Decentralized Heart Failure Management in Neno, Malawi.
Decentralized Heart Failure Management in Neno, Malawi.
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作者：
Mailosi BGD;Ruderman T;Klassen SL;Kachimanga C;Aron MB;Boti M;Kumwenda K;Bukhman G;Muula AS;Banda NPK;Kwan GF
心血管疾病是马拉维的主要死因。在农村地区，心力衰竭（HF）护理有限，由非医生提供。在非洲农村，HF的病因和患者结局在很大程度上是未知的。在我们的研究中，在马拉维的Neno，非医生提供者进行了聚焦心脏超声（FOCUS）用于HF诊断和纵向临床随访。我们描述了在马拉维Neno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，非医生提供者在马拉维农村的一家门诊慢性病诊所进行了FOCUS诊断和纵向随访。对HF诊断类别、入组与随访之间的临床状态变化以及临床结局进行了回顾性图表审查。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，患者平均入组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是高血压性心脏病（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），端坐呼吸、水肿、疲劳、血容量过多和双基底动脉爆裂音的症状均减少（p < 0.05）。高血压性心脏病和心肌病是马拉维农村老年人群HF的主要原因。经过培训的非医生提供者可以在有限的资源领域成功管理心力衰竭，以改善症状和临床结果。类似的护理模式可以改善非洲其他农村地区的医疗保健服务。
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.
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影响因子：
13
作者：
Kwan, Gene F.;Bukhman, Alice K.;Bukhman, Gene
通讯作者：
Bukhman, Gene
影响因子：
3.5
作者：
Dokainish, Hisham;Teo, Koon;Yusuf, Salim
通讯作者：
Yusuf, Salim
影响因子：
2.9
作者：
Wroe EB;Kalanga N;Dunbar EL;Nazimera L;Price NF;Shah A;Dullie L;Mailosi B;Gonani G;Ndarama EPL;Talama GC;Bukhman G;Kerr L;Connolly E;Kachimanga C
通讯作者：
Kachimanga C
影响因子：
--
作者：
Damasceno, Albertino;Mayosi, Bongani M.;Sliwa, Karen
通讯作者：
Sliwa, Karen
影响因子：
5.7
作者：
Kwan, Gene F.;Jean-Baptiste, Waking;Hirschhorn', Lisa R.
通讯作者：
Hirschhorn', Lisa R.