Kwan Gene F, Jean-Baptiste Waking, Cleophat Philip, Leandre Fèrnet, Louine Martineau, Luma Maxo, Benjamin Emelia J, Mukherjee Joia S, Bukhman Gene, Hirschhorn Lisa R
Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA Partners In Health, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.
Heart. 2016 Jan;102(2):140-6. doi: 10.1136/heartjnl-2015-308451.
There is increasing attention to cardiovascular diseases in low-income countries. However, little is known about heart failure (HF) in rural areas, where most of the populations in low-income countries live. We studied HF epidemiology, care delivery and outcomes in rural Haiti.
Among adults admitted with HF to a rural Haitian tertiary care hospital during a 12-month period (2013-2014), we studied the clinical characteristics and short-term outcomes including length of stay, inhospital death and outpatient follow-up rates.
HF accounted for 392/1049 (37%) admissions involving 311 individuals; over half (60%) were women. Mean age was 58.8 (SD 16.2) years for men and 48.3 (SD 18.8) years for women; 76 (41%) women were <40 years of age. Median length of stay was 10 days (first and second quartiles 7, 17), and inhospital mortality was 12% (n=37). Ninety nine (36%) of the 274 who survived their primary hospitalisation followed-up at the hospital's outpatient clinic, and 18 (6.6%) were readmitted to the same hospital within 30 days postdischarge. Decreased known follow-up (p<0.01) and readmissions (p=0.03) were associated with increased distance between patient residence and hospital. Among the one-quarter (81) patients with echocardiograms, causes of HF included: non-ischaemic cardiomyopathy (64%), right HF (12%), hypertensive heart disease (7%) and rheumatic heart disease (5%). One-half of the women with cardiomyopathy by echocardiogram had peripartum cardiomyopathy.
HF is a common cause of hospitalisation in rural Haiti. Among diagnosed patients, HF is overwhelming due to non-atherosclerotic heart disease and particularly affects young adults. Implementing effective systems to improve HF diagnosis and linkage to essential outpatient care is needed to reduce long-term morbidity and mortality.
低收入国家对心血管疾病的关注日益增加。然而，对于低收入国家大多数人口居住的农村地区的心力衰竭（HF）情况却知之甚少。我们研究了海地农村地区的心力衰竭流行病学、医疗服务提供情况及治疗结果。
在12个月期间（2013 - 2014年），对于入住海地农村一家三级护理医院的成年心力衰竭患者，我们研究了其临床特征和短期治疗结果，包括住院时间、院内死亡情况及门诊随访率。
心力衰竭占1049例入院病例中的392例（37%），涉及311名患者；超过半数（60%）为女性。男性的平均年龄为58.8（标准差16.2）岁，女性为48.3（标准差18.8）岁；76名（41%）女性年龄小于40岁。住院时间中位数为10天（第一和第二四分位数分别为7天、17天），院内死亡率为12%（n = 37）。在274名度过首次住院期的患者中，99名（36%）在医院门诊进行了随访，18名（6.6%）在出院后30天内再次入住同一家医院。已知随访率降低（p < 0.01）和再入院率（p = 0.03）与患者居住地与医院之间距离增加有关。在四分之一（81例）进行了超声心动图检查的患者中，心力衰竭的病因包括：非缺血性心肌病（64%）、右心衰竭（12%）、高血压性心脏病（7%）和风湿性心脏病（5%）。超声心动图显示患有心肌病的女性患者中，一半患有围产期心肌病。
心力衰竭是海地农村地区住院的常见原因。在确诊患者中，心力衰竭主要由非动脉粥样硬化性心脏病引起，尤其影响年轻人。需要实施有效的系统来改善心力衰竭的诊断以及与基本门诊护理的联系，以降低长期发病率和死亡率。
