staff strength, inadequate equipment, and inadequate consultation with staff during procurement of medical supplies. Conclusion Quality of care for cardiac patients in a Nigerian tertiary hospital was perceived as sub-optimal. There is a need for the improvement of the structure and process of quality of care to enhance quality of care for cardiac patients in Nigeria.
Collapse
Affiliation(s)
| | | | - Susan Ogwu
- Department of Physiotherapy, University of Ibadan
| | - Akinuemi Aje
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
11
|
Akpa MR, Iheji O. Short-term rehospitalisation or death and determinants after admission for acute heart failure in a cohort of African patients in Port Harcourt, southern Nigeria. Cardiovasc J Afr 2019; 29:46-50. [PMID: 29582879 PMCID: PMC6002800 DOI: 10.5830/cvja-2017-038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/12/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart failure (HF) is a major health burden globally and contributes significantly to morbidity and mortality related to cardiovascular disease. The aim of this study was to determine the outcome, and factors determining these outcomes in patients admitted for acute HF and followed up for six months. METHOD This was a hospital-based, prospective study. Subjects included consecutive patients with a confirmed diagnosis of acute HF admitted to the medical wards of the University of Port Harcourt Teaching Hospital (UPTH) in Nigeria over one year. All had a full physical examination and relevant investigations, including echocardiography. Subjects were followed up for six months and reassessed for outcome/endpoint, which was rehospitalisation or death. Factors that predicted these outcomes were also determined. RESULTS There were 160 subjects, 84 females and 76 males, age range 20 to 87 years, mean age 52.49 ± 13.89 years. Sixteen subjects (10.0%) were lost to follow up, 66 (41.3%) showed clinical improvement, 57 (35.6%) were rehospitalised, while 21 (13.1%) died. Determinants of rehospitalisation were New York Heart Association (NYHA) class, heart failure type, haemoglobin level at presentation and estimated glomerular filtration rate (eGFR). Determinants of mortality were NYHA class and haemoglobin level at presentation. CONCLUSION Heart failure rehospitalisation and mortality rates of 35.6 and 13.1%, respectively, were high compared to developed countries.
Collapse
Affiliation(s)
- Maclean R Akpa
- Cardiovascular Division, Department of Internal Medicine, Faculty of Clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria. ; ;
| | - Okechukwu Iheji
- Cardiovascular Division, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| |
Collapse
|
12
|
Makubi A, Lwakatare J, Ogah OS, Rydén L, Lund LH, Makani J. Anaemia and iron deficiency in heart failure: epidemiological gaps, diagnostic challenges and therapeutic barriers in sub-Saharan Africa. Cardiovasc J Afr 2018; 28:331-337. [PMID: 29144533 PMCID: PMC5730725 DOI: 10.5830/cvja-2017-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 01/02/2017] [Indexed: 11/06/2022] Open
Abstract
Anaemia and iron deficiency (ID) are common and of prognostic importance in heart failure (HF). In both conditions the epidemiology, diagnosis and therapies have been extensively studied in high-income countries but are still largely unexplored in sub-Saharan Africa (SSA). The lack of adequate and robust epidemiological data in SSA makes it difficult to recognise the significance of anaemia and ID in HF. From a clinical perspective, less attention is paid by clinicians to screening for anaemia in HF, and as far as interventions are concerned, there are no clinical trials in SSA that provide guidance on the appropriate interventional approach. Therefore studies are needed to provide more insight into the burden and peculiarities of and intervention for anaemia and ID in HF in SSA, where the pathophysiology might be different from that in high-income countries. There is increasing appreciation that targeting ID may serve as a useful additional treatment strategy for patients with chronic HF in high-income countries. However, there is limited information on the diagnosis of and therapy for ID in HF in SSA, where infections and malnutrition are more likely to influence the situation. This article reviews the present epidemiological gap in knowledge about anaemia and ID in HF, as well as the diagnostic and therapeutic challenges in SSA.
Collapse
Affiliation(s)
- Abel Makubi
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden; Muhimbili National Hospital, Dar es Salaam, Tanzania.
| | - Johnson Lwakatare
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Lars Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars H Lund
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Julie Makani
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Muhimbili National Hospital, Dar es Salaam, Tanzania; Nuffield Department of Clinical Medicine, University of Oxford, London, United Kingdom
| |
Collapse
|
13
|
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]
|
14
|
Nyaga UF, Bigna JJ, Agbor VN, Essouma M, Ntusi NA, Noubiap JJ. Data on the epidemiology of heart failure in Sub-Saharan Africa. Data Brief 2018; 17:1218-1239. [PMID: 29876481 PMCID: PMC5988512 DOI: 10.1016/j.dib.2018.01.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 12/04/2022] Open
Abstract
In Sub-Saharan Africa (SSA), chronic non-communicable diseases and cardiovascular diseases in particular, are progressively taking over infectious diseases as the leading cause of morbidity and mortality. Heart failure is a major public health problem in the region. We summarize here available data on the prevalence, aetiologies, treatment, rates and predictors of mortality due to heart failure in SSA.
Collapse
Affiliation(s)
- Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Joel Bigna
- Faculty of Medicine, University of Paris Sud XI, Le Kremlin Bicêtre, Paris, France
| | | | - Mickael Essouma
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ntobeko A.B. Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Center, University of Cape Town, Cape Town, South Africa
| | - Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
15
|
Mene-Afejuku TO, Balogun MO, Akintomide AO, Adebayo RA, Ajayi OE, Amadi VN, Oketona OA, Ikwu AN, Mene-Afejuku B, Bamikole OJ. Clinical and Echocardiographic Predictors of Arrhythmias Detected With 24-Hour Holter Electrocardiography Among Hypertensive Heart Failure Patients in Nigeria. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2017; 11:1179546817746632. [PMID: 29270037 PMCID: PMC5731613 DOI: 10.1177/1179546817746632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 11/07/2017] [Indexed: 01/14/2023]
Abstract
Background Hypertensive heart failure (HHF) is the commonest form of heart failure in Nigeria. There is paucity of data in Nigeria on 24-hour Holter electrocardiography (24-HHECG) and important predictors of arrhythmias among HHF patients. Objectives To determine the 24-HHECG characteristics among HHF patients. To determine the clinical and echocardiographic predictors of arrhythmias detected using 24-HHECG among HHF patients. Methods A total of 100 HHF patients as well as 50 age-matched and sex-matched apparently healthy controls were prospectively recruited over a period of 1 year. They all had baseline laboratory tests, echocardiography, and 24-HHECG. Results Hypertensive heart failure patients had significantly higher counts of premature ventricular contractions (PVCs) than the controls (P ≤ .001). Ventricular tachycardia (VT) was recorded in 29% of HHF patients as compared with controls who had no VT on 24-HHECG. The standard deviation of all normal to normal sinus RR intervals over 24 hours (SDNN) was abnormally reduced among HHF patients when compared with controls (P = .046). There was positive correlation between atrial fibrillation (AF) and the following parameters: PVCs (r = .229, P = .015), New York Heart Association (NYHA) (r = .196, P = .033), and VT (r = .223, P = .018). Following multiple linear regression, left ventricular ejection fraction (LVEF) (P ≤ .001) and serum urea (P = .037) were predictors of PVCs among HHF patients. Serum creatinine (P ≤ .001), elevated systolic blood pressure (SBP) (P = .005), and PVCs (P ≤ .001) were important predictors of VT among HHF patients. Conclusions Renal dysfunction and reduced LVEF were important predictors of ventricular arrhythmias. High counts of PVCs and elevated SBP were predictive of the occurrence of VT among HHF patients. The NYHA class and ventricular arrhythmias have a significant positive correlation with AF. The SDNN is reduced in HHF patients.
Collapse
Affiliation(s)
| | - Michael Olabode Balogun
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Anthony Olubunmi Akintomide
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Rasaaq Ayodele Adebayo
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olufemi Eyitayo Ajayi
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Valentine N Amadi
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Omolola Abiodun Oketona
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Amanze Nkemjika Ikwu
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Bamidele Mene-Afejuku
- Faculty of Dentistry, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olaniyi James Bamikole
- Cardiology Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
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.
Collapse
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
Collapse
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
| | | | | |
Collapse
|
18
|
Kwan GF, Mayosi BM, Mocumbi AO, Miranda JJ, Ezzati M, Jain Y, Robles G, Benjamin EJ, Subramanian SV, Bukhman G. Endemic Cardiovascular Diseases of the Poorest Billion. Circulation 2016; 133:2561-75. [PMID: 27297348 DOI: 10.1161/circulationaha.116.008731] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The poorest billion people are distributed throughout the world, though most are concentrated in rural sub-Saharan Africa and South Asia. Cardiovascular disease (CVD) data can be sparse in low- and middle-income countries beyond urban centers. Despite this urban bias, CVD registries from the poorest countries have long revealed a predominance of nonatherosclerotic stroke, hypertensive heart disease, nonischemic and Chagas cardiomyopathies, rheumatic heart disease, and congenital heart anomalies, among others. Ischemic heart disease has been relatively uncommon. Here, we summarize what is known about the epidemiology of CVDs among the world’s poorest people and evaluate the relevance of global targets for CVD control in this population. We assessed both primary data sources, and the 2013 Global Burden of Disease Study modeled estimates in the world’s 16 poorest countries where 62% of the population are among the poorest billion. We found that ischemic heart disease accounted for only 12% of the combined CVD and congenital heart anomaly disability-adjusted life years (DALYs) in the poorest countries, compared with 51% of DALYs in high-income countries. We found that as little as 53% of the combined CVD and congenital heart anomaly burden (1629/3049 DALYs per 100 000) was attributed to behavioral or metabolic risk factors in the poorest countries (eg, in Niger, 82% of the population among the poorest billion) compared with 85% of the combined CVD and congenital heart anomaly burden (4439/5199 DALYs) in high-income countries. Further, of the combined CVD and congenital heart anomaly burden, 34% was accrued in people under age 30 years in the poorest countries, while only 3% is accrued under age 30 years in high-income countries. We conclude although the current global targets for noncommunicable disease and CVD control will help diminish premature CVD death in the poorest populations, they are not sufficient. Specifically, the current framework (1) excludes deaths of people <30 years of age and deaths attributable to congenital heart anomalies, and (2) emphasizes interventions to prevent and treat conditions attributed to behavioral and metabolic risks factors. We recommend a complementary strategy for the poorest populations that targets premature death at younger ages, addresses environmental and infectious risks, and introduces broader integrated health system interventions, including cardiac surgery for congenital and rheumatic heart disease.
Collapse
Affiliation(s)
- Gene F Kwan
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.).
| | - Bongani M Mayosi
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| | - Ana O Mocumbi
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| | - J Jaime Miranda
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| | - Majid Ezzati
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| | - Yogesh Jain
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| | - Gisela Robles
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| | - Emelia J Benjamin
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| | - S V Subramanian
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| | - Gene Bukhman
- From Department of Medicine, Boston University School of Medicine, MA (G.F.K.); Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA (G.F.K., G.B.); Partners In Health, Boston, MA (G.F.K., G.B.); Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (B.M.M.); Universidade Eduardo Mondlane and the Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Department of Medicine, School of Medicine Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (J.J.M.); MRC-PHE Centre for Environment and Health, and Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, UK (M.E.); Jan Swasthya Sahyog, Village and Post Ganiyari, Bilaspur (Chhattisgarh), India (Y.J.); Oxford Department of International Development, University of Oxford, UK (G.R.); Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.); Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (S.V.S.); and Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA (G.B.)
| |
Collapse
|
19
|
Bloomfield GS, Alenezi F, Barasa FA, Lumsden R, Mayosi BM, Velazquez EJ. Human Immunodeficiency Virus and Heart Failure in Low- and Middle-Income Countries. JACC-HEART FAILURE 2016; 3:579-90. [PMID: 26251085 DOI: 10.1016/j.jchf.2015.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/29/2015] [Accepted: 05/01/2015] [Indexed: 12/11/2022]
Abstract
Successful combination therapy for human immunodeficiency virus (HIV) has transformed this disease from a short-lived infection with high mortality to a chronic disease associated with increasing life expectancy. This is true for high- as well as low- and middle-income countries. As a result of this increased life expectancy, people living with HIV are now at risk of developing other chronic diseases associated with aging. Heart failure has been common among people living with HIV in the eras of pre- and post- availability of antiretroviral therapy; however, our current understanding of the pathogenesis and approaches to management have not been systematically addressed. HIV may cause heart failure through direct (e.g., viral replication, mitochondrial dysfunction, cardiac autoimmunity, autonomic dysfunction) and indirect (e.g., opportunistic infections, antiretroviral therapy, alcohol abuse, micronutrient deficiency, tobacco use) pathways. In low- and middle-income countries, 2 large observational studies have recently reported clinical characteristics and outcomes in these patients. HIV-associated heart failure remains a common cardiac diagnosis in people living with heart failure, yet a unifying set of diagnostic criteria is lacking. Treatment patterns for heart failure fall short of society guidelines. Although there may be promise in cardiac glycosides for treating heart failure in people living with HIV, clinical studies are needed to validate in vitro findings. Owing to the burden of HIV in low- and middle-income countries and the concurrent rise of traditional cardiovascular risk factors, strategic and concerted efforts in this area are likely to impact the care of people living with HIV around the globe.
Collapse
Affiliation(s)
- Gerald S Bloomfield
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina.
| | - Fawaz Alenezi
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Felix A Barasa
- Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rebecca Lumsden
- School of Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
20
|
Kimani K, Namukwaya E, Grant L, Murray SA. What is known about heart failure in sub-Saharan Africa: a scoping review of the English literature. BMJ Support Palliat Care 2016; 7:122-127. [DOI: 10.1136/bmjspcare-2015-000924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 11/10/2015] [Accepted: 12/17/2015] [Indexed: 11/03/2022]
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Callender T, Woodward M, Roth G, Farzadfar F, Lemarie JC, Gicquel S, Atherton J, Rahimzadeh S, Ghaziani M, Shaikh M, Bennett D, Patel A, Lam CSP, Sliwa K, Barretto A, Siswanto BB, Diaz A, Herpin D, Krum H, Eliasz T, Forbes A, Kiszely A, Khosla R, Petrinic T, Praveen D, Shrivastava R, Xin D, MacMahon S, McMurray J, Rahimi K. Heart failure care in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001699. [PMID: 25117081 PMCID: PMC4130667 DOI: 10.1371/journal.pmed.1001699] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 06/24/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Heart failure places a significant burden on patients and health systems in high-income countries. However, information about its burden in low- and middle-income countries (LMICs) is scant. We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs. METHODS AND FINDINGS Medline, Embase, Global Health Database, and World Health Organization regional databases were searched for studies from LMICs published between 1 January 1995 and 30 March 2014. Additional unpublished data were requested from investigators and international heart failure experts. We identified 42 studies that provided relevant information on acute hospital care (25 LMICs; 232,550 patients) and 11 studies on the management of chronic heart failure in primary care or outpatient settings (14 LMICs; 5,358 patients). The mean age of patients studied ranged from 42 y in Cameroon and Ghana to 75 y in Argentina, and mean age in studies largely correlated with the human development index of the country in which they were conducted (r = 0.71, p<0.001). Overall, ischaemic heart disease was the main reported cause of heart failure in all regions except Africa and the Americas, where hypertension was predominant. Taking both those managed acutely in hospital and those in non-acute outpatient or community settings together, 57% (95% confidence interval [CI]: 49%-64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% CI: 28%-41%) with beta-blockers, and 32% (95% CI: 25%-39%) with mineralocorticoid receptor antagonists. Mean inpatient stay was 10 d, ranging from 3 d in India to 23 d in China. Acute heart failure accounted for 2.2% (range: 0.3%-7.7%) of total hospital admissions, and mean in-hospital mortality was 8% (95% CI: 6%-10%). There was substantial variation between studies (p<0.001 across all variables), and most data were from urban tertiary referral centres. Only one population-based study assessing incidence and/or prevalence of heart failure was identified. CONCLUSIONS The presentation, underlying causes, management, and outcomes of heart failure vary substantially across LMICs. On average, the use of evidence-based medications tends to be suboptimal. Better strategies for heart failure surveillance and management in LMICs are needed. Please see later in the article for the Editors' Summary.
Collapse
Affiliation(s)
- Thomas Callender
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Gregory Roth
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - John Atherton
- Department of Cardiology, Royal Brisbane and Women's Children Hospital and University of Queensland School of Medicine, Brisbane, Australia
| | - Shadi Rahimzadeh
- Non-Communicable Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Ghaziani
- Non-Communicable Diseases Research Centre, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Maaz Shaikh
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Hyderabad, India
| | - Derrick Bennett
- Clinical Trials Service Unit, University of Oxford, Oxford, United Kingdom
| | - Anushka Patel
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | | | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Antonio Barretto
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Alejandro Diaz
- Universidad Nacional del Centro de la Provincia de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Herpin
- Centre Hospitalier Universitaire de Poitiers, Poitiers Cedex, France
| | - Henry Krum
- Centre of Cardiovascular Research & Education in Therapeutics, Monash University, Melbourne, Australia
| | - Thomas Eliasz
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Anna Forbes
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Alastair Kiszely
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Rajit Khosla
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Tatjana Petrinic
- Bodleian Healthcare Libraries, University of Oxford, Oxford, United Kingdom
| | - Devarsetty Praveen
- The George Institute for Global Health, University of Sydney, Sydney, Australia
- The George Institute for Global Health, Hyderabad, India
| | - Roohi Shrivastava
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Du Xin
- The George Institute for Global Health, Peking University, Beijing, China
| | - Stephen MacMahon
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | | | - Kazem Rahimi
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
23
|
Orisakwe OE. Lead and cadmium in public health in Nigeria: physicians neglect and pitfall in patient management. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:61-70. [PMID: 24696827 PMCID: PMC3968567 DOI: 10.4103/1947-2714.127740] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Low-level heavy metals exposure may contribute much more toward the causation of chronic disease and impaired functioning than previously thought. Among the suggested preventive and intervention measures for the control of renal diseases are the reduction in the exposure to heavy metals. Although these indicate knowledge and awareness of possible role of some heavy metals in the etiogenesis of some chronic diseases by Nigerian Physicians, heavy metal assay as diagnostic guide in patient management is often omitted in most healthcare settings. This is a synoptic capture of the increased incidence and prevalence of some metabolic disorders where heavy metals may be implicated. A search of the terms heavy metal exposure, source, toxicity, metabolic disorders, poisoning in Nigeria, in bibliographical databases (in English language) such as PubMed, Scopus, Google Scholar, and Africa Journal Online (AJOL) digital library was conducted. Leaded gasoline, refuse dumping, absence of poison information centers, and poor record keeping characterize environmental health in Nigeria. Lead and cadmium are of most significant public health importance in Nigeria. The recognition and inclusion of heavy metals assays in the diagnosis of metabolic disorders may ensure early diagnosis and improve management.
Collapse
Affiliation(s)
- Orish Ebere Orisakwe
- Toxicology Unit, Clinical Pharmacy, Faculty of Pharmacy, University of Port Harcourt Rivers State Nigeria, Port Harcourt Nigeria
| |
Collapse
|
24
|
Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Ajani AA, Adesina JO, Durodola A, Sliwa K. Contemporary profile of acute heart failure in Southern Nigeria: data from the Abeokuta Heart Failure Clinical Registry. JACC-HEART FAILURE 2014; 2:250-9. [PMID: 24952692 DOI: 10.1016/j.jchf.2013.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/16/2013] [Accepted: 12/18/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to determine the contemporary profile, clinical characteristics, and intrahospital outcomes of acute heart failure (AHF) in an African urban community. BACKGROUND There are limited data on the current burden and characteristics of AHF in Nigerian Africans. METHODS Comprehensive and detailed clinical and sociodemographic data were prospectively collected from 452 consecutive patients presenting with AHF to the only tertiary hospital in Abeokuta, Nigeria (population about 1 million) over a 2-year period. RESULTS The mean age was 56.6 ± 15.3 years (57.3 ± 13.4 years for men, 55.7 ± 17.1 years for women), and 204 patients (45.1%) were women. Overall, 415 subjects (91.8%) presented with de novo AHF. The most common risk factor for heart failure was hypertension (pre-existing in 64.3% of patients). Type 2 diabetes mellitus was present in 41 patients (10.0%). Hypertensive heart failure was the most common etiological cause of heart failure, responsible for 78.5% of cases. Dilated cardiomyopathy (7.5%), cor pulmonale (4.4%), pericardial disease (3.3%), rheumatic heart disease (2.4%), and ischemic heart disease were less common (0.4%) causes. The majority of subjects (71.2%) presented with left ventricular dysfunction (mean left ventricular ejection fraction 43.9 ± 9.0%), with valvular dysfunction and abnormal left ventricular geometry frequently documented. The mean duration of hospital stay was 11.4 ± 9.1 days, and intrahospital mortality was 3.8%. CONCLUSIONS Compared with those in high-income countries, patients presenting with AHF in Abeokuta, Nigeria, are relatively younger and still of working age. It is also more common in men and associated with severe symptoms because of late presentation. Intrahospital mortality is similar to that in other parts of the world.
Collapse
Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gail D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokua, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokua, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Julius O Adesina
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokua, Nigeria
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Hatter Institute for Cardiovascular Research in Africa & IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
25
|
Jacques Cabral TT, Tantchou Tchoumi JC, Butera G. Profile of cardiac disease in Cameroon and impact on health care services. Cardiovasc Diagn Ther 2014; 3:236-43. [PMID: 24400207 DOI: 10.3978/j.issn.2223-3652.2013.12.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/04/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) have emerged as a major public health problem and impose an escalating burden on the health care system in Cameroon. The aim of the study was to investigate the preparedness of health care services for patients presenting with CVD in general and specifically, in St. Elizabeth catholic general hospital Shisong, cardiac centre. PATIENTS AND METHODS Between November 2009 and November 2011, a population of 8,389 adults and 706 children consulted the referral cardiac centre of St. Elizabeth Catholic General Hospital. The patients' age ranges between 5 days and 103 years old, with a mean of 48.7±18 years. Female represented 54.2% of the total population. RESULTS Hypertension was diagnosed in 41.5% of patients. Isolated systolic hypertension was rarely found (4.2%) and 45.2% of patients were classified as class II according to the JNC7. Congestive heart failure was diagnosed in 29.6%. Forty-four percent of patients were in class III and 7% in class IV heart failure (NYHA). Arrhythmia was seen in 12.2% cases, with atrial fibrillation in 35.2%, followed by ventricular ectopic beats in 20.3%. Stable angina was diagnosed in 1.5%, and acute myocardial infarction 0.9%. In children, the prevalence of congenital heart disease was (4.3%). The disease the most detected was isolated ventricular septal defect, followed by tetralogy of Fallot. Post rheumatic valvulopathies were the main cause of heart failure in teenagers and young adults. Valve replacement with a mechanical valve was performed in 110 patients, valvuloplasty in eight patients, and surgical correction of congenital heart diseases in 105 cases. CONCLUSIONS Our data, collected in a rural area, shows the high prevalence of hypertension in rural sub-Saharan Africa. Congestive heart failure mainly due to post rheumatic valvulopathies is common amongst children and young adults.
Collapse
Affiliation(s)
| | | | - Gianfranco Butera
- Pediatric Cardiology, Cardiac Surgery and GUCH unit, Policlinico San Donato IRCCS, Italy
| |
Collapse
|
26
|
Salinas Botrán A, Ramos Rincón JM, de Górgolas Hernández-Mora M. [Cardiovascular disease: a view from global health perspective]. Med Clin (Barc) 2013; 141:210-6. [PMID: 23522729 DOI: 10.1016/j.medcli.2013.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/26/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
Globalization has facilitated the movement of large number of people around the world, leading modern clinicians to attend patients with rare or forgotten diseases. In the last few years many doctors are working in developing countries as volunteers or expatriates. The aim of this article is to summarize the basic epidemiological, clinical and therapeutic knowledge of the main cardiovascular diseases that a medical doctor from a developed country may attend in a tropical rural hospital, or with challenging diseases in patients coming from developing countries.
Collapse
Affiliation(s)
- Alejandro Salinas Botrán
- Servicio de Medicina Interna, Clínica Nuestra Señora de la Paz, Hnos. de San Juan de Dios, Madrid, España.
| | | | | |
Collapse
|
27
|
Akinwusi PO, Peter JO, Oyedeji AT, Odeyemi AO. The new face of rheumatic heart disease in South West Nigeria. Int J Gen Med 2013; 6:375-81. [PMID: 23723716 PMCID: PMC3666550 DOI: 10.2147/ijgm.s44289] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To determine the current prevalence of rheumatic heart disease (RHD), clinical features, types of valvular lesions, complications and mortality, at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, South West Nigeria. METHODS We conducted a retrospective, descriptive study of all the cases of RHD seen in the medical outpatient clinics and wards of LAUTECH for 9 years, from January 2003 to December 2011. Statistical analysis of data obtained was done using SPSS 16. RESULTS The total number of attendees of all the medical outpatient clinics during the 9-year period was 67,378, with a subset of 9423 attending the cardiology clinic. There were 11 cases of RHD, which translates to a prevalence of 0.16/1000 and 1.2/1000 for medical outpatient clinics and the cardiology clinic respectively. The mean age of the patients was 25.64 ± 9.65 years, age range 14-40 years and male to female ratio of 1:1.2. The most common valve affected was mitral (90.9%), followed by the aortic (36.4%), and the tricuspid (18.2%). Mitral and aortic lesions coexisted in 18.2% of the patients, and late presentation was common in all RHD cases. Heart failure was the most common complication (90.9%). Other complications were secondary pulmonary hypertension (36.4%), infective endocarditis (27.3%), atrial fibrillation (27.3%), cardioembolic cerebrovascular disease (18.2%), and atrial flutter (9.1%). Mortality was 9.1%, while only one patient (9.1%) had definitive surgery. Financial constraints precluded others from having definitive surgery. CONCLUSION The prevalence of RHD has declined considerably as a result of improvements in the primary health care delivery system, with widespread use of appropriate antibiotic therapy for sore throats resulting in the prevention of rheumatic fever and RHD. However, late presentation is still very common, hence we advocate a more aggressive drive to make the Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease functional in our practice area.
Collapse
Affiliation(s)
- Patience Olayinka Akinwusi
- Department of Medicine, College of Health Sciences, Osun State University, Osogbo, Osun State, Nigeria
- Department of Medicine, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria
| | | | | | | |
Collapse
|
28
|
Bloomfield GS, Barasa FA, Doll JA, Velazquez EJ. Heart failure in sub-Saharan Africa. Curr Cardiol Rev 2013; 9:157-73. [PMID: 23597299 PMCID: PMC3682399 DOI: 10.2174/1573403x11309020008] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/15/2012] [Accepted: 11/18/2012] [Indexed: 02/06/2023] Open
Abstract
The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs.
Collapse
|
29
|
Ojji D, Stewart S, Ajayi S, Manmak M, Sliwa K. A predominance of hypertensive heart failure in the Abuja Heart Study cohort of urban Nigerians: a prospective clinical registry of 1515 de novo cases. Eur J Heart Fail 2013; 15:835-42. [PMID: 23612705 DOI: 10.1093/eurjhf/hft061] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Even though cardiovascular disease is gradually becoming the major cause of morbidity and mortality in sub-Saharan Africa, there are very few data on the pattern of heart disease in this part of the world. We therefore decided to determine the pattern of heart disease in Abuja, which is one of the fastest growing and most westernized cities in Nigeria, and compare our findings with those of the Heart of Soweto Study in South Africa. METHODS AND RESULTS Detailed clinical data were consecutively captured from 1515 subjects of African descent, residing in Abuja, and equivalent Soweto data from 4626 subjects were available for comparison. In Abuja, male subjects were on average, ∼2 years older than female subjects. Hypertension was the primary diagnosis in 45.8% of the cohort, comprising more women than men [odds ratio (OR) 1.96, 95% confidence interval (CI) 1.26-2.65], and hypertensive heart failure (HF) was the most common form of HF in 61% of cases. On an age- and sex-adjusted basis, compared with the Soweto cohort, the Abuja cohort were more likely to present with a primary diagnosis of hypertension (adjusted OR 2.10, 95% CI 1.85-2.42) or hypertensive heart disease/failure (OR 2.48, 95% CI 2.18-2.83); P < 0.001 for both. They were, however, far less likely to present with CAD (OR 0.04, 95% CI 0.02-0.11) and right heart failure (2.5% vs. 27%). CONCLUSION As in Soweto, but more so, hypertension is the most common cause of de novo HF presentations in Abuja, Nigeria.
Collapse
Affiliation(s)
- Dike Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | | | | | | |
Collapse
|
30
|
Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJ, Falase AO, Stewart S, Sliwa K. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol 2012; 4:327-40. [PMID: 23272273 PMCID: PMC3530788 DOI: 10.4330/wjc.v4.i12.327] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 10/23/2012] [Accepted: 10/30/2012] [Indexed: 02/06/2023] Open
Abstract
To review studies on hypertension in Nigeria over the past five decades in terms of prevalence, awareness and treatment and complications. Following our search on Pubmed, African Journals Online and the World Health Organization Global cardiovascular infobase, 1060 related references were identified out of which 43 were found to be relevant for this review. The overall prevalence of hypertension in Nigeria ranges from 8%-46.4% depending on the study target population, type of measurement and cut-off value used for defining hypertension. The prevalence is similar in men and women (7.9%-50.2% vs 3.5%-68.8%, respectively) and in the urban (8.1%-42.0%) and rural setting (13.5%-46.4%).The pooled prevalence increased from 8.6% from the only study during the period from 1970-1979 to 22.5% (2000-2011). Awareness, treatment and control of hypertension were generally low with attendant high burden of hypertension related complications. In order to improve outcomes of cardiovascular disease in Africans, public health education to improve awareness of hypertension is required. Further epidemiological studies on hypertension are required to adequately understand and characterize the impact of hypertension in society.
Collapse
Affiliation(s)
- Okechukwu S Ogah
- Okechukwu S Ogah, Ministry of Health, Nnamdi Azikiwe Secretariat, Umuahia 440233, Abia State, Nigeria
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Tantchou Tchoumi JC, Ambassa JC, Kingue S, Giamberti A, Cirri S, Frigiola A, Butera G. Occurrence, aetiology and challenges in the management of congestive heart failure in sub-Saharan Africa: experience of the Cardiac Centre in Shisong, Cameroon. Pan Afr Med J 2011; 8:11. [PMID: 22121420 PMCID: PMC3201578 DOI: 10.4314/pamj.v8i1.71059] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 01/08/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to investigate the occurrence, the aetiology and the management of congestive heart failure in the cardiac centre of the St. Elizabeth catholic general hospital Shisong in Cameroon. METHODS Between November 2002 and November 2008, a population of 8121 patients was consulted in the referral cardiac centre of St. Elizabeth Catholic General Hospital. Of these patients, 462 were diagnosed with congestive heart failure according to the modified Framingham criteria for the diagnosis of heart failure. Complementary investigations used to confirm and establish the aetiology of the disease were the chest X-ray, electrocardiography, bi-dimensional Doppler echocardiography. RESULTS The results showed that the occurrence of congestive heart failure in our centre was 5.7%. Congestive heart failure was diagnosed in 198 females and 264 males, aged between 8 and 86 years old (42.5±18 years old). Post rheumatic valvulopathies (14.6%) and congenital heart diseases (1.9%) were the first aetiologic factor of congestive heart failure in the young, meanwhile cardiomyopathies (8.3%) in elderly followed by hypertensive cardiomyopathy (4.4%). Congestive heart failure was also seen in adults with congenital heart diseases in 0.01%. In this zone of Cameroon, we discovered that HIV cardiomyopathy (1.6%) and Cor pulmonale (8%) were represented, aetiological factors not mentioned in previous studies conducted in urban areas of Cameroon. The mean duration of hospital stay for the compensation treatment was thirteen days, ranging between 7 and 21 days), the mortality being 9.2%. All the medications recommended for the treatment of congestive heart failure are available in our centre but many patients are not compliant to the therapy or cannot afford them. Financial limitation is causing the exacerbation of the disease and premature death. CONCLUSION Our data show a high incidence of congestive heart failure mainly due to post rheumatic valvulopathies in young patients in our centre. National program to fight against rheumatic fever and complications are of great urgency in our country. The compensation treatment of congestive heart failure is challenging in our milieu, characterized by poor compliance and financial limitations.
Collapse
|