Abstract 12243: Symptomatic Improvement of Patients with Heart Failure in Sub-Saharan Africa Treated by a Simplified Decentralized Strategy
Background: Heart failure (HF) contributes significantly to the burden of non-communicable diseases in sub-Saharan Africa, and is generally managed by specialists at referral centers in large cities. We describe the symptom relief of patients treated in rural Rwanda using simplified protocols.
Methods: Generalist physicians and nurses were trained in evidence based protocols to manage HF at rural health centers and district hospitals in Rwanda. Symptoms were assessed using the New York Heart Association (NYHA) functional classification at baseline and follow-up. Analysis includes consecutive patients enrolled between November 2006 and August 2009. Change from baseline NYHA class was assessed using one-way ANOVA with Sidek method post-hoc pairwise comparisons.
Results: Of 218 patients diagnosed with HF, 101 patients had recorded symptom assessments at both baseline and follow-up (mean age 39.4 ±23.1 years, 60% men, mean follow-up visits 7.3±5.1). Figure 1 shows the distribution of patients by baseline and follow-up NYHA class. The mean change in NYHA class was -0.56 (±0.82). Figure 2 shows mean change in NYHA class by baseline class (p<0.000 omnibus difference; p<0.05 for individual group differences, except p=0.15 between baseline class I and II, and p=0.41 between baseline NYHA class II and III).
Conclusion: Outpatient care of patients with HF in rural Rwanda results in symptomatic improvement. The most symptomatic patients had the greatest incremental benefit. Decentralized care for impoverished patients with advanced chronic diseases can be accomplished in resource-limited settings in sub-Saharan Africa.
- © 2012 by American Heart Association, Inc.