Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates.
Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates.
Curr Probl Cardiol. 2024 Jul;49(7):102564. doi: 10.1016/j.cpcardiol.2024.102564. Epub 2024 Apr 8.
While there has been a global decrease in rates of heart failure (HF) prevalence between 1990 and 2019, the Eastern Mediterranean region (EMR) is experiencing an increase. In 2019, approximately 1,229,766 individuals lived with moderate to severe HF in the EMR. Despite the growth in the utilization of advanced heart failure (AHF) therapies in the EMR in the past two decades, current volumes are yet to meet the growing AHF burden in the region. Heart transplantation (HT) volumes in EMR have grown from 9 in the year 2000 to 179 HTs in 2019. However, only a few centers provide the full spectrum of AHF therapies, including durable mechanical circulatory support (MCS) and HT. Published data on the utilization of left ventricular assist devices (LVAD) in the EMR are scarce. Notably, patients undergoing LVAD implantation in the EMR are on average, 13 year younger, and more likely to present with critical cardiogenic shock, as compared to their counterparts in the Western world. Furthermore, AHF care in the region is hampered by the paucity of multidisciplinary HF programs, inherent costs of AHF therapies, limited access to short and long-term MCS, organ shortage, and lack of public awareness and acceptance of AHF therapeutics. All stakeholders in the EMR should work together to strategize tackling the challenging AHF burden in the region.
尽管 1990 年至 2019 年期间全球心力衰竭（HF）患病率有所下降，但东地中海地区（EMR）的患病率却在上升。2019 年，EMR 地区约有 1229766 人患有中重度 HF。尽管在过去二十年中，EMR 地区先进心力衰竭（AHF）治疗的使用率有所增长，但目前的使用率仍未满足该地区不断增长的 AHF 负担。EMR 地区的心脏移植（HT）数量从 2000 年的 9 例增长到 2019 年的 179 例。然而，只有少数中心提供全谱 AHF 治疗，包括耐用性机械循环支持（MCS）和 HT。关于 EMR 地区左心室辅助装置（LVAD）使用的数据很少。值得注意的是，与西方世界的患者相比，在 EMR 地区接受 LVAD 植入的患者平均年轻 13 岁，更有可能出现严重的心源性休克。此外，该地区的 AHF 治疗受到多学科 HF 项目匮乏、AHF 治疗固有成本、短期和长期 MCS 获得机会有限、器官短缺以及公众对 AHF 治疗的认识和接受程度有限等因素的阻碍。EMR 地区的所有利益相关者都应共同努力，制定策略应对该地区具有挑战性的 AHF 负担。
