Burden of Cardiovascular Morbidity and Mortality Following Humanitarian Emergencies: A Systematic Literature Review

Abstract

Background The global burden of cardiovascular mortality is increasing, as is the number of large-scale humanitarian emergencies. The interaction between these phenomena is not well understood. This review aims to clarify the relationship between humanitarian emergencies and cardiovascular morbidity and mortality. Methods With assistance from a research librarian, electronic databases (PubMed, Scopus, CINAHL, Global Health) were searched in January 2014. Findings were supplemented by reviewing citations of included trials. Observational studies reporting the effect of natural disasters and conflict events on cardiovascular morbidity and mortality in adults since 1997 were included. Studies without a comparison group were not included. Double-data extraction was utilized to abstract information on acute coronary syndrome (ACS), acute decompensated heart failure (ADHF), and cardiac death (SCD). Review Manager 5.0 was used to create figures for qualitative synthesis (Version 5.2, Copenhagen Denmark, The Nordic Cochrane Centre). Results The search retrieved 1697 unique records; 24 studies were included (17 studies of natural disasters, 7 studies of conflict). These studies involved 14,583 cardiac events. All studies utilized retrospective designs: 4 were population-based, 15 were single-center, and 5 were multicenter studies. 23 studies utilized historical controls in the primary analysis, and 1 utilized primarily geographical controls. Conflicts are associated with an increase in long-term morbidity from ACS; the short-term effects of conflict vary by study. Natural disasters exhibit heterogeneous effects including increased occurrence of ACS, ADHF, and SCD. Conclusions In certain settings, humanitarian emergencies are associated with increased cardiac morbidity and mortality that may persist for years following the event. Humanitarian aid organizations should consider morbidity from non-communicable disease when planning relief and recuperation projects.

The Interaction Effects of Meteorological Factors and Air Pollution on the Development of Acute Coronary Syndrome

“…Furthermore, another study on Hurricane Sandy also demonstrated that diabetic adults aged 65 years and older were especially at risk for developing acute myocardial infarction the week after that extreme weather event48. The development of ACS in the above-mentioned studies was attributed to the psychological stress of the event and corresponding physiologic derangements49. Although we agree that acute psychological stress plays a role in triggering cardiac events, our results show that other factors are also involved.…”

Global Emergency Medicine: A Review of the Literature From 2014

“…The top 25 global EM articles for 2014 are listed in Table . The complete database of all 477 global EM articles for 2014, as well as full summaries and critical analyses of the top 25 global EM articles of 2014 can be found in Data Supplements S1 and S2 (available as supporting information in the online version of this article).…”

“…Hayman et al . performed a systematic review to evaluate the interaction between the increasing frequency of large‐scale humanitarian emergencies and global burden of cardiovascular mortality.…”

Cardiovascular Disease among Syrian refugees: a descriptive study of patients in two Médecins Sans Frontières clinics in northern Lebanon

“…While there is growing evidence on the burden and gaps in access to care for NCDs in humanitarian crisis settings, very little has been published on the cost effective management of NCDs in general, and still less on the management of ASCVD, in humanitarian settings [11][12][13][14][15]. This is a significant gap, especially given that limited evidence shows that crises may actually increase CVD mortality, morbidity and risk factors [12,[16][17][18]. Commentators have noted the challenges that exist around identifying and treating ASCVD even in high-income, stable settings with ready access to medications and diagnostics [19].…”