Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
University Teaching Hospital of Kigali, Kigali, Rwanda.
Curr Cardiol Rep. 2019 Aug 31;21(10):120. doi: 10.1007/s11886-019-1200-2.
Acute heart failure (AHF) is a common emergency presentation in Sub-Saharan Africa (SSA). In the current review, we present the most recent data on the epidemiology of AHF in SSA and discuss recommended approaches to management in resource-limited settings, with a particular focus on primary and secondary facilities (e.g., health centers and district hospitals), where these patients often present.
AHF in SSA is most often due to hypertension, cardiomyopathies, and rheumatic heart disease. The etiology of AHF may be different in rural as compared with urban settings. Diagnostic tools for AHF are often lacking in SSA, especially at the first-level facilities. Point-of-care ultrasound (POCUS) and biomarker tests, such as brain natriuretic peptide (BNP), offer promise in helping to mitigate diagnostic challenges. POCUS can also help distinguish among types of heart failure and prompt the correct treatment strategy. Many of the drugs and equipment commonly used to treat AHF in resource-rich settings are lacking in SSA. However, some adaptations of commonly available materials may provide temporary alternatives. The epidemiology of AHF in SSA differs from that of high-income settings. Management of AHF at the first-level facility in SSA is an important and understudied problem. Simplified diagnostic and treatment algorithms rooted in knowledge of the local epidemiology should be developed and tested as part of broader efforts to combat cardiovascular disease in SSA.
急性心力衰竭（AHF）是撒哈拉以南非洲（SSA）常见的急症。在本次综述中，我们呈现了关于 SSA 地区 AHF 流行病学的最新数据，并讨论了在资源有限的环境下推荐的管理方法，特别关注基层和二级医疗机构（如卫生中心和地区医院），这些患者通常在这些机构就诊。
SSA 地区的 AHF 多由高血压、心肌病和风湿性心脏病引起。与城市环境相比，农村地区 AHF 的病因可能有所不同。SSA 地区缺乏 AHF 的诊断工具，尤其是在基层医疗机构。即时床旁超声（POCUS）和生物标志物检测（如脑利钠肽（BNP））有望缓解诊断挑战。POCUS 还可以帮助鉴别心力衰竭的类型，并提示正确的治疗策略。在资源丰富地区常用于治疗 AHF 的许多药物和设备在 SSA 都缺乏。然而，一些常用材料的改进可能提供临时替代方案。SSA 地区 AHF 的流行病学与高收入地区不同。在 SSA 的基层医疗机构中管理 AHF 是一个重要但研究不足的问题。基于当地流行病学知识制定和测试简化的诊断和治疗算法，应作为 SSA 心血管疾病防治工作的一部分。
