College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Ministry of Health, Kigali, Rwanda.
Heart. 2018 Oct;104(20):1707-1713. doi: 10.1136/heartjnl-2017-312644. Epub 2018 Apr 20.
In sub-Saharan Africa, continued clinical follow-up, after cardiac surgery, is only available at urban referral centres. We implemented a decentralised, integrated care model to provide longitudinal care for patients with advanced rheumatic heart disease (RHD) at district hospitals in rural Rwanda before and after heart surgery.
We collected data from charts at non-communicable disease (NCD) clinics at three rural district hospitals in Rwanda to describe the outcomes of 54 patients with RHD who received cardiac valve surgery during 2007-2015.
The majority of patients were adults (46/54; 85%), and 74% were females. The median age at the time of surgery was 22 years in adults and 11 years in children. Advanced symptoms-New York Heart Association class III or IV-were present in 83% before surgery and only 4% afterwards. The mitral valve was the most common valve requiring surgery. Valvular surgery consisted mostly of a single valve (56%) and double valve (41%). Patients were followed for a median of 3 years (range 0.2-7.9) during which 7.4% of them died; all deaths were patients who had undergone bioprosthetic valve replacement. For patients with mechanical valves, anticoagulation was checked at 96% of visits. There were no known bleeding or thrombotic events requiring hospitalisation.
Outcomes of postoperative patients with RHD tracked in rural Rwanda health facilities were generally good. With appropriate training and supervision, it is feasible to safely decentralise follow-up of patients with RHD to nurse-led specialised NCD clinics after cardiac surgery.
在撒哈拉以南非洲,心脏手术后的临床随访仅在城市转诊中心提供。我们实施了一种分散的综合护理模式,以便在卢旺达农村地区的区医院为接受过心脏手术的晚期风湿性心脏病(RHD)患者提供纵向护理。
我们从卢旺达三个农村地区医院的非传染性疾病(NCD)诊所的图表中收集数据,以描述 2007 年至 2015 年间接受心脏瓣膜手术的 54 例 RHD 患者的结局。
大多数患者为成年人(46/54;85%),其中 74%为女性。手术时成年人的中位年龄为 22 岁,儿童为 11 岁。手术前,大多数患者出现晚期症状-纽约心脏协会(NYHA)III 级或 IV 级,占 83%,手术后仅占 4%。二尖瓣是最常见需要手术的瓣膜。瓣膜手术主要是单瓣(56%)和双瓣(41%)。患者中位随访 3 年(0.2-7.9 年),在此期间,7.4%的患者死亡;所有死亡患者均为接受生物瓣置换术的患者。对于接受机械瓣膜的患者,96%的就诊时进行了抗凝检查。没有已知的出血或血栓形成事件需要住院治疗。
在卢旺达农村医疗机构中接受追踪的 RHD 术后患者的结局总体良好。通过适当的培训和监督,将 RHD 患者的随访安全地下放给护士主导的专门 NCD 诊所是可行的。