A Simplified Echocardiographic Strategy for Heart Failure Diagnosis and Management Within an Integrated Noncommunicable Disease Clinic at District Hospital Level for Sub-Saharan Africa

Kwan, Gene F.; Bukhman, Alice; Miller, Ann C.; Ngoga, Gedeon; Mucumbitsi, Joseph; Bavuma, Charlotte; Dusabeyezu, Symaque; Rich, Michael; Mutabazi, Francis; Mutumbira, Cadet; Ngiruwera, Jean Paul; Amoroso, Cheryl; Ball, Ellen; Fraser, Hamish; Hirschhorn, Lisa R.; Farmer, Paul; Rusingiza, Emmanuel; Bukhman, Gene

doi:10.1016/j.jchf.2013.03.006

Cited by 79 publications

(70 citation statements)

References 17 publications

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“…Our series had a majority of women (57.43%), which is comparable to the findings of Sani MU et al [17] and in two Haitian series [18] [19]. This could be explained by the predominance of hypertension in women and the presence of PPMC which occurs only in women.…”

Section: Discussionsupporting

confidence: 90%

Clinical Pattern and Outcome of Acute Heart Failure at the Yaounde Central Hospital

Boombhi¹,

Moampea²,

Kuaté³

et al. 2017

OALib

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Section: Discussionsupporting

confidence: 90%

Clinical Pattern and Outcome of Acute Heart Failure at the Yaounde Central Hospital

Boombhi¹,

Moampea²,

Kuaté³

et al. 2017

OALib

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“…Innovative strategies will be needed, building on current strategies on task shifting or task sharing in Rwanda 38 and Mozambique, 39,40 the results of which are encouraging. Although thought to further exacerbate income and healthcare inequality, industry involvement in promoting high-tech imaging, devices, and procedures may be revolutionary.…”

Section: Implications For Clinical and Public Health Actionmentioning

confidence: 99%

“…If cost-effective strategies are chosen, directed to the relevant problems and tailored to the local conditions, hightech tools may be developed both to assess the epidemiology and to improve the management of noncommunicable diseases in low-resource areas. 38 In line with this, African leadership has moved from skepticism to investment in portable and battery-powered laboratory devices, training of nonspecialists on the use of diagnostic tools and provision of care, and promotion of the use of multiplex rapid test systems at point of care for the assessment of cardiovascular risk factors.…”

Section: Implications For Clinical and Public Health Actionmentioning

confidence: 99%

Impact of Socioeconomic Status, Ethnicity, and Urbanization on Risk Factor Profiles of Cardiovascular Disease in Africa

et al. 2016

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Abstract-Africa is a continent characterized by marked ethnic, sociodemographic, and economic diversity, with profound changes in many regions over the past 2 decades. This diversity has an impact on cardiovascular disease presentation and outcomes. Within Africa and within the individual countries, one can find regions having predominantly communicable diseases such as rheumatic heart disease, tuberculous pericarditis, or cardiomyopathy and others having a marked increase in noncommunicable disease such as hypertension and hypertensive heart disease. Ischemic heart disease remains rare in most countries. Difficulties in the planning and implementation of effective health care in most African countries are compounded by a paucity of studies and a low rate of investment in research and data acquisition. The fiduciary responsibilities of companies working in Africa should include the effective and efficient use of natural resources to promote the overall health of populations.

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“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Even the registries share an urban or referral bias (only Rwanda had echocardiographic data from a secondary [district] hospital in a rural area). 12 Within a previous systematic review of heart failure studies, there were no published registries from geographic areas with high concentrations of extreme poverty within South Asia and Western China. 28 Several patterns emerge from the African and Haitian registries.…”

Section: Facility-based Cvd Registriesmentioning

confidence: 99%

“…97 In addition, integrated delivery models are needed to decentralize initial echocardiographic diagnosis and management of heart failure and RHD (including anticoagulation) to district hospitals. 12,98,99 Health centers need to be equipped to both identify and manage suspected streptococcal pharyngitis, rheumatic fever, hypertension, and stable RHD as part of primary care. [100][101][102] Community health workers need to be equipped to both offer adherence support and refer sick individuals to higher levels when necessary.…”

Section: Public Health Policies Promoting Health Equitymentioning

confidence: 99%

Endemic Cardiovascular Diseases of the Poorest Billion

et al. 2016

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The 2 most commonly used approaches for measuring poverty are (1) 1-dimensional approaches focused on income or 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 disabilityadjusted 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.

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A Simplified Echocardiographic Strategy for Heart Failure Diagnosis and Management Within an Integrated Noncommunicable Disease Clinic at District Hospital Level for Sub-Saharan Africa

Cited by 79 publications

References 17 publications

Clinical Pattern and Outcome of Acute Heart Failure at the Yaounde Central Hospital

Clinical Pattern and Outcome of Acute Heart Failure at the Yaounde Central Hospital

Impact of Socioeconomic Status, Ethnicity, and Urbanization on Risk Factor Profiles of Cardiovascular Disease in Africa

Endemic Cardiovascular Diseases of the Poorest Billion

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