Abstract P110: Heart Failure in Rural Sub-Saharan Africa: Etiology and Severity
Background: Heart failure contributes significantly to the noncommunicable disease (NCD) burden in sub-Saharan Africa. However, diagnosis and treatment is largely performed at referral centers. We describe a cohort of patients enrolled in a rural heart failure clinic in Rwanda.
Methods: A longitudinal heart failure clinic was established as part of integrated NCD programs in rural Rwanda. Patients were recruited after hospital discharge and from outpatient acute care clinics. Nurses used simplified diagnostic algorithms incorporating clinical and echocardiographic findings. Diagnoses were confirmed by a cardiologist. Retrospective data from clinical electronic medical records between November 2006 and March 2011 were extracted.
Results: 192 patients had confirmed heart failure. Median age was 35 years, 70% were women, 63% were subsistence farmers, 8% smoked tobacco and the mean adult weight was 53 kg. Forty-seven percent had New York Heart Association Class III or IV symptoms on presentation. Of children <18 years (n=54), rheumatic heart disease (RHD, 48%), congenital heart disease (39%) and dilated cardiomyopathy (DCMP, 9%) were the leading causes. Among adults (n=138), DCMP (54%), RHD (25%) and hypertensive heart disease (8%) were most prevalent. No patient had findings consistent with ischemic heart disease. Among patients with available data (n=157), mean LVEF was 44% (SD 18.8) and 46% had moderate or severe LV dysfunction (LVEF ≤44%). Of patients with available data (n=166), 36% had BP≥140/90 mmHg.
Conclusion: Patients presenting with heart failure in rural Rwanda are generally young, women and active subsistence farmers while the prevalence of traditional cardiovascular risk factors are relatively low. Symptoms are advanced at the time of presentation while the causes of heart failure are generally endemic, and not related to ischemic heart disease. Decentralized services for heart failure diagnosis and management are needed to address this current burden.
- © 2013 by American Heart Association, Inc.