Unmet needs in the management of arrhythmias among heart failure patients in Africa

Mutagaywa, Reuben; Chin, Ashley; Karaye, Kamilu M; Bonny, Aimé

doi:10.1093/eurheartj/ehac040

Cited by 2 publications

(6 citation statements)

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“…31 Indeed, we had previously reported that there is unmet need in management of arrhythmias among heart failure patients in Africa. 32 In this study, the proportion of patients with AF was 31.4% which is similar to the approximated 30% in some studies 1,33,34 but lower than the 60% that was reported in another study. 35 Among patients with AF, oral anticoagulants were prescribed in 62.3%, which is slightly lower than the 68.6% use of oral anticoagulants that was reported in the REMEDY registry.…”

Section: Discussionsupporting

confidence: 79%

“…Currently, in sub-Saharan Africa, there are great challenges with anticoagulation, with wide variation in its use and time in the therapeutic range of 27-56%. 32,36 The current study showed that multivalvular disease was present in 116 (40%) patients. This number is higher and lower than a 13% and 64.8% reported in VALVAFRIC 5 and REMEDY 1 registries, respectively.…”

Section: Discussionmentioning

confidence: 51%

“…Recently, we have published from our hospital RHD cohort that arrhythmias were detected on 12‐lead ECG in 49.5% of RHD patients highlighting a need for its early detection and management 31 . Indeed, we had previously reported that there is unmet need in management of arrhythmias among heart failure patients in Africa 32 …”

Section: Discussionmentioning

confidence: 93%

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Comparison between interventional versus medical therapy in patients with rheumatic mitral valve stenosis in Tanzania

Mutagaywa,

Kifai,

Elinisa

et al. 2023

Eur J Clin Investigation

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BackgroundRheumatic heart disease remains the most common cardiovascular disease in children and young adults. The outcome of interventional versus medical therapy on the long term is not fully elucidated yet. This study provides contemporary data on the clinical profile, treatment and follow up of patients with rheumatic mitral stenosis (MS) in Tanzania.MethodsPatients' medical information, investigations and treatment data were recorded in this prospective cohort study. They were followed up for 6–24 months to determine the long‐term outcome. Interventional therapy was defined as a combination of surgery and percutaneous balloon mitral valvuloplasty. Kaplan–Meier curves and Cox proportional hazards model were used in analyses. p‐Value < 0.05 was considered statistically significant.ResultsWe enrolled 290 consecutive patients. Interventions were done in half of the patients. Median follow up was 23.5 months. Mortality was higher in the medical than interventional treatment (10.4% vs. 4%, log‐rank p = 0.001). Median age was 36 years, females (68.3%) and low income (55.5%). Multivalvular disease was found in 116 (40%) patients, atrial fibrillation (31.4%), stroke/transient ischaemic attack (18.9%) and heart failure class III–IV (44.1%). Median (IQR) duration of disease was 3 (4) years, secondary prophylaxis (27.7%) and oral anticoagulants use (62.3%). In multivariable analysis, the risk of death among patients on medical was 3.07 times higher than those on interventional treatment (crude HR 3.07, 95% CI 1.43–6.56, p = 0.004), 2.44 times higher among patients with arrhythmias versus without arrhythmias (crude HR 2.44, 95% CI 1.19–4.49, p = 0.015) and 2.13 times higher among patients with multivalvular than single valve disease (crude HR 2.13, 95% CI 1.09–4.16, p = 0.026).ConclusionsIntervention is carrying low mortality compared to medical treatment. Arrhythmias and multivalvular disease are associated with a high mortality. Rheumatic MS is more prevalent in young people, females and individuals with low income. There is a late hospital presentation and a low use of both secondary prophylactic antibiotics and anticoagulants.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 51%

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Comparison between interventional versus medical therapy in patients with rheumatic mitral valve stenosis in Tanzania

Mutagaywa,

Kifai,

Elinisa

et al. 2023

Eur J Clin Investigation

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“…In RHD, as valve damage progresses, the consequences for the affected patients are devastating in terms of morbidity and mortality as well as poor quality of life [ 11 , 40 ]. In developing countries, including sub-Saharan Africa, patients usually present in New York Heart Association (NYHA) functional class II-III, atrial fibrillation (28%), thromboembolic events (3.2%) pulmonary hypertension, and infective endocarditis [ 1 , 7 , 11 , 41 , 42 ]. These factors are signifying late presentation of patients to health facilities and/or delayed appropriate management [ 7 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…Rheumatic heart disease (RHD) continues to be among the causes of cardiac morbidity and death among school children and young adults in Africa and the third most common cause of heart failure after hypertension and cardiomyopathy [ 1 ]. The prevalence of RHD in this region is as high as 1–3 for every 100 school children [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Health related quality of life of patients following mechanical valve replacement surgery for rheumatic mitral stenosis in Tanzania

Mutagaywa

Chillo

Khamis

et al. 2023

J Cardiothorac Surg

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Background The assessment of outcomes of interventions based on the patient’s perspective using patient-reported outcome measures (PROMs) has been increasingly highlighted in clinical practice. However, health related quality of life (HRQoL), one of the common constructs measured by PROMs remain unknown among patients after heart valve replacement (HVR) in Tanzania. Objectives To assess the HRQoL amongst patients operated on for rheumatic mitral stenosis at Jakaya Kikwete Cardiac Institute (JKCI). Methods A prospective study of patients operated on due to rheumatic mitral stenosis at JKCI from January 2020 to April 2021 was undertaken. The HRQoL was assessed by using the MacNew questionnaire, addressing three domains (physical, emotional, and social function); the score ranges from 0 to 7. We categorized HRQoL as low (mean score ≤ 4.9), moderate (5–6) and high (> 6). We analysed several sociodemographic and clinical variables for HRQoL. Results Out of 54 patients, there were 34 females and 20 males. Their mean (± SD) age was 37.98 (± 12.58) years. The reliability of translated Kiswahili version of MacNew was good. The mean (± SD) global scores were 3.47 ± 0.59, 4.88 ± 0.71 and 6.14 ± 0.50 preoperatively, at 3 months and 6 months respectively (p-values < 0.001 preoperatively vs. 3 months, preoperatively vs. 6 months and at 3 months vs. 6 months). The median of individual mean difference HRQoL score pre-operatively and at 6 months was 2.67. The preoperative and 6 months mean difference HRQoL scores were higher among patients with vs. without atrial fibrillation (2.95 ± 0.59 vs. 2.45 ± 0.53, p = 0.003) and those on anticoagulants (preoperatively) vs. not on anticoagulants (3.14 ± 0.58 vs. 2.57 ± 0.57, 0.009). The mean difference HRQoL scores were similar for sociodemographic and other clinical parameters, including those with stroke vs. without stroke. Conclusion Six months after HVR the overall MacNew HRQoL scores improved markedly. This improvement in HRQoL was regardless of the presence of comorbidities (e.g. stroke and atrial fibrillation) which underscores the importance of considering valvular surgery if they fit the criteria. Clinicians and researchers in low-resource settings should collaborate to promote the utilization of PROMs in the routine care of patients.

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Unmet needs in the management of arrhythmias among heart failure patients in Africa

Cited by 2 publications

References 10 publications

Comparison between interventional versus medical therapy in patients with rheumatic mitral valve stenosis in Tanzania

Comparison between interventional versus medical therapy in patients with rheumatic mitral valve stenosis in Tanzania

Health related quality of life of patients following mechanical valve replacement surgery for rheumatic mitral stenosis in Tanzania

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