Understanding the Etiology of Heart Failure Among the Rural Poor in Sub-Saharan Africa: A 10-Year Experience From District Hospitals in Rwanda

Eberly, Lauren A.; Rusingiza, Emmanuel; Park, Paul H.; Ngoga, Gedeon; Dusabeyezu, Symaque; Mutabazi, Francis; Harerimana, Emmanuel; Mucumbitsi, Joseph; Nyembo, Philippe F.; Borg, Ryan; Gahamanyi, Cyprien; Mutumbira, Cadet; Ntaganda, Evariste; Rusangwa, Christian; Kwan, Gene F.; Bukhman, Gene

doi:10.1016/j.cardfail.2018.10.002

Cited by 19 publications

(17 citation statements)

References 12 publications

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“…In a worldwide systematic review of heart failure aetiologies, an overlap of underlying aetiologies was observed, and crude IHD prevalence was >50% in Europe and North America and <10% in SSA [76]. The most common etiologies of heart failure among children in SSA are congenital heart disease (52%) and rheumatic heart disease (36%) in one study [9].…”

Section: Heart Failurementioning

confidence: 97%

“…Despite improvements in survival, absolute mortality rates from heart failure remain approximately 50% within five years of diagnosis and 30-day heart failure re-hospitalization rates are still about 25% in developed countries [73]. While the underlying etiology of heart failure in adults in HIC is IHD [34,74,75], in SSA the leading causes are hypertensive heart disease, cardiomyopathy, and rheumatic heart disease [7,9,53,56,76,77], although the relative percentage of heart failure caused by IHD in SSA in increasing [57]. In fact, hypertensive heart disease is the most common cause of de novo heart failure presentations in adults in SSA [7,9,53,56,57,76,77].…”

Section: Heart Failurementioning

confidence: 99%

“…SSA has 23% of the world's prevalent RHD cases (8.9 million of world's 39.3 million estimated cases in 2017 were in SSA), with high prevalence rate of 864/100,000 compared to only 9.8 and 7.7/100,000 in North America and Western Europe respectively [2]. In SSA, RHD is the second most common cause of heart failure in children after congenital heart disease and third most common etiology of heart failure in adults after hypertension and dilated cardiomyopathies [9,53,56,57]. Nonetheless, disease management remains sub-optimal and case fatality high in SSA and other low-and middle-income countries [17].…”

Section: Rheumatic Heart Diseasementioning

confidence: 99%

“…Congenital heart disease is the most common etiology of heart failure among children in SSA [9]. In 2017, approximately 12 million people were living with congenital heart disease (CHD) worldwide, with nearly 3 million of these in SSA [2].…”

Section: Congenital Heart Diseasementioning

confidence: 99%

“…Although age-adjusted CVD mortality rates in SSA are low compared to HIC, absolute number of CVD deaths has increased by more than 50% in the past three decades in this region [2] and tend to occur at younger ages, leading to a high number of disability adjusted life years (DALYs) [5][6][7][8][9][10][11][12]. IHD, stroke, and hypertensive heart disease are the three most common causes of CVD death in SSA [2,13].…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

Yuyun

Sliwa

Kengne

et al. 2020

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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests that SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations. Highlights:-The burden of non-communicable diseases including cardiovascular diseases is rising in SSA.-Levels of hypertension diagnosis, treatment, and control are low at <40%, <35%, and 10-20%, respectively, and more than 40% of patients with diabetes are not aware of their diagnosis in SSA. -SSA has 23% of the world's prevalent rheumatic heart disease cases.-The leading causes of heart failure in SSA are hypertensive heart disease, cardiomyopathy, and rheumatic heart disease, with ischemic heart disease accounting for <10% of cases compared to >50% in high-income countries.

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Section: Heart Failurementioning

confidence: 97%

Section: Heart Failurementioning

confidence: 99%

Section: Rheumatic Heart Diseasementioning

confidence: 99%

Section: Congenital Heart Diseasementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

Yuyun

Sliwa

Kengne

et al. 2020

Self Cite

245

211

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PEN-Plus Strategies I: Decentralizing and Integrating Preoperative Medical Management, Cardiac Surgery Screening, and Referral

Eberly

Alizadeh

Balinda

et al. 2021

Sustainable Development Goals Series

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Cardiac Surgery and Interventional Cardiology Capacity Development: Insights from Ethiopia and Côte d’Ivoire

Park

Heo

Kim

et al. 2021

Sustainable Development Goals Series

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In this chapter, the global surgery research team of the JW LEE Center for Global Medicine, Seoul National University College of Medicine, introduced the cardiac surgery and interventional cardiology workforce training programs in Ethiopia and Côte d'Ivoire. A team-based collaborative capacity-building model was implemented in both countries, and details of program design and delivery are documented. The research team shared their experiences and identified achievements, lessons, and challenges for cardiac surgical interventions in Sub-Saharan Africa. Future directions were put forward to advance and strengthen the LMICs' "Safe Surgery."

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Understanding the Etiology of Heart Failure Among the Rural Poor in Sub-Saharan Africa: A 10-Year Experience From District Hospitals in Rwanda

Cited by 19 publications

References 12 publications

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective

PEN-Plus Strategies I: Decentralizing and Integrating Preoperative Medical Management, Cardiac Surgery Screening, and Referral

Cardiac Surgery and Interventional Cardiology Capacity Development: Insights from Ethiopia and Côte d’Ivoire

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