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Berhanu H, Mekonnen Y, Workicho A, Hassen K, Negeri Z, Sudhakar M, Mitiku S, Mossie A. The prevalence of rheumatic heart disease in Ethiopia: a systematic review and meta-analysis. Trop Dis Travel Med Vaccines 2023; 9:16. [PMID: 37828598 PMCID: PMC10571304 DOI: 10.1186/s40794-023-00192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/10/2023] [Indexed: 10/14/2023] Open
Abstract
Globally, more than 33 million people are living with rheumatic heart disease (RHD). A high prevalence of the disease is observed in people with poor socio-economic status, overcrowding, and low access to medical facilities. Even though different studies have been conducted in different settings, there is no reliable data regarding RHD prevalence. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of RHD in Ethiopia. PubMed/Medline, SCOPUS, HINARI, and Google Scholar databases were used to search for peer-reviewed articles. Articles published in English between the years 1992 and 2022 September were considered. The pooled prevalence of RHD was calculated using a random-effect model at a 95% confidence interval, including the weight of each study. Finally, statistical meta-analysis STATA version 16.0 software was used to calculate the pooled prevalence of RHD.A total of twelve cross-sectional studies were included in the meta-analysis. Individual study prevalence ranges from 0.32 to 32.78%. The pooled prevalence of RHD was 3.19% (95% CI: 1.46-5.56%). The prevalence was higher among the population who visited hospitals at 5.42% (95% CI: 1.09-12.7%) compared to schoolchildren at 0.73% (95% CI: 0.30-1.34%) and community-based studies at 3.83% (95% CI: 3.16-4.55%). Addis Ababa had the lowest prevalence of RHD (0.75% (95% CI: 0.38-1.25%), whereas the highest prevalence was observed in the Amhara region (8.95% (95% CI: 7.21-11.06%). A significant variation in the overall estimated prevalence of RHD was not observed between males and females.Trial registration Protocol registration (PROSPERO): CRD42021251553, Date of registration May 28 2021.
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Affiliation(s)
- Hiwot Berhanu
- Department of Biomedical Sciences, Faculty of Medical Science, Jimma Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Yimer Mekonnen
- Department of Pharmacy, Faculty of Health Sciences, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abdulhalik Workicho
- Department of Epidemiology, Institute of Health, Jimma University, P.O.Box 378, Jimma, Ethiopia
| | - Kalkidan Hassen
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Zenebe Negeri
- Department of Biomedical Sciences, Faculty of Medical Science, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Morankar Sudhakar
- Department of Health, Behavior and Society, Faculty of Public Health, Ethiopian Evidence Based Health Care CenterInstitute of HealthJimma University, Jimma, Ethiopia
| | - Shimelis Mitiku
- Department of Biomedical Sciences, Faculty of Medical Science, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Andualem Mossie
- Department of Biomedical Sciences, Faculty of Medical Science, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
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Puddu PE, Menotti A. Heart Diseases of Uncertain Etiology: A New Definition of Heart Failure for Epidemiological Studies. J Cardiovasc Dev Dis 2023; 10:jcdd10030132. [PMID: 36975896 PMCID: PMC10054351 DOI: 10.3390/jcdd10030132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023] Open
Abstract
It has been a long time since, in the spectrum of ischemic (IHD) or coronary (CHD) heart diseases, a differentiation was performed between the forms presenting with and those without pain [...].
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Mboweni N, Maseko M, Tsabedze N. Heart failure with reduced ejection fraction and atrial fibrillation: a Sub-Saharan African perspective. ESC Heart Fail 2023; 10:1580-1596. [PMID: 36934444 DOI: 10.1002/ehf2.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/06/2023] [Accepted: 02/07/2023] [Indexed: 03/20/2023] Open
Abstract
Cardiovascular diseases are a well-established cause of death in high-income countries. In the last 20 years, Sub-Saharan Africa (SSA) has seen one of the sharpest increases in cardiovascular disease-related mortality, superseding that of infectious diseases, including HIV/AIDS, in South Africa. This increase is evidenced by a growing burden of heart failure and atrial fibrillation (AF) risk factors. AF is a common comorbidity of heart failure with reduced ejection fraction (HFrEF), which predisposes to an increased risk of stroke, rehospitalizations, and mortality compared with patients in sinus rhythm. AF had the largest relative increase in cardiovascular disease burden between 1990 and 2010 in SSA and the second highest (106.4%) increase in disability-adjusted life-years (DALY) between 1990 and 2017. Over the last decade, significant advancements in the management of both HFrEF and AF have emerged. However, managing HFrEF/AF remains a clinical challenge for physicians, compounded by the suboptimal efficacy of guideline-mandated pharmacotherapy in this group of patients. There may be an essential role for racial differences and genetic influence on therapeutic outcomes of HFrEF/AF patients, further complicating our overall understanding of the disease and its pathophysiology. In SSA, the lack of accurate and up-to-date epidemiological data on this subgroup of patients presents a challenge in our quest to prevent and reduce adverse outcomes. This narrative review provides a contemporary overview of the epidemiology of HFrEF/AF in SSA. We highlight important differences in the demographic and aetiological profile and the management of this subpopulation, emphasizing what is currently known and, more importantly, what is still unknown about HFrEF/AF in SSA.
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Affiliation(s)
- Nonkanyiso Mboweni
- School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.,Department of Internal Medicine, Division of Cardiology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Gauteng, Johannesburg, South Africa
| | - Muzi Maseko
- School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Nqoba Tsabedze
- Department of Internal Medicine, Division of Cardiology, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Gauteng, Johannesburg, South Africa
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Contemporary aetiology of acute heart failure in a teaching hospital in Ghana. BMC Cardiovasc Disord 2023; 23:82. [PMID: 36765294 PMCID: PMC9921595 DOI: 10.1186/s12872-023-03103-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Heart failure (HF) is recognized as a global public health disease associated with high morbidity and mortality. It is suggested that the main underlying causes of HF in developing countries differ from those identified in well-resourced countries. This study therefore presents the cardiovascular risk factors and the underlying aetiology of HF among admitted patients in a teaching Hospital in Ghana. METHOD The study prospectively recruited 140 consecutive patients admitted for heart failure at the Medical department of the Korle-Bu Teaching Hospital from March to October, 2014. The study evaluated the cardiovascular risk factors and the aetiologies of heart failure, and compared the risk factors and aetiologies with patient's age and gender. RESULTS The mean age of the study participants was 51.3 ± 16.8 years. The commonest cardiovascular risk factors observed were hypertension (46.5%), history of previous HF (40.7%), excessive alcohol use (38.6%), and family history of heart disease (29.3%); predominantly hypertension (68.3%). The major underlying aetiology of HF were dilated cardiomyopathy (38.6%), hypertensive heart disease (21.4%), ischaemic heart disease (13.6%) and valvular heart disease (12.9%). These underlying aetiology of HF were more common in patients aged 40 years and above (p = 0.004) and those presenting with multiple risk factors (p = 0.001). CONCLUSION The major underlying aetiology of heart failure in adults were dilated cardiomyopathy, hypertensive heart disease, ischaemic heart disease and valvular heart disease, which were significantly high among patients aged 40 years and above and those presenting multiple risk factors. Hypertension, excessive alcohol use, family history of heart disease and personal history of previous heart failure diagnosis are noted as the main cardiovascular risk factors among heart failure patients.
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Minja NW, Nakagaayi D, Aliku T, Zhang W, Ssinabulya I, Nabaale J, Amutuhaire W, de Loizaga SR, Ndagire E, Rwebembera J, Okello E, Kayima J. Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward. Front Cardiovasc Med 2022; 9:1008335. [PMID: 36440012 PMCID: PMC9686438 DOI: 10.3389/fcvm.2022.1008335] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.
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Affiliation(s)
- Neema W. Minja
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Doreen Nakagaayi
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Twalib Aliku
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Wanzhu Zhang
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nabaale
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Willington Amutuhaire
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Sarah R. de Loizaga
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Emma Ndagire
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | | | - Emmy Okello
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Kayima
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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6
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Risk Factors and Prevalence of Dilated Cardiomyopathy in Sub-Saharan Africa: A Systematic Review. Glob Heart 2022; 17:76. [DOI: 10.5334/gh.1166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/30/2022] [Indexed: 01/17/2023] Open
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Gtif I, Bouzid F, Charfeddine S, Abid L, Kharrat N. Heart failure disease: An African perspective. Arch Cardiovasc Dis 2021; 114:680-690. [PMID: 34563468 DOI: 10.1016/j.acvd.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Heart failure remains a health challenge in Africa, associated with significant rates of hospitalization, morbidity and mortality. The current review aims to summarize the most recent data on the epidemiology, aetiology, risk factors and management of heart failure, comparing countries in North Africa and sub-Saharan Africa. There is a paucity of data on heart failure epidemiology, aetiology and management, and on the sociodemographic characteristics of African patients with heart failure. Heart failure prevalence has been evaluated among all medical admissions or admissions to cardiac units or emergency departments in a few hospital-based studies conducted in countries in North Africa and sub-Saharan Africa. Common causes of heart failure in Africa include ischaemic heart disease, hypertensive heart disease, dilated cardiomyopathy and valvular heart disease. The aetiology of heart failure differs between countries in North Africa and sub-Saharan Africa. Diagnosing heart failure proves challenging in Africa because of a lack of basic tools and the necessary human resources. The principal drugs used frequently for heart failure therapy are lacking in sub-Saharan Africa. The clinical profile of heart failure in sub-Saharan Africa differs from that in North African countries; this is related to aetiological factors, socioeconomic status and availability of diagnostic tools. There is an evident need to establish a large multicentre registry to evaluate the heart failure burden in almost all African countries, and to highlight the major cardiovascular risk factors and co-morbidities. The present review highlights the importance of this syndrome in Africa, and calls for improvements in its early diagnosis, treatment and, possibly, prevention.
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Affiliation(s)
- Imen Gtif
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia.
| | - Fériel Bouzid
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
| | - Salma Charfeddine
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Leila Abid
- Department of Cardiology, Hédi Chaker University Hospital, Faculty of Medicine of Sfax, University of Sfax, 3000 Sfax, Tunisia
| | - Najla Kharrat
- Laboratory of Molecular and Cellular Screening Processes, Centre of Biotechnology of Sfax, University of Sfax, Sidi Mansour, 3061 Sfax, Tunisia
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8
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Kraus SM, Shaboodien G, Francis V, Laing N, Cirota J, Chin A, Pandie S, Lawrenson J, Comitis GAM, Fourie B, Zühlke L, Wonkam A, Wainwright H, Damasceno A, Mocumbi AO, Pepeta L, Moeketsi K, Thomas BM, Thomas K, Makotoko M, Brown S, Ntsekhe M, Sliwa K, Badri M, Gumedze F, Cordell HJ, Keavney B, Ferreira V, Mahmod M, Cooper LT, Yacoub M, Neubauer S, Watkins H, Mayosi BM, Ntusi NAB. Rationale and design of the African Cardiomyopathy and Myocarditis Registry Program: The IMHOTEP study. Int J Cardiol 2021; 333:119-126. [PMID: 33607192 DOI: 10.1016/j.ijcard.2021.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF), the dominant form of cardiovascular disease in Africans, is mainly due to hypertension, rheumatic heart disease and cardiomyopathy. Cardiomyopathies pose a great challenge because of poor prognosis and high prevalence in low- and middle-income countries (LMICs). Little is known about the etiology and outcome of cardiomyopathy in Africa. Specifically, the role of myocarditis and the genetic causes of cardiomyopathy are largely unidentified in Africans. METHOD The African Cardiomyopathy and Myocarditis Registry Program (the IMHOTEP study) is a pan-African multi-centre, hospital-based cohort study, designed with the primary aim of describing the clinical characteristics, genetic causes, prevalence, management and outcome of cardiomyopathy and myocarditis in children and adults. The secondary aim is to identify barriers to the implementation of evidence-based care and provide a platform for trials and other intervention studies to reduce morbidity and mortality in cardiomyopathy. The registry consists of a prospective cohort of newly diagnosed (i.e., incident) cases and a retrospective (i.e., prevalent) cohort of existing cases from participating centres. Patients with cardiomyopathy and myocarditis will be subjected to a standardized 3-stage diagnostic process. To date, 750 patients have been recruited into the multi-centre pilot phase of the study. CONCLUSION The IMHOTEP study will provide comprehensive and novel data on clinical features, genetic causes, prevalence and outcome of African children and adults with all forms of cardiomyopathy and myocarditis in Africa. Based on these findings, appropriate strategies for management and prevention of the cardiomyopathies in LMICs are likely to emerge.
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Affiliation(s)
- Sarah M Kraus
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Gasnat Shaboodien
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Veronica Francis
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Nakita Laing
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Human Genetics, Department of Medicine, UCT, Cape Town, South Africa
| | - Jacqui Cirota
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Ashley Chin
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Shahiemah Pandie
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - John Lawrenson
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - George A M Comitis
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Barend Fourie
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Liesl Zühlke
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, UCT and Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Ambroise Wonkam
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; Division of Human Genetics, Department of Medicine, UCT, Cape Town, South Africa
| | - Helen Wainwright
- Department of Pathology, National Health Laboratory Service and UCT, Cape Town, South Africa
| | | | - Ana Olga Mocumbi
- Instituto Nacional de Saúde and Eduardo Mondlane University, Maputo, Mozambique
| | - Lungile Pepeta
- Department of Paediatrics, Port Elizabeth Hospital Complex and Nelson Mandela Metropolitan University, Port Elizabeth, South Africa
| | - Khulile Moeketsi
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Baby M Thomas
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Kandathil Thomas
- Division of Cardiology, Nelson Mandela Academic Hospital and Walter Sisulu University, Mthatha, South Africa
| | - Makoali Makotoko
- Division of Cardiology, Universitas Hospital and University of the Free State, Bloemfontein, South Africa
| | - Stephen Brown
- Division of Cardiology, Universitas Hospital and University of the Free State, Bloemfontein, South Africa
| | - Mpiko Ntsekhe
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Karen Sliwa
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Motasim Badri
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa; College of Medicine, King Saudi Bin Abdulaziz University for Medical Sciences, Riyadh, Saudi Arabia
| | | | - Heather J Cordell
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Bernard Keavney
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Vanessa Ferreira
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Masliza Mahmod
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, USA
| | | | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Hugh Watkins
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Bongani M Mayosi
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- The Cardiac Clinic and Hatter Institute of Cardiovascular Research in Africa, Department of Medicine, University of Cape Town (UCT) and Groote Schuur Hospital, Cape Town, South Africa.
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9
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Sliwa K. Heart failure can affect everyone: the ESC Geoffrey Rose lecture. Eur Heart J 2021; 41:1298-1306. [PMID: 32118263 DOI: 10.1093/eurheartj/ehaa084] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/03/2019] [Accepted: 01/29/2020] [Indexed: 12/22/2022] Open
Abstract
The principle of 'sick individuals vs. sick population', a concept pioneered by Geoffrey Rose 35 years ago, is particularly applicable to heart failure (HF). This perspective article summarizes and expands on the Geoffrey Rose lecture given at the European Society of Cardiology meeting held in conjunction with the World Congress of Cardiology, in Paris, 2019. This article focuses on the fact that, clearly, HF not only affects a large spectrum of the population globally, but it occurs in all ages and equally in both genders. Heart failure, in most parts of the world, is clearly not a disease of the elderly. There are multiple and complex pathways leading to HF which include various risk factors (including communicable diseases and exposure to indoor and environmental pollutants), poverty and overcrowding, as well as sub-optimal access to health care systems due to socioeconomic inequities. Reflecting on Geoffrey Rose's concept 35 years later motivates us to confront our global responsibility to address the population distribution of risk factors more effectively, instead of focusing solely on interventions that target high-risk individuals.
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Affiliation(s)
- Karen Sliwa
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, 3 Anzio road, Observatory 7925, Cape Town, South Africa.,Soweto Cardiovascular Research Unit, University of the Witwatersrand, 1 Jan Smuts Ave, Johannesburg 2000, South Africa.,Mary McKillop Institute, Melbourne, 215 Spring St, Melbourne, Victoria, 3000, Australia
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10
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Shaboodien G, Spracklen TF, Kamuli S, Ndibangwi P, Van Niekerk C, Ntusi NAB. Genetics of inherited cardiomyopathies in Africa. Cardiovasc Diagn Ther 2020; 10:262-278. [PMID: 32420109 DOI: 10.21037/cdt.2019.10.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCDs) is rising disproportionately in comparison to the rest of the world, affecting urban, semi-urban and rural dwellers alike. NCDs are predicted to surpass infections like human immunodeficiency virus, tuberculosis and malaria as the leading cause of mortality in SSA over the next decade. Heart failure (HF) is the dominant form of cardiovascular disease (CVD), and a leading cause of NCD in SSA. The main causes of HF in SSA are hypertension, cardiomyopathies, rheumatic heart disease, pericardial disease, and to a lesser extent, coronary heart disease. Of these, the cardiomyopathies deserve greater attention because of the relatively poor understanding of mechanisms of disease, poor outcomes and the disproportionate impact they have on young, economically active individuals. Morphofunctionally, cardiomyopathies are classified as dilated, hypertrophic, restrictive and arrhythmogenic; regardless of classification, at least half of these are inherited forms of CVD. In this review, we summarise all studies that have investigated the incidence of cardiomyopathy across Africa, with a focus on the inherited cardiomyopathies. We also review data on the molecular genetic underpinnings of cardiomyopathy in Africa, where there is a striking lack of studies reporting on the genetics of cardiomyopathy. We highlight the impact that genetic testing, through candidate gene screening, association studies and next generation sequencing technologies such as whole exome sequencing and targeted resequencing has had on the understanding of cardiomyopathy in Africa. Finally, we emphasise the need for future studies to fill large gaps in our knowledge in relation to the genetics of inherited cardiomyopathies in Africa.
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Affiliation(s)
- Gasnat Shaboodien
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Timothy F Spracklen
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stephen Kamuli
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Polycarp Ndibangwi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Carla Van Niekerk
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ntobeko A B Ntusi
- Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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11
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Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective. Glob Heart 2020; 15:15. [PMID: 32489788 PMCID: PMC7218780 DOI: 10.5334/gh.403] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
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.
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Badran HM, Elgharably MA, Faheem N. Clinical characteristics and in-hospital outcome of heart failure in women: a single center registry from Egyptian cardiac care unit. Egypt Heart J 2019; 71:30. [PMID: 31820129 PMCID: PMC6901647 DOI: 10.1186/s43044-019-0032-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/19/2019] [Indexed: 12/01/2022] Open
Abstract
Background This study represents figures from a cardiac care unit (CCU) of a university hospital; it describes an example of a tertiary academic center in Egypt and provides an epidemiological view of the female HF patients, their risk profile, and short-term outcome during hospitalization. Results It is a local single-center cross-sectional observational registry of CCU patients 1 year from July 2015 to July 2016. Patient’s data were collected through a special software program. Women with evidence of HF were thoroughly studied. Among the 1006 patients admitted to CCU in 1 year, 345 (34.2%) patients were females and 118 (34.2%) had evidence of HF, whereas 661 (65.7%) were males and 178 (26.9%) of them had HF. Women with HF showed 11.7% prevalence of the total population admitted to CCU. 72.7% were HFrEF and 27.3% were HFpEF. Compared to men, women with HF were older in age, more obese, less symptomatic than men, had higher incidence of associated co-morbidities, less likely to be re-admitted for HF, and less likely to have ACS and PCI. Valvular heart diseases and cardiomyopathies were the commonest etiologies of their HF. Women had more frequent normal ECG, higher EF%, and smaller LA size. There is no difference in medications and CCU procedures. While females had shorter stay, there is no significant difference in hospital mortality compared to male patients. Conclusions Despite higher prevalence of HF in females admitted to CCU and different clinical characteristics and etiology of HF, female gender was associated with similar prognosis during hospital course compared to male gender.
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Affiliation(s)
| | | | - Naglaa Faheem
- Menoufia University, 55-ElGish street, Tanta, Gharbia, P.O box 34, Egypt
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Ogbemudia EJ, Obasohan AO. Association between Common Etiologies and Precipitants of Acute Decompensated Heart Failure. Niger Med J 2019; 60:113-116. [PMID: 31543561 PMCID: PMC6737795 DOI: 10.4103/nmj.nmj_63_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Acute decompensated heart failure (ADHF) comprises the etiology of heart failure and the precipitant of acute decompensation. Early identification of the precipitant of ADHF is important in management, but an association between the precipitant and etiology of ADHF has not been established. Objective: The objective of this study is to determine whether the precipitant of acute decompensation is associated with the etiology of heart failure. Methods: This was a prospective observational study conducted over 2 years. Patients with ADHF secondary to common etiologies such as hypertension and rheumatic heart diseases (RHD) were enrolled in the study. The demographics, precipitants, and relevant variables on echocardiography and electrocardiography were documented. The frequencies of the etiology and precipitants of heart failure were derived. The Chi-square test was used to determine an association between categorical variables, and independent t-test was used to compare the means of continuous variables. A value of P < 0.05 was considered statistically significant. Results: There were a total of 190 participants. Hypertensive and RHD were 96 (50.5%) and 94 (49.5%), respectively. One hundred and three (54.2%) were females and males were 87 (45.8%). The precipitants were pneumonia 104 (54.7%), arrhythmias 47 (24.7%), urinary tract infection 36 (19.5%), and infective endocarditis 3 (1.6%). The association between these etiologies and precipitants of ADHF yielded a value of P = 0.597. Conclusion: There is no association between the precipitant and etiology of ADHF. Therefore, the precipitant of ADHF should be actively sought for in every case for optimal management and better outcomes.
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Affiliation(s)
- Ehi J Ogbemudia
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Austine O Obasohan
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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Agbor VN, Essouma M, Ntusi NA, Nyaga UF, Bigna JJ, Noubiap JJ. Heart failure in sub-Saharan Africa: A contemporaneous systematic review and meta-analysis. Int J Cardiol 2018; 257:207-215. [DOI: 10.1016/j.ijcard.2017.12.048] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 01/13/2023]
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15
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Saldarriaga CI. Insuficiencia cardiaca en la mujer. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Gap Between Clinical Practice and Guidelines: A National Survey of the Knowledge of Recommended Heart Failure Guidelines Among Chinese Physicians. Qual Manag Health Care 2017; 26:196-204. [PMID: 28991815 DOI: 10.1097/qmh.0000000000000150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated the current level of knowledge of Chinese heart failure (HF) guidelines among physicians, as a reference for the promotion and transformation of HF knowledge. METHODS AND RESULTS Physicians from 88 hospitals in 27 provinces of China completed our survey between July and December 2014. The questions covered the main points included in the Chinese HF diagnosis and treatment guidelines (2014). A total of 2146 physicians, aged 20 to 62 years (35.6 ± 7.6 years), completed the survey. The correctness rate of their answers to the 15 multiple-choice questions in the HF questionnaire was generally low (mean 32.6%). The mean correctness rate for 10 blank-filling questions about the target doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and β-blockers was 42.5%. On the basis of their responses, physicians whose knowledge of the guidelines was "excellent," "good," "medium," and "bad" accounted for 1.1%, 11.4%, 14.2%, and 73.4%, respectively. Physicians who possessed a higher level of qualifications had significantly greater awareness of HF guidelines than those with relatively low qualifications (P < .001). A statistically significant association was found between hospital level and adherence to treatment guidelines (P < .001). A significant difference was also observed among physicians in different practice scopes (P < .001). CONCLUSIONS The survey found an obvious deficiency in physicians' mastery of fundamental knowledge about HF. There is a need to improve physicians' education about HF in China.
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Breedt E, Lacerda L, Essop MF. Trimetazidine therapy for diabetic mouse hearts subjected to ex vivo acute heart failure. PLoS One 2017; 12:e0179509. [PMID: 28632748 PMCID: PMC5478112 DOI: 10.1371/journal.pone.0179509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/30/2017] [Indexed: 11/19/2022] Open
Abstract
Acute heart failure (AHF) is the most common primary diagnosis for hospitalized heart diseases in Africa. As increased fatty acid β-oxidation (FAO) during heart failure triggers detrimental effects on the myocardium, we hypothesized that trimetazidine (TMZ) (partial FAO inhibitor) offers cardioprotection under normal and obese-related diabetic conditions. Hearts were isolated from 12-14-week-old obese male and female diabetic (db/db) mice versus lean non-diabetic littermates (db/+) controls. The Langendorff retrograde isolated heart perfusion system was employed to establish an ex vivo AHF model: a) Stabilization phase-Krebs Henseleit buffer (10 mM glucose) at 100 mmHg (25 min); b) Critical Acute Heart Failure (CAHF) phase-(1.2 mM palmitic acid, 2.5 mM glucose) at 20 mmHg (25 min); and c) Recovery Acute Heart Failure phase (RAHF)-(1.2 mM palmitic acid, 10 mM glucose) at 100 mmHg (25 min). Treated groups received 5 μM TMZ in the perfusate during either the CAHF or RAHF stage for the full duration of each respective phase. Both lean and obese males benefited from TMZ treatment administered during the RAHF phase. Sex differences were observed only in lean groups where the phases of the estrous cycle influenced therapy; only the lean follicular female group responded to TMZ treatment during the CAHF phase. Lean luteal females rather displayed an inherent cardioprotection (without treatments) that was lost with obesity. However, TMZ treatment initiated during RAHF was beneficial for obese luteal females. TMZ treatment triggered significant recovery for male and obese female hearts when administered during RAHF. There were no differences between lean and obese male hearts, while lean females displayed a functional recovery advantage over lean males. Thus TMZ emerges as a worthy therapeutic target to consider for AHF treatment in normal and obese-diabetic individuals (for both sexes), but only when administered during the recovery phase and not during the very acute stages.
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Affiliation(s)
- Emilene Breedt
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Lydia Lacerda
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - M. Faadiel Essop
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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Sliwa K, Zühlke L, Kleinloog R, Doubell A, Ebrahim I, Essop M, Kettles D, Jankelow D, Khan S, Klug E, Lecour S, Marais D, Mpe M, Ntsekhe M, Osrin L, Smit F, Snyders A, Theron JP, Thornton A, Chin A, van der Merwe N, Dau E, Sarkin A. Cardiology-cardiothoracic subspeciality training in South Africa: a position paper of the South Africa Heart Association. Cardiovasc J Afr 2017; 27:188-193. [PMID: 27841903 PMCID: PMC5783290 DOI: 10.5830/cvja-2016-063] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/18/2016] [Indexed: 11/17/2022] Open
Abstract
Over the past decades, South Africa has undergone rapid demographic changes, which have led to marked increases in specific cardiac disease categories, such as rheumatic heart disease (now predominantly presenting in young adults with advanced and symptomatic disease) and coronary artery disease (with rapidly increasing prevalence in middle age). The lack of screening facilities, delayed diagnosis and inadequate care at primary, secondary and tertiary levels have led to a large burden of patients with heart failure. This leads to suffering of the patients and substantial costs to society and the healthcare system. In this position paper, the South African Heart Association (SA Heart) National Council members have summarised the current state of cardiology, cardiothoracic surgery and paediatric cardiology reigning in South Africa. Our report demonstrates that there has been minimal change in the number of successfully qualified specialists over the last decade and, therefore, a de facto decline per capita. We summarise the major gaps in training and possible interventions to transform the healthcare system, dealing with the colliding epidemic of communicable disease and the rapidly expanding epidemic of non-communicable disease, including cardiac disease.
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Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, MRC Inter-University Cape Heart Group, Department of Medicine, Faculty of Health Sciences, University of Cape Town; Soweto Cardiovascular Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
| | - Liesl Zühlke
- Departments of Paediatric Cardiology and Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Robert Kleinloog
- Cardiothoracic Surgery, Ethekwini Hospital and Heart Centre, Durban, South Africa
| | - Anton Doubell
- Division of Cardiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa
| | - Iftikhar Ebrahim
- Netcare Unitas Hospital, Lyttleton Manor, Pretoria, South Africa
| | - Mohammed Essop
- Division of Cardiology, Baragwanath Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dave Kettles
- St Dominic's Hospital, and Frere Hospital, East London, South Africa
| | - David Jankelow
- Netcare Linksfield Hospital, Linksfield West, Johannesburg, South Africa
| | - Sajidah Khan
- Department of Cardiology, Faculty of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Eric Klug
- Netcare Sunninghill Hospital, Sunninghill, Johannesburg, South Africa
| | - Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - David Marais
- Division of Chemical Pathology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Martin Mpe
- Mediclinic Heart Hospital, Arcadia, Pretoria, South Africa
| | - Mpiko Ntsekhe
- Department of Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa
| | - Les Osrin
- Zuid-Afrikaans Hospital, Muckleneuk and Department of Cardiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Francis Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Adriaan Snyders
- Wilgers Medical Consortium, Die Wilgers, Pretoria, South Africa
| | - Jean Paul Theron
- Interventional Cardiology Unit, Netcare Union Hospital, Alberton, South Africa
| | - Andrew Thornton
- Netcare Sunninghill Hospital, Sunninghill, Johannesburg, South Africa
| | - Ashley Chin
- Department of Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa
| | | | - Erika Dau
- South African Heart Association, Tygerberg, South Africa
| | - Andrew Sarkin
- Department of Cardiology, Faculty of Health Sciences, Steve Biko Academic Hospital and University of Pretoria, South Africa
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Gemechu T, Mahmoud H, Parry EHO, Phillips DIW, Yacoub MH. Community-based prevalence study of rheumatic heart disease in rural Ethiopia. Eur J Prev Cardiol 2017; 24:717-723. [DOI: 10.1177/2047487316687104] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - Magdi H Yacoub
- Aswan Heart Centre, Aswan, Egypt
- NHLI, Heart Science Centre, Imperial College London, UK
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Abstract
South Africa and other areas of sub-Saharan Africa have in the past 20 years undergone rapid demographical changes, largely due to urbanisation and changes in lifestyle. This rapid change has led to a marked increase in specific cardiac conditions, such as hypertensive heart disease and coronary artery disease (with the highest prevalence in the middle-aged population), in conjunction with a range of other heart diseases, which are historically common in Africa-eg, rheumatic heart disease, cardiomyopathies, and unoperated congenital heart disease. The short supply of well-equipped screening facilities, late diagnosis, and inadequate care at primary, secondary, and tertiary levels have led to a large burden of patients with poorly treated heart failure. Excellent progress has been made in the understanding of the epidemiology, sociodemographical factors, effect of urbanisation, and pathophysiology of cardiac conditions, such as peripartum cardiomyopathy, rheumatic heart disease, and tuberculous pericarditis, which are common in sub-Saharan Africa. This progress has been achieved largely through several studies, such as the Heart of Soweto, THESUS, REMEDY, BA-HEF, Abeokuta-HF, and the PAPUCO studies. Studies on the suitable therapeutic management of several heart conditions have also been done or are underway. In this Lecture, I provide a personal perspective on the evolving burden of cardiac disease, as witnessed since my appointment at Chris Hani Baragwanath Hospital, in Soweto, South Africa, in 1992, which was also the year that the referendum to end apartheid in South Africa was held. Subsequently, a network of cardiologists was formed under the umbrella of the Heart of Africa Studies and the Pan African Cardiac Society. Furthermore, I summarise the major gaps in the health-care system dealing with the colliding epidemic of communicable and non-communicable heart diseases, including cardiac diseases common in peripartum women. I also touch on the fantastic opportunities available for doing meaningful research with enthusiastic colleagues and, thereby, having a large effect, despite the need to be highly innovative in finding much needed funding support.
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Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, South African Medical Research Council Inter-University Cape Heart Group, University of Cape Town, Cape Town, South Africa; The Institute of Infectious Disease and Molecular Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; The Mary MacKillop Institute for Health Research, Faculty of Health Sciences, Australian Catholic University, Melbourne, VIC, Australia; Soweto Cardiovascular Research Group, University of the Witwatersrand, Johannesburg, South Africa.
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Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1775-1812. [PMID: 27733286 PMCID: PMC5224694 DOI: 10.1016/s0140-6736(16)31470-2] [Citation(s) in RCA: 626] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/13/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. METHODS We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. FINDINGS Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. INTERPRETATION Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. FUNDING Bill & Melinda Gates Foundation.
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Shi A, Tao Z, Wei P, Zhao J. Epidemiological aspects of heart diseases. Exp Ther Med 2016; 12:1645-1650. [PMID: 27602082 PMCID: PMC4998208 DOI: 10.3892/etm.2016.3541] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 07/25/2016] [Indexed: 01/19/2023] Open
Abstract
Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Coronary heart disease (CHD) is the main cause of mortality in heart patients following stroke, rheumatic heart disease and myocardial infarctions. Approximately 80% of individuals succumb to CVDs, due to poor living conditions in low and middle income families and malnutrition. Infectious diseases, human immunodeficiency, tuberculosis, malaria, high blood pressure or hypertension, obesity and overweight, and nutritional disorders including smoking, excessive alcohol consumption, high salt and sugar intake, as well as other factors are responsible for CVDs and CHDs in young as well as elderly individuals. The focus of the present review are recent epidemiological aspects of CVD and CHD as well as the usefulness of a Mediterranean diet for heart patients and the prevention of heart diseases.
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Affiliation(s)
- Aimin Shi
- School of Public Health of Nanjing Medical University, Nanjing, Jiangsu 211166, P.R. China
| | - Ziqi Tao
- Department of Science and Education, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Peng Wei
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Jing Zhao
- Department of Science and Education Division, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
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Malebranche R, Tabou Moyo C, Morisset PH, Raphael NA, Wilentz JR. Clinical and echocardiographic characteristics and outcomes in congestive heart failure at the Hospital of The State University of Haiti. Am Heart J 2016; 178:151-60. [PMID: 27502863 DOI: 10.1016/j.ahj.2016.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to evaluate the clinical and epidemiologic profile of congestive heart failure at the principal free-care hospital in Haiti. Cardiovascular disease represents the most prevalent cause of admissions to the medical service of the University Hospital of the State of Haiti. No previous study has examined the demographics of congestive heart failure in urban Haiti. METHODS Two hundred forty-seven patients presented to the inpatient service between May 2011 and May 2013. Evaluation included history and physical, CBC, renal/metabolic profile, serum glucose, anti-HIV antibody, ECG, chest radiograph and echocardiogram. Treatment included angiotensin converting enzyme inhibitors, furosemide and spironolactone, carvedilol, digoxin and anticoagulation. RESULTS Women (62.4%) outnumbered men; patients were relatively young (mean age 50.1) and from the lowest socio-economic levels of the population. Nearly all (98.8%) presented with NYHA III-IV status, with correspondingly high mortality (23.3%). Echocardiography showed 73% dilated cardiomyopathy; 83% showed moderate to severe LV systolic dysfunction (mean EF 36.5 +/- 15%) and 17% preserved LV systolic function. The three principal etiologies were dilated cardiomyopathy (29%) hypertensive cardiomyopathy (27%) and peripartum cardiomyopathy (20%). Ischemic cardiomyopathy was rare (3.4%). At 27 months follow-up, 76.7% of the patients were alive and well. Among those who died, mean survival time was 113 days. Readmission carried a poor prognosis. CONCLUSIONS This congestive heart failure study from Haiti shows an unusually high proportion of young women, primarily due to peripartum cardiomyopathy. Ischemic cardiomyopathy is rare, as in Africa. Further study is warranted to address the particular problem of the high frequency of peripartum cardiomyopathy in this population.
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MESH Headings
- Adolescent
- Adrenergic beta-Antagonists/therapeutic use
- Adult
- Age Distribution
- Aged
- Aged, 80 and over
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Anticoagulants/therapeutic use
- Carbazoles/therapeutic use
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/drug therapy
- Cardiomyopathy, Dilated/epidemiology
- Cardiomyopathy, Dilated/physiopathology
- Cardiotonic Agents/therapeutic use
- Carvedilol
- Cohort Studies
- Digoxin/therapeutic use
- Diuretics/therapeutic use
- Echocardiography
- Electrocardiography
- Female
- Furosemide/therapeutic use
- Haiti
- Heart Failure/diagnostic imaging
- Heart Failure/drug therapy
- Heart Failure/epidemiology
- Heart Failure/physiopathology
- Hospitalization
- Hospitals, University
- Hospitals, Urban
- Humans
- Hypertension/epidemiology
- Male
- Middle Aged
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnostic imaging
- Pregnancy Complications, Cardiovascular/drug therapy
- Pregnancy Complications, Cardiovascular/epidemiology
- Pregnancy Complications, Cardiovascular/physiopathology
- Propanolamines/therapeutic use
- Prospective Studies
- Puerperal Disorders/diagnostic imaging
- Puerperal Disorders/drug therapy
- Puerperal Disorders/epidemiology
- Puerperal Disorders/physiopathology
- Sex Distribution
- Spironolactone/therapeutic use
- Stroke Volume
- Young Adult
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Affiliation(s)
- Rodolphe Malebranche
- Cardiology Unit, Department of Medicine, Hospital of the University of the State of Haiti, Port-au-Prince, Haiti; Faculty of Medicine and Pharmacy of the University of the State of Haiti, Port-au-Prince, Haiti
| | - Christian Tabou Moyo
- Cardiology Unit, Department of Medicine, Hospital of the University of the State of Haiti, Port-au-Prince, Haiti
| | - Paul-Henry Morisset
- Cardiology Unit, Department of Medicine, Hospital of the University of the State of Haiti, Port-au-Prince, Haiti
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Makubi A, Hage C, Sartipy U, Lwakatare J, Janabi M, Kisenge P, Dahlström U, Rydén L, Makani J, Lund LH. Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF). Int J Cardiol 2016; 220:750-8. [PMID: 27393861 DOI: 10.1016/j.ijcard.2016.06.239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/26/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden. METHODS A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after matching 1:3 by gender and age±5years (n 411 vs. 1232). The association between cohort and all-cause mortality was assessed with multivariable Cox regression. RESULTS In the unmatched cohorts, TaHeF (as compared to SwedeHF) patients were younger (median age [interquartile range] 55 [40-68] vs. 77 [64-84] years, p<0.001) and more commonly women (51% vs. 40%, p<0.001). The three-year survival was 61% in both cohorts. In the matched cohorts, TaHeF patients had more hypertension (47% vs. 37%, p<0.001), more anemia (57% vs. 9%), more preserved EF, more advanced HF, longer duration of HF, and less use of beta-blockers. Crude mortality was worse in TaHeF (HR 2.25 [95% CI 1.78-2.85], p<0.001), with three-year survival 61% vs. 83%. However, covariate-adjusted risk was similar (HR 1.07, 95% CI 0.69-1.66; p=0.760). In both cohorts, preserved EF was associated with higher mortality in crude but not adjusted analysis. CONCLUSIONS Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis.
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Affiliation(s)
- Abel Makubi
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania.
| | - Camilla Hage
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johnson Lwakatare
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania
| | - Mohammed Janabi
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania
| | - Peter Kisenge
- Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania
| | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, 58191 Linköping, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden
| | - Julie Makani
- School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Nuffield Department of Clinical Medicine, University of Oxford, OX3 7BN Oxford, London, United Kingdom; Muhimbili Wellcome Programme, PO Box 65001, Dar es Salaam, Tanzania
| | - Lars H Lund
- Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden
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Rosendaal NTA, Hendriks ME, Verhagen MD, Bolarinwa OA, Sanya EO, Kolo PM, Adenusi P, Agbede K, van Eck D, Tan SS, Akande TM, Redekop W, Schultsz C, Gomez GB. Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program. PLoS One 2016; 11:e0157925. [PMID: 27348310 PMCID: PMC4922631 DOI: 10.1371/journal.pone.0157925] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 06/07/2016] [Indexed: 12/02/2022] Open
Abstract
Background High blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA). We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI) program in rural Nigeria. Methods A Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD) within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY) averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1) presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy) and 2) presence of hypertension in combination with a CVD risk of >20% (risk based strategy). We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario. Results Screening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second strategy respectively ranged from US$ 1,406 to US$ 7,815 and US$ 732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment. Conclusions Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities to finance CVD prevention care in SSA.
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Affiliation(s)
- Nicole T. A. Rosendaal
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
- Office of Public Health Studies, University of Hawaii, John A. Burns School of Medicine, 1960 East-West Road, Honolulu, HI, United States of America
| | - Marleen E. Hendriks
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
- * E-mail:
| | - Mark D. Verhagen
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
| | - Oladimeji A. Bolarinwa
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
| | - Emmanuel O. Sanya
- Department of Medicine, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
| | - Philip M. Kolo
- Department of Medicine, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
| | - Peju Adenusi
- Hygeia Nigeria Ltd, 13B Idejo Street, Victoria Island, Lagos, Nigeria
| | | | | | - Siok Swan Tan
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tanimola M. Akande
- Department of Epidemiology and Community Health, University of Ilorin Teaching Hospital, P.M.B. 1459, Ilorin, postal code 240001, Nigeria
| | - William Redekop
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Constance Schultsz
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
| | - Gabriela B. Gomez
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Pietersbergweg 17, Amsterdam, 1105 BM, The Netherlands
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abstract
Heart failure (HF) is a rapidly growing public health issue with an estimated prevalence of >37.7 million individuals globally. HF is a shared chronic phase of cardiac functional impairment secondary to many aetiologies, and patients with HF experience numerous symptoms that affect their quality of life, including dyspnoea, fatigue, poor exercise tolerance, and fluid retention. Although the underlying causes of HF vary according to sex, age, ethnicity, comorbidities, and environment, the majority of cases remain preventable. HF is associated with increased morbidity and mortality, and confers a substantial burden to the health-care system. HF is a leading cause of hospitalization among adults and the elderly. In the USA, the total medical costs for patients with HF are expected to rise from US$20.9 billion in 2012 to $53.1 billion by 2030. Improvements in the medical management of risk factors and HF have stabilized the incidence of this disease in many countries. In this Review, we provide an overview of the latest epidemiological data on HF, and propose future directions for reducing the ever-increasing HF burden.
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Mutation analysis of the phospholamban gene in 315 South Africans with dilated, hypertrophic, peripartum and arrhythmogenic right ventricular cardiomyopathies. Sci Rep 2016; 6:22235. [PMID: 26917049 PMCID: PMC4808831 DOI: 10.1038/srep22235] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 02/09/2016] [Indexed: 02/07/2023] Open
Abstract
Cardiomyopathy is an important cause of heart failure in Sub-Saharan Africa, accounting for up to 30% of adult heart failure hospitalisations. This high prevalence poses a challenge in societies without access to resources and interventions essential for disease management. Over 80 genes have been implicated as a cause of cardiomyopathy. Mutations in the phospholamban (PLN) gene are associated with dilated cardiomyopathy (DCM) and severe heart failure. In Africa, the prevalence of PLN mutations in cardiomyopathy patients is unknown. Our aim was to screen 315 patients with arrhythmogenic right ventricular cardiomyopathy (n = 111), DCM (n = 95), hypertrophic cardiomyopathy (n = 40) and peripartum cardiomyopathy (n = 69) for disease-causing PLN mutations by high resolution melt analysis and DNA sequencing. We detected the previously reported PLN c.25C > T (p.R9C) mutation in a South African family with severe autosomal dominant DCM. Haplotype analysis revealed that this mutation occurred against a different haplotype background to that of the original North American family and was therefore unlikely to have been inherited from a common ancestor. No other mutations in PLN were detected (mutation prevalence = 0.2%). We conclude that PLN is a rare cause of cardiomyopathy in African patients. The PLN p.R9C mutation is not well-tolerated, emphasising the importance of this gene in cardiac function.
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Li L, Xie W, Zheng XL, Yin WD, Tang CK. A novel peptide adropin in cardiovascular diseases. Clin Chim Acta 2016; 453:107-13. [DOI: 10.1016/j.cca.2015.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/05/2015] [Accepted: 12/08/2015] [Indexed: 12/16/2022]
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29
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Mbogo GW, Nedeva C, Puthalakath H. Isolation of Cardiomyocytes and Cardiofibroblasts for Ex Vivo Analysis. Methods Mol Biol 2016; 1419:117-29. [PMID: 27108436 DOI: 10.1007/978-1-4939-3581-9_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) is a common clinical endpoint to several underlying causes including aging, hypertension, stress, and cardiomyopathy. It is characterized by a significant decline in the cardiac output. Cardiomyocytes are terminally differentiated cells and therefore, apoptotic death due to beta adrenergic (β-AR) signaling contributes to high attrition rate of these cells. Past treatments of HF offer some survival benefit to patients (e.g., the beta blockers), but at the expense of blocking the compensatory beta-adrenergic signaling in surviving cells. One prerequisite for developing new therapeutics is to be able to grow cardiomyocytes ex vivo, and test their apoptotic response to drugs. Here we describe methods for isolation and culturing of neonatal and adult calcium tolerant cardiomyocytes. Similarly, cardiofibroblasts can also be isolated using the same protocol and subsequently, immortalized with SV40 T-Antigen for ex vivo studies.
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Affiliation(s)
- George Williams Mbogo
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Christina Nedeva
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Hamsa Puthalakath
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, VIC, 3086, Australia.
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Amare H, Hamza L, Asefa H. Malnutrition and associated factors among heart failure patients on follow up at Jimma university specialized hospital, Ethiopia. BMC Cardiovasc Disord 2015; 15:128. [PMID: 26471898 PMCID: PMC4608297 DOI: 10.1186/s12872-015-0111-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 09/23/2015] [Indexed: 11/25/2022] Open
Abstract
Background Malnutrition and cachexia are serious consequences of numerous chronic diseases. Severe heart failure patients could be related with marked weight loss. Malnutrition is associated with poor prognosis among heart failure patients. Despite its implication, factors associated with malnutrition among heart failure patients in Africa and Ethiopia was not addressed. Hence, in this study we tried to determine factors associated with malnutrition among heart failure patients on follow up at Jimma University specialized hospital, Ethiopia. Methods A cross-sectional study was done on 284 randomly selected heart failure patients. The nutritional status of the patients was assessed based on their serum albumin level (normal value 4–5 mg/dl) and triceps skin fold thickness. The data was analyzed using SPSS version 20.0. Multivariable logistic regression was used to identify factors associated with malnutrition among heart failure patients using SPSS 20.0. Results Based on serum albumin and triceps skin fold thickness, 77.8 % of patients were malnourished. Mean age of the patients was 48.3 ± 15.9 years. The commonest cause of heart failure was ischemic heart disease (34.9 %). Hypertension (36 %) was the commonest co morbid disease. Forty four percent of patients had New York heart association functional class II heart failure. Serum hemoglobin (AOR = 0.77, 95 % CI: 0.67–0.92) was found to be significantly associated with nutritional status of heart failure patients. As serum hemoglobin increases by 1gm/dl, the risk of malnutrition decreased by 15 % (P value = 0.03). Conclusions The majority of patients were malnourished. A higher hemoglobin concentration was associated with reduced odds of being malnourished.
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Affiliation(s)
- Hiwot Amare
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia.
| | - Leja Hamza
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia.
| | - Henok Asefa
- Department of Epidemiology and Biostatistics, Jimma University, Jimma, Ethiopia.
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31
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Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends. Clin Ther 2015; 37:2225-33. [DOI: 10.1016/j.clinthera.2015.08.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/20/2015] [Accepted: 08/22/2015] [Indexed: 12/31/2022]
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Ezzati M, Obermeyer Z, Tzoulaki I, Mayosi BM, Elliott P, Leon DA. Contributions of risk factors and medical care to cardiovascular mortality trends. Nat Rev Cardiol 2015; 12:508-30. [PMID: 26076950 PMCID: PMC4945698 DOI: 10.1038/nrcardio.2015.82] [Citation(s) in RCA: 195] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Ischaemic heart disease, stroke, and other cardiovascular diseases (CVDs) lead to 17.5 million deaths worldwide per year. Taking into account population ageing, CVD death rates are decreasing steadily both in regions with reliable trend data and globally. The declines in high-income countries and some Latin American countries have been ongoing for decades without slowing. These positive trends have broadly coincided with, and benefited from, declines in smoking and physiological risk factors, such as blood pressure and serum cholesterol levels. These declines have also coincided with, and benefited from, improvements in medical care, including primary prevention, diagnosis, and treatment of acute CVDs, as well as post-hospital care, especially in the past 40 years. These variables, however, explain neither why the decline began when it did, nor the similarities and differences in the start time and rate of the decline between countries and sexes. In Russia and some other former Soviet countries, changes in volume and patterns of alcohol consumption have caused sharp rises in CVD mortality since the early 1990s. An important challenge in reaching firm conclusions about the drivers of these remarkable international trends is the paucity of time-trend data on CVD incidence, risk factors throughout the life-course, and clinical care.
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Affiliation(s)
- Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Ziad Obermeyer
- Department of Emergency Medicine, Harvard Medical School, Neville House, 75 Francis Street, Boston, MA 02115, USA
| | - Ioanna Tzoulaki
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Main Building, Observatory, Cape Town 7925, South Africa
| | - Paul Elliott
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - David A Leon
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Sciences, London School of Hygiene &Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Serum selenium and ceruloplasmin in nigerians with peripartum cardiomyopathy. Int J Mol Sci 2015; 16:7644-54. [PMID: 25853263 PMCID: PMC4425040 DOI: 10.3390/ijms16047644] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/07/2015] [Accepted: 03/31/2015] [Indexed: 11/17/2022] Open
Abstract
The study aimed to determine if selenium deficiency, serum ceruloplasmin and traditional birth practices are risk factors for peripartum cardiomyopathy (PPCM), in Kano, Nigeria. This is a case-control study carried out in three hospitals, and PPCM patients were followed up for six months. Critically low serum selenium concentration was defined as <70 µg/L. A total of 39 PPCM patients and 50 controls were consecutively recruited after satisfying the inclusion criteria. Mean serum selenium in patients (61.7 ± 14.9 µg/L) was significantly lower than in controls (118.4 ± 45.6 µg/L) (p < 0.001). The prevalence of serum selenium <70 µg/L was significantly higher among patients (76.9%) than controls (22.0%) (p < 0.001). The mean ceruloplasmin and prevalence of socio-economic indices, multiparity, pregnancy-induced hypertension, obesity and twin pregnancy were not different between the groups (p > 0.05). Logistic regression showed that rural residency significantly increased the odds for serum selenium <70 µg/L by 2.773-fold (p = 0.037). Baseline serum levels of selenium and ceruloplasmin were not associated with six-month mortality. This study has shown that selenium deficiency is a risk factor for PPCM in Kano, Nigeria, and is related to rural residency. However, serum ceruloplasmin, customary birth practices and some other characteristics were not associated with PPCM in the study area.
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Palliative and supportive care needs of heart failure patients in Africa. Curr Opin Support Palliat Care 2015; 9:20-5. [DOI: 10.1097/spc.0000000000000107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hilfiker-Kleiner D, Haghikia A, Nonhoff J, Bauersachs J. Peripartum cardiomyopathy: current management and future perspectives. Eur Heart J 2015; 36:1090-7. [PMID: 25636745 PMCID: PMC4422973 DOI: 10.1093/eurheartj/ehv009] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/08/2015] [Indexed: 01/06/2023] Open
Abstract
Pregnancy is associated with marked physiological changes challenging the cardiovascular system. Among the more severe pregnancy associated cardiovascular complications, peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging towards the end of pregnancy or in the first postpartal months in previously healthy women. A major challenge is to distinguish the peripartum discomforts in healthy women (fatigue, shortness of breath, and oedema) from the pathological symptoms of PPCM. Moreover, pregnancy-related pathologies such as preeclampsia, myocarditis, or underlying genetic disease show overlapping symptoms with PPCM. Difficulties in diagnosis and the discrimination from other pathological conditions in pregnancy may explain why PPCM is still underestimated. Additionally, underlying pathophysiologies are poorly understood, biomarkers are scarce and treatment options in general limited. Experience in long-term prognosis and management including subsequent pregnancies is just beginning to emerge. This review focuses on novel aspects of physiological and pathophysiological changes of the maternal cardiovascular system by comparing normal conditions, hypertensive complications, genetic aspects, and infectious disease in PPCM-pregnancies. It also presents clinical and basic science data on the current state of knowledge on PPCM and brings them in context thereby highlighting promising new insights in diagnostic tools and therapeutic approaches and management.
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Affiliation(s)
- Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Arash Haghikia
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Justus Nonhoff
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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CardioPulse ArticlesProf. Raimund Erbel and Prof. Victor Aboyans discuss the 2014 European Society of Cardiology Guidelines on the diagnosis and treatment of aortic diseases with Emma WilkinsonThe ‘Ten Commandments’ for European Society of Cardiology Guidelines on Aortic DiseasesEuropean interventionists leading treatment of valvular heart diseaseTackling Heart Failure in Africa via innovative research: setting the agendaThe 62nd Annual Scientific Session of the Japanese College of CardiologyLeadless pacing debate: current issues in pacing. Eur Heart J 2014; 35:2989-90. [DOI: 10.1093/eurheartj/ehu379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Alhurani AS, Dekker R, Tovar E, Bailey A, Lennie TA, Randall DC, Moser DK. Examination of the potential association of stress with morbidity and mortality outcomes in patient with heart failure. SAGE Open Med 2014; 2. [PMID: 26246898 PMCID: PMC4523379 DOI: 10.1177/2050312114552093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objectives: The high mortality and morbidity rates associated with heart failure are still not well explained. A few psychosocial factors have been studied and explain some of this risk, but other factors, like stress, remain largely unexplored in heart failure. This study aimed to (1) examine the association of stress with 6-month cardiac event-free survival, (2) examine the relationship of stress with salivary cortisol, and (3) examine the association of salivary cortisol level with 6-month cardiac event-free survival. Method: A total of 81 heart failure patients participated. Stress was measured using the brief Perceived Stress Scale. Cortisol was measured from unstimulated whole expectorated saliva. Cox regression analyses were used to determine whether stress predicted event-free survival, and if salivary cortisol predicted event-free survival. Linear and multiple regressions were used to determine the association of stress with salivary cortisol. Results: Stress was not a significant predictor of event-free survival in heart failure (heart rate = 1.06; 95% confidence interval = 0.95–1.81; p = 0.32). Salivary cortisol was a significant predictor of event-free survival in the unadjusted model (heart rate = 2.30; 95% confidence interval = 0.99–5.927; p = 0.05), but not in the adjusted model. Stress (β 1.06; 95% confidence interval = 0.95–1.18; p = 0.32) was not a significant predictor of salivary cortisol level. Conclusion: Stress is a complex phenomenon, and our measure of stress may not have captured it well. Alternatively, the physical stressors acting in heart failure produce levels of neurohormonal activation that mask the effects of psychosocial stressors or an indirect association of stress with outcomes that is mediated through another construct. Future studies are needed to investigate stress in patients with heart failure to provide definitive answers.
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Affiliation(s)
- Abdullah S Alhurani
- College of Nursing, University of Kentucky, Lexington, KY, USA
- The University of Jordan, Amman, Jordan
| | - Rebecca Dekker
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Elizabeth Tovar
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Alison Bailey
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Terry A Lennie
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - David C Randall
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Ponikowski P, Anker SD, AlHabib KF, Cowie MR, Force TL, Hu S, Jaarsma T, Krum H, Rastogi V, Rohde LE, Samal UC, Shimokawa H, Budi Siswanto B, Sliwa K, Filippatos G. Heart failure: preventing disease and death worldwide. ESC Heart Fail 2014; 1:4-25. [DOI: 10.1002/ehf2.12005] [Citation(s) in RCA: 712] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
| | | | - Khalid F. AlHabib
- King Fahad Cardiac Centre; King Saud University; Riyadh Saudi Arabia
| | - Martin R. Cowie
- National Heart and Lung Institute; Imperial College London (Royal Brompton Hospital); London UK
| | - Thomas L. Force
- Center for Translational Medicine and Cardiology Division; Temple University School of Medicine; Philadelphia PA USA
| | - Shengshou Hu
- State Key Laboratory of Cardiovascular Disease; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Tiny Jaarsma
- Faculty of Health Sciences; Linköping University; Linköping Sweden
| | - Henry Krum
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | - Vishal Rastogi
- Medical Advanced Heart Failure Program; Fortis Escorts Heart Institute; New Delhi India
| | - Luis E. Rohde
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre; Medical School of the Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | - Umesh C. Samal
- Heart Failure Subspecialty; Cardiological Society of India; Kolkata India
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine; University of Indonesia, National Cardiovascular Center Harapan Kita; Jakarta Indonesia
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences; University of Cape Town, Cape Town, and Soweto Cardiovascular Research Unit, University of the Witwatersrand; Johannesburg South Africa
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital; University of Athens; Athens Greece
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Abstract
To mark the 10th anniversary of Nature Reviews Cardiology in November 2014, five of our Advisory Board members were invited to consider a topic within cardiology about which we know too little. A diverse range of subjects are highlighted in this Perspectives article, including preoperative assessment of right ventricular function, the burden of cardiomyopathies in Africa, the measurement of fractional flow reserve to guide coronary intervention, the interaction between genes and environment in cardiovascular disease, and the difficulty of predicting atherosclerotic plaque rupture. The five key opinion leaders from around the globe also suggest ways in which future research could be targeted to address the deficits in our understanding, with the aim of preventing cardiovascular disease, improving patient care, and reducing morbidity and mortality.
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Affiliation(s)
- Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele Scientific Institute, Via Olgettina, 58, 20132 Milan, Italy
| | - Bongani M Mayosi
- Department of Medicine, J Floor, Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Seung-Jung Park
- Asan Medical Center, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, South Korea
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Avenue, PO Box 81465-1148, Isfahan, Iran
| | - Renu Virmani
- CVPath Institute Inc., 19 Firstfield Road, Gaithersburg, MD 20878, USA
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Sliwa K, Libhaber E, Elliott C, Momberg Z, Osman A, Zühlke L, Lachmann T, Nicholson L, Thienemann F, Roos-Hesselink J, Anthony J. Spectrum of cardiac disease in maternity in a low-resource cohort in South Africa. Heart 2014; 100:1967-74. [PMID: 25227705 PMCID: PMC4251204 DOI: 10.1136/heartjnl-2014-306199] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Lack of evidence-based data on the spectrum of cardiovascular disease (CVD) in pregnancy or in the postpartum period, as well as on maternal and fetal outcome, provides challenges for treating physicians, particularly in areas of low resources. The objectives of this study were to investigate the spectrum of disease, mode of presentation and maternal and fetal outcome of patients referred to a dedicated Cardiac Disease and Maternity Clinic (CDM). Methods The prospective cohort study was conducted at a single tertiary care centre in South Africa. Two hundred and twenty-five women presenting with CVD in pregnancy, or within 6 months postpartum, were studied over a period of 2 years. Clinical assessment, echocardiography and laboratory tests were performed at baseline and follow-up visits. Prepartum, peripartum and postpartum complications were grouped into cardiac, neonatal and obstetric events. Results Ethnicity was black African (45%), mixed ethnicity (32%), white (15%), Indian/others (8%) and 12% were HIV positive. Of the 225 consecutive women (mean age 28.8±6.4), 196 (86.7%) presented prepartum and 73 in modified WHO class I. The 152 women presenting in a higher risk group (modified WHO class II–IV) were offered close follow-up at the CDM clinic and were diagnosed with congenital heart disease (32%, 15 operated previously), valvular heart disease (26%, 15 operated previously), cardiomyopathy (27%) and other (15%). Women presenting with symptoms of CVD or heart failure postpartum (n=30) presented in a higher New York Heart Association, had higher heart rates (p<0.001) and NTproBNP levels (p<0.0005). Of the 152 patients, 9 (6%) died within the 6-month follow-up period. Eight of the nine patients died >42 days postpartum. Perinatal death occurred in 1/152 (0.7%)—translating to a perinatal mortality rate of 7/1000 live births. Conclusions Disease patterns were markedly different to that seen in the developed world. However, joint obstetric–cardiac care in the low-resource cohort was associated with excellent survival outcome rates of pregnant mothers (even with complex diseases) and their offspring and was similar to that seen in the western world. Mortality typically occurred in the postpartum period, beyond the standard date of recording maternal death.
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Affiliation(s)
- Karen Sliwa
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa Faculty of Health Sciences, Inter-Cape Heart MRC Unit and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Libhaber
- Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine Elliott
- Division of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Zoe Momberg
- Division of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Ayesha Osman
- Division of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Liesl Zühlke
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa Department of Paediatrics, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Tony Lachmann
- Division of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Lauren Nicholson
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Friedrich Thienemann
- Faculty of Health Sciences, Inter-Cape Heart MRC Unit and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Jolien Roos-Hesselink
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - John Anthony
- Division of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Bonny A, Ngantcha M, Amougou SN, Kane A, Marrakchi S, Okello E, Taty G, Gehani A, Diakite M, Talle MA, Lambiase PD, Houenassi M, Chin A, Otieno H, Temu G, Owusu IK, Karaye KM, Awad AAM, Winkel BG, Priori SG. Rationale and design of the Pan-African Sudden Cardiac Death survey: the Pan-African SCD study. Cardiovasc J Afr 2014; 25:176-84. [PMID: 25192301 PMCID: PMC4170179 DOI: 10.5830/cvja-2014-035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300,000 to 400,000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD in Africa. METHODS The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms' or 'unwitnessed natural death within 24 hours of the onset of symptoms'. After approval from institutional boards, we will record demographic, clinical, electrocardiographic and biological variables of SCD victims (including survivors of cardiac arrest) in several African cities. All deaths occurring in residents of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. CONCLUSION This study will provide comprehensive, contemporary data on the epidemiology of SCD in Africa and will help in the development of strategies to prevent and manage cardiac arrest in this region of the world.
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Affiliation(s)
- Aimé Bonny
- Teaching Hospital Laquintinie, University of Douala, Douala, Cameroon; Service de Cardiologie, Centre Hospitalier Victor Provo, Roubaix, France.
| | | | - Sylvie Ndongo Amougou
- Service de Réanimation Médicale, Centre Hospitalier, Universitaire de Yaoundé, Cameroon
| | - Adama Kane
- Service de Cardiologie, Centre Hospitalier le Dantec, Dakar, Senegal
| | - Sonia Marrakchi
- Service de Cardiologie, Hopital Abderrrahmen Mami Ariana, Tunis, Tunisia
| | - Emmy Okello
- Department of Internal Medicine, Mulago Hospital, Makerere University, Kampala, Uganda
| | - Georges Taty
- Service de Médecine Interne, Centre Hospitalier Général de Port-Gentil, Gabon
| | | | | | - Mohammed A Talle
- Department of Internal Medicine, University of Maiduguri Teaching Hospital, Nigeria
| | - Pier D Lambiase
- Institute of Cardiovascular Sciences, University College London, UK
| | - Martin Houenassi
- Service de Cardiologie, Centre Hospitalier Universitaire Abomey Calavi de Cotonou, Benin
| | - Ashley Chin
- Department of Cardiology, UCT Private Academic Hospital, Cape Town, South Africa
| | - Harun Otieno
- Department of Cardiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Gloria Temu
- Department of Cardiology, Kilimanjaro Christian Medical Centre, Tanzania
| | - Isaac Koffi Owusu
- Department of Cardiology, University Teaching Hospital of Accra, Ghana
| | - Kamilu M Karaye
- Department of Cardiology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abdalla A M Awad
- Department of Cardiology, University Hospital of Khartoum, Sudan
| | | | - Silvia G Priori
- Department of Molecular Genetics, Fondazione Salvatore Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy
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Makubi A, Hage C, Lwakatare J, Kisenge P, Makani J, Rydén L, Lund LH. Contemporary aetiology, clinical characteristics and prognosis of adults with heart failure observed in a tertiary hospital in Tanzania: the prospective Tanzania Heart Failure (TaHeF) study. Heart 2014; 100:1235-41. [PMID: 24743164 DOI: 10.1136/heartjnl-2014-305599] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE This study aimed to describe the contemporary aetiology, clinical characteristics and mortality and its predictors in heart failure (HF) in Tanzania. METHODS Design; Prospective observational study. Setting; Cardiovascular Center of the Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients ≥18 years of age with HF defined by the Framingham criteria. MAIN OUTCOME MEASURE All-cause mortality. RESULTS Among 427 included patients, 217 (51%) were females and the mean (SD) age was 55 (17) years. HF aetiologies included hypertension (45%), cardiomyopathy (28%), rheumatic heart disease (RHD) (12%) and ischaemic heart disease (9%). Concurrent atrial fibrillation (AF), clinically significant anaemia, diabetes, tuberculosis and HIV were found in 16%, 12%, 12%, 3% and 2%, respectively, while warfarin was used in 3% of the patients. The mortality rate, 22.4 per 100 person-years over a median follow-up of 7 months, was independently associated with AF, HR 3.4 (95% CI 1.6 to 7.0); in-patient 3.2 (1.5 to 6.8); anaemia 2.3 (1.2 to 4.5); pulmonary hypertension 2.1 (1.1 to 4.2) creatinine clearance 0.98 (0.97 to 1.00) and lack of education 2.3 (1.3 to 4.2). CONCLUSIONS In HF in Tanzania, patients are younger than in the developed world, but aetiologies are becoming more similar, with hypertension becoming more and RHD less important. Predictors of mortality possible to intervene against are anaemia, AF and lack of education.
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Affiliation(s)
- Abel Makubi
- Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Camilla Hage
- Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Johnson Lwakatare
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Cardiovascular Center, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Peter Kisenge
- Cardiovascular Center, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Julie Makani
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Lars Rydén
- Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Lars H Lund
- Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Sliwa K, Hilfiker-Kleiner D, Mebazaa A, Petrie MC, Maggioni AP, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Roos-Hesslink JW, Shah AJ, Seferovic PM, Elkayam U, van Spaendonck-Zwarts K, Bachelier-Walenta K, Mouquet F, Kraigher-Krainer E, Hall R, Ponikowski P, McMurray JJV, Pieske B. EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Eur J Heart Fail 2014; 16:583-91. [DOI: 10.1002/ejhf.68] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/05/2013] [Accepted: 12/13/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa; University of Cape Town; South Africa
| | | | - Alexandre Mebazaa
- Hôpital Lariboisière; Université Paris Diderot, Inserm 942; Paris France
| | | | - Aldo P. Maggioni
- EURObservational Research Programme (EORP); European Society of Cardiology; Sophie Antipolis France
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine (GiM); Charité - Universitätsmedizin; Berlin Germany
| | - Maria Schaufelberger
- Department of Medicine; Sahlgrenska University Hospital Ostra; Gothenburg Sweden
| | - Luigi Tavazzi
- Maria Cecilia Hospital; GVM Care & Research, E.S. Health Science Foundation; Cotignola Italy
| | | | | | - Ajay J. Shah
- King's College London BHF Centre of Excellence; London UK
| | | | - Uri Elkayam
- University of Southern California; Los Angeles CA USA
| | | | - Katrin Bachelier-Walenta
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin; Universitätsklinikum des Saarlandes; Homburg Saar Germany
| | - Frederic Mouquet
- Service de Cardiologie, Pôle Cardio-vasculaire et Pulmonaire; Hôpital Cardiologique; CHRU Lille France
| | - Elisabeth Kraigher-Krainer
- Department of Cardiology; Medical University Graz & Ludwig-Boltzmann Institute for Translational Heart Failure Research; Graz Austria
| | - Roger Hall
- Norfolk and Norwich University Hospitals; UK
| | - Piotr Ponikowski
- Department of Cardiology; Military Hospital, Center for Heart Diseases; Wroclaw Poland
| | | | - Burkert Pieske
- Department of Cardiology; Medical University Graz; Austria
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Abstract
Worldwide, the numbers of women who have a pre-existing cardiovascular disease or develop cardiac problems during pregnancy are increasing and, due to the lack of evidenced-based data, this provides challenges for the treating physician. Cardiovascular disease in pregnancy is a complex topic as women can present either pre- or post-partum, due to a pre-existing heart disease such as operated on or unoperated on congenital heart disease, valvular heart disease, chronic hypertension, or familial dilated cardiomyopathy. Women often present with symptoms and signs of acute heart failure. On the other hand, there are diseases which are directly related to pregnancy, such as hypertensive disorders of pregnancy and peripartum cardiomyopathy, or where pregnancy increases risk of a disease as, for example, the risk of myocardial infarction. These diseases can have long-term implications to the life of the affected women and their families. There is, in particular, a paucity of data from developing countries of this unique disease pattern and its presentations. This review summarizes the current knowledge of the incidence and prevalence of pregnancy-related cardiovascular disease in women presenting pre- or post-partum.
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Affiliation(s)
- Karen Sliwa
- Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and IIDMM, University of Cape Town, Cape Town, South Africa
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46
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Population Health Studies – What Do They Tell Us? Heart Lung Circ 2013; 22:885-6. [DOI: 10.1016/j.hlc.2013.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 11/18/2022]
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Moran A, Forouzanfar M, Sampson U, Chugh S, Feigin V, Mensah G. The epidemiology of cardiovascular diseases in sub-Saharan Africa: the Global Burden of Diseases, Injuries and Risk Factors 2010 Study. Prog Cardiovasc Dis 2013; 56:234-9. [PMID: 24267430 DOI: 10.1016/j.pcad.2013.09.019] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The epidemiology of cardiovascular diseases in sub-Saharan Africa is unique among world regions, with about half of cardiovascular diseases (CVDs) due to causes other than atherosclerosis. CVD epidemiology data are sparse and of uneven quality in sub-Saharan Africa. Using the available data, the Global Burden of Diseases, Risk Factors, and Injuries (GBD) 2010 Study estimated CVD mortality and burden of disease in sub-Saharan Africa in 1990 and 2010. The leading CVD cause of death and disability in 2010 in sub-Saharan Africa was stroke; the largest relative increases in CVD burden between 1990 and 2010 were in atrial fibrillation and peripheral arterial disease. CVD deaths constituted only 8.8% of all deaths and 3.5% of all disability-adjusted life years (DALYs) in sub-Sahara Africa, less than a quarter of the proportion of deaths and burden attributed to CVD in high income regions. However, CVD deaths in sub-Saharan Africa occur at younger ages on average than in the rest of the world. It remains uncertain if increased urbanization and life expectancy in some parts of sub-Saharan African nations will transition the region to higher CVD burden in future years.
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Affiliation(s)
- Andrew Moran
- Division of General Medicine, Columbia University Medical Center, New York, NY.
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Abstract
Adverse trends in blood pressure, diabetes mellitus, and other cardiometabolic risk factors, together with population growth and ageing, are contributing to the burden of cardiovascular diseases in Africa. This increasing problem, coupled with inadequate access to effective interventions for prevention, diagnosis, and treatment, is creating major public-health challenges across the continent.
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