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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A simplified echocardiographic strategy for heart failure diagnosis and management within an integrated noncommunicable disease clinic at district hospital level for sub-saharan africa
JACC: Heart Failure, Volume 1, No. 3, Year 2013
Notification
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Description
Objectives: This study sought to describe a decentralized strategy for heart failure diagnosis and management and report the clinical epidemiology at district hospitals in rural Rwanda. Background: Heart failure contributes significantly to noncommunicable disease burden in sub-Saharan Africa. Specialized care is provided primarily at referral hospitals by physicians, limiting patients' access. Simplifying clinical strategies can facilitate decentralization of quality care to the district hospital level and improve care delivery. Methods: Heart failure services were established within integrated advanced noncommunicable disease clinics in 2 rural district hospitals in Rwanda. Nurses, supervised by physicians, were trained to use simplified diagnostic and treatment algorithms including echocardiography with diagnoses confirmed by a cardiologist. Data on 192 heart failure patients treated between November 2006 and March 2011 were reviewed from an electronic medical record. Results: In our study population, the median age was 35 years, 70% were women, 63% were subsistence farmers, and 6% smoked tobacco. At entry, 47% had New York Heart Association class III or IV functional status. Of children age <18 years (n = 54), rheumatic heart disease (48%), congenital heart disease (39%), and dilated cardiomyopathy (9%) were the leading diagnoses. Among adults (n = 138), dilated cardiomyopathy (54%), rheumatic heart disease (25%), and hypertensive heart disease (8%) were most common. During follow-up, 62% were retained in care, whereas 9% died and 29% were lost to follow-up. Conclusions: In rural Rwanda, the causes of heart failure are almost exclusively nonischemic even though patients often present with advanced symptoms. Training nurses, supervised by physicians, in simplified protocols and basic echocardiography is 1 approach to integrated, decentralized care for this vulnerable population. © 2013 American College of Cardiology Foundation.
Authors & Co-Authors
Kwan, Gene F.
United States, Boston
Brigham and Women's Hospital
United States, Boston
Boston Medical Center
Bukhman, Alice Kidder
United States, Boston
Brigham and Women's Hospital
Miller, Ann C.
United States, Boston
Harvard Medical School
Ngoga, Gedeon
Unknown Affiliation
Mucumbitsi, Joseph
Rwanda, Kigali
King Faisal Hospital
Bavuma, Charlotte Munganyinka
Rwanda, Kigali
Centre Hospitalier Universitaire de Kigali
Rwanda, Kigali
Ministry of Health
Dusabeyezu, Symaque
Rwanda, Kigali
Ministry of Health
Rich, Michael Leonard
United States, Boston
Brigham and Women's Hospital
United States, Boston
Partners in Health
Mutabazi, Francis
Rwanda, Kigali
Ministry of Health
Mutumbira, Cadet
Rwanda, Kigali
Ministry of Health
Ngiruwera, Jean Paul
Rwanda, Kigali
Ministry of Health
Amoroso, Cheryl L.
United States, Boston
Partners in Health
Ball, Ellen
United States, Boston
Partners in Health
Fraser, Hamish Sf F.
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
United States, Boston
Partners in Health
Hirschhorn, Lisa Ruth
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
United States, Boston
Partners in Health
Farmer, Paul E.
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
United States, Boston
Partners in Health
Rusingiza, Emmanuel Kamanzi
Rwanda, Kigali
Ministry of Health
Rwanda, Kigali
Centre Hospitalier Universitaire de Kigali
Bukhman, Gene Y.
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
Rwanda, Kigali
Ministry of Health
United States, Boston
Partners in Health
United States, West Roxbury
Va Boston Healthcare System
Statistics
Citations: 84
Authors: 18
Affiliations: 8
Identifiers
Doi:
10.1016/j.jchf.2013.03.006
ISSN:
22131779
Research Areas
Health System And Policy
Maternal And Child Health
Noncommunicable Diseases
Substance Abuse
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Rwanda
Participants Gender
Female