Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi.
Partners In Health, Boston, MA, 02199, USA.
Glob Heart. 2023 Jun 16;18(1):35. doi: 10.5334/gh.1210. eCollection 2023.
Cardiovascular disease (CVD) is a major cause of death in Malawi. In rural districts, heart failure (HF) care is limited and provided by non-physicians. The causes and patient outcomes of HF in rural Africa are largely unknown. In our study, non-physician providers performed focused cardiac ultrasound (FOCUS) for HF diagnosis and longitudinal clinical follow-up in Neno, Malawi.
We described the clinical characteristics, HF categories, and outcomes of patients presenting with HF in chronic care clinics in Neno, Malawi.
Between November 2018 and March 2021, non-physician providers performed FOCUS for diagnosis and longitudinal follow-up in an outpatient chronic disease clinic in rural Malawi. A retrospective chart review was performed for HF diagnostic categories, change in clinical status between enrollment and follow-up, and clinical outcomes. For study purposes, cardiologists reviewed all available ultrasound images.
There were 178 patients with HF, a median age of 67 years (IQR 44 - 75), and 103 (58%) women. During the study period, patients were enrolled for a mean of 11.5 months (IQR 5.1-16.5), after which 139 (78%) were alive and in care. The most common diagnostic categories by cardiac ultrasound were hypertensive heart disease (36%), cardiomyopathy (26%), and rheumatic, valvular or congenital heart disease (12.3%).At follow-up, the proportion of New York Heart Association (NYHA) class I patients increased from 24% to 50% (p < 0.001; 95% CI: 31.5 - 16.4), and symptoms of orthopnea, edema, fatigue, hypervolemia, and bibasilar crackles all decreased (p < 0.05).
Hypertensive heart disease and cardiomyopathy are the predominant causes of HF in this elderly cohort in rural Malawi. Trained non-physician providers can successfully manage HF to improve symptoms and clinical outcomes in limited resource areas. Similar care models could improve healthcare access in other rural African settings.
心血管疾病（CVD）是马拉维的主要死亡原因。在农村地区，心力衰竭（HF）的治疗由非医师提供，且十分有限。农村非洲心力衰竭的病因和患者结局在很大程度上尚不清楚。在我们的研究中，在马拉维的 Neno，非医师提供者为 HF 诊断和纵向临床随访执行了焦点心脏超声（FOCUS）。
我们描述了在马拉维农村 Neno 的慢性护理诊所就诊的 HF 患者的临床特征、HF 类别和结局。
2018 年 11 月至 2021 年 3 月期间，非医师提供者在农村马拉维的一家门诊慢性疾病诊所进行 FOCUS 诊断和纵向随访。对 HF 诊断类别、入组和随访之间临床状况的变化以及临床结局进行回顾性图表审查。出于研究目的，心脏病专家审查了所有可用的超声图像。
共有 178 例 HF 患者，中位年龄为 67 岁（IQR 44-75），103 例（58%）为女性。在研究期间，患者的平均入组时间为 11.5 个月（IQR 5.1-16.5），之后 139 例（78%）存活并接受治疗。心脏超声最常见的诊断类别为高血压性心脏病（36%）、心肌病（26%）和风湿性、瓣膜性或先天性心脏病（12.3%）。随访时，纽约心脏协会（NYHA）I 级患者的比例从 24%增加到 50%（p<0.001；95%CI：31.5-16.4），呼吸困难、水肿、疲劳、血容量过多和双基底部爆裂声的症状均有所改善（p<0.05）。
在马拉维农村的这个老年队列中，高血压性心脏病和心肌病是 HF 的主要原因。经过培训的非医师提供者可以成功管理 HF，以改善有限资源地区的症状和临床结局。类似的护理模式可以改善其他农村非洲地区的医疗保健服务可及性。
