Complete congenital heart block in a neonate with a complex congenital heart defect in Africa

Nkoké, Clovis; Wawo, Edvine Yonta; Mfeukeu, Liliane Kuate; Makamte, Larissa; Edie, Sandrine Dikosso; Balana, Flore Esiene

doi:10.21037/cdt.2016.09.04

Cited by 11 publications

(10 citation statements)

References 3 publications

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“…In Tanzania, for example, ACS is currently estimated to be the fourth leading cause of death in the country [18]. Despite such estimates, ACS remains a rare diagnosis across SSA [2,13], a fact that has perplexed epidemiologists [17,26]. Some have speculated that the disease may be under-diagnosed due to a combination of limited community awareness of ACS, inadequate clinician training, and lack of diagnostic equipment [4,14,26].…”

Section: Introductionmentioning

confidence: 99%

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

Hertz

Kweka

Bloomfield

et al. 2020

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Background: Acute coronary syndrome (ACS) is thought to be a rare diagnosis in sub-Saharan Africa, but little is known about diagnostic practices for patients with possible ACS symptoms in the region. Objective: To describe current care practices for patients with ACS symptoms in Tanzania to identify factors that may contribute to ACS under-detection. Methods: Emergency department patients with chest pain or shortness of breath at a Tanzanian referral hospital were prospectively observed. Medical histories were obtained, and diagnostic workups, treatments, and diagnoses were recorded. Five-year risk of cardiovascular events was calculated via the Harvard National Health and Nutrition Examination Survey risk score. Telephone follow-ups were conducted 30 days after enrollment. Results: Of 339 enrolled patients, the median (IQR) age was 60 (46, 72) years, 252 (74.3%) had hypertension, and 222 (65.5%) had >10% five-year risk of cardiovascular event. The median duration of symptoms prior to presentation was 7 days, and 314 (92.6%) reported symptoms worsened by exertion. Of participants, 170 (50.1%) received an electrocardiogram, and 9 (2.7%) underwent cardiac biomarker testing. There was no univariate association between five-year cardiovascular risk and decision to obtain an electrocardiogram (p = 0.595). The most common physician-documented diagnoses were symptomatic hypertension (104 patients, 30.7%) and heart failure (99 patients, 29.2%). Six patients (1.8%) were diagnosed with ACS, and 3 (0.9%) received aspirin. Among 284 (83.8%) patients completing 30-day follow-up, 20 (7.0%) had died. Conclusions: Many patients with ACS risk factors present to the emergency department of a Tanzanian referral hospital with possible ACS symptoms, but marked delays in care-seeking are common. Complete diagnostic workups for ACS are uncommon, ACS is rarely diagnosed or treated with evidence-based therapies, and mortality in patients with these symptoms is high. Physician practices may be contributing to ACS under-detection in Tanzania, and interventions are needed to improve ACS care.

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Section: Introductionmentioning

confidence: 99%

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

Hertz

Kweka

Bloomfield

et al. 2020

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“…While our study was conducted at a facility with access to cardiac biomarkers and ECGs, this is not the case for all EDs in Tanzania or SSA 6,17,39,40 . Thus, risk stratification tools that rely on history, physical examination, and vital signs may be needed to support ED clinicians working in resource‐limited facilities.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the performance of the HEART score in a Tanzanian emergency department

Grisel,

Adisa,

Sakita

et al. 2024

Academic Emergency Medicine

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ObjectiveThe HEART score successfully risk stratifies emergency department (ED) patients with chest pain in high‐income settings. However, this tool has not been validated in low‐income countries.MethodsThis is a secondary analysis of a prospective observational study that was conducted in a Tanzanian ED from January 2019 through January 2023. Adult patients with chest pain were consecutively enrolled, and their presenting symptoms and medical history were recorded. Electrocardiograms and point‐of‐care troponin assays were obtained for all participants. Thirty‐day follow‐up was conducted, assessing for major adverse cardiac events (MACEs), defined as death, myocardial infarction, or coronary revascularization (coronary artery bypass grafting or percutaneous coronary intervention). HEART scores were calculated for all participants. Likelihood ratios, sensitivity, specificity, and negative predictive values (NPVs) were calculated for each HEART cutoff score to predict 30‐day MACEs, and area under the curve (AUC) was calculated from the receiver operating characteristic curve.ResultsOf 927 participants with chest pain, the median (IQR) age was 61 (45.5–74.0) years. Of participants, 216 (23.3%) patients experienced 30‐day MACEs, including 163 (17.6%) who died, 48 (5.2%) with myocardial infarction, and 23 (2.5%) with coronary revascularization. The positive likelihood ratio for each cutoff score ranged from 1.023 (95% CI 1.004–1.042; cutoff ≥ 1) to 3.556 (95% CI 1.929–6.555; cutoff ≥ 7). The recommended cutoff of ≥4 to identify patients at high risk of MACEs yielded a sensitivity of 59.4%, specificity of 52.8%, and NPV of 74.7%. The AUC was 0.61.ConclusionsAmong patients with chest pain in a Tanzanian ED, the HEART score did not perform as well as in high‐income settings. Locally validated risk stratification tools are needed for ED patients with chest pain in low‐income countries.

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“…However, the current global reports and regional estimates indicate the rising trends in the shared risk factors for chronic non-communicable diseases (NCDs), and therefore likely to substantially contribute to the silent epidemic of CAD in SSA [ 2 , 3 ]. Regrettably, lack of awareness, underreporting and misdiagnosis of CAD could account for observed fallacy of its low burden in SSA [ 4 ]. The global prevalence of CAD is estimated at 1.74% as reported by Khan MA et al [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Angiographic characteristics of coronary artery disease in patients undergoing diagnostic coronary angiography at a tertiary hospital in Tanzania

Meda,

Kusima,

Magitta

2024

BMC Cardiovasc Disord

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Background Coronary artery disease (CAD) is an important cause of global burden of disease. There is a paucity of data on the burden and risk factors for CAD in sub-Saharan Africa (SSA), despite the rising trends in the shared risk factors across regions. The recent introduction of cardiac catheterization laboratory services in SSA could shed light on the burden of CAD in the region. We aimed to assess the angiographic characteristics among patients undergoing diagnostic coronary angiography (CAG) at a single tertiary care hospital in Tanzania. Methods This study was a retrospective chart review. A total of 728 patients ≥ 18 years of age who underwent CAG from January 2020 to December 2022 were recruited into the study. Basic demographic variables, risk factors and clinical characteristics including CAG findings were obtained from the registry. In addition, CAG images were retrieved for assessment of angiographic features. The luminal vessel stenosis was assessed based on eyeballing and the degree of obstruction was agreed by two independent and experienced cardiologists. The coronary stenosis of ≥ 50% was considered significant for obstructive CAD. The study was approved by the local ethics committee. Results Of patients who were recruited into the study, 384 (52.23%) were female. The study participants had a mean age of 59.46 ± 10.83 standard deviation (SD) and mean body mass index (BMI) of 31.18 kg/m2. The prevalence of CAD of any degree was estimated at 24.43% (34.18% in male, 15.50% in female), while that of obstructive CAD was 18.27%. Forty six percent of those with obstructive CAD had multiple vessel disease (MVD). Nearly 77% of patients were found to have ≥ 50–70% luminal stenosis and while those with ≥ 70% luminal coronary artery stenosis constituted 56.65%. Right coronary artery (RCA) was the most commonly affected vessel, accounting for 36.84% when any vessel disease or 56% when single vessel disease were considered. Being 65 years or older and comorbidity with type 2 diabetes (T2D) were independent risk factors for developing CAD. Conclusion There is a high prevalence of obstructive CAD among patients undergoing diagnostic CAG in Tanzania, with male gender preponderance and increasingly higher in older age, often with severe disease. A large, prospective study is needed to provide epidemiological and clinical data for developing a locally-relevant cardio-preventive strategy for CAD intervention in Tanzania.

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Complete congenital heart block in a neonate with a complex congenital heart defect in Africa

Cited by 11 publications

References 3 publications

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

Patterns of Emergency Care for Possible Acute Coronary Syndrome Among Patients with Chest Pain or Shortness of Breath at a Tanzanian Referral Hospital

Evaluating the performance of the HEART score in a Tanzanian emergency department

Angiographic characteristics of coronary artery disease in patients undergoing diagnostic coronary angiography at a tertiary hospital in Tanzania

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