Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

被引：193

作者：

Callender, Thomas ^{[1
]}

Woodward, Mark ^{[1
,2
]}

Roth, Gregory ^{[3
]}

Farzadfar, Farshad ^{[4
,5
]}

Lemarie, Jean-Christophe ^{[6
]}

Gicquel, Stephanie ^{[6
]}

Atherton, John ^{[7
,8
]}

Rahimzadeh, Shadi ^{[4
,9
]}

Ghaziani, Mehdi ^{[4
,5
]}

Shaikh, Maaz ^{[1
,10
]}

Bennett, Derrick ^{[11
]}

Patel, Anushka ^{[2
]}

Lam, Carolyn S. P. ^{[12
]}

Sliwa, Karen ^{[13
]}

Barretto, Antonio ^{[14
]}

Siswanto, Bambang Budi ^{[15
]}

Diaz, Alejandro ^{[16
]}

Herpin, Daniel ^{[17
]}

Krum, Henry ^{[18
]}

Eliasz, Thomas ^{[1
]}

Forbes, Anna ^{[1
]}

Kiszely, Alastair ^{[1
]}

Khosla, Rajit ^{[1
]}

Petrinic, Tatjana ^{[19
]}

Praveen, Devarsetty ^{[2
,10
]}

Shrivastava, Roohi ^{[1
]}

Xin, Du ^{[20
]}

MacMahon, Stephen ^{[1
,2
]}

McMurray, John ^{[21
]}

Rahimi, Kazem ^{[1
]}

机构：

[1] Univ Oxford, George Inst Global Hlth, Oxford, England

[2] Univ Sydney, George Inst Global Hlth, Sydney, NSW 2006, Australia

[3] Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98195 USA

[4] Univ Tehran Med Sci, Noncommunicable Dis Res Ctr, Tehran, Iran

[5] Univ Tehran Med Sci, Endocrinol & Metab Res Ctr, Tehran, Iran

[6] Effi Stat, Paris, France

[7] Royal Brisbane & Womens Children Hosp, Dept Cardiol, Brisbane, Qld, Australia

[8] Univ Queensland, Sch Med, Brisbane, Qld, Australia

[9] Shahid Beheshti Univ Med Sci, Dept Epidemiol, Tehran, Iran

[10] George Inst Global Hlth, Hyderabad, Andhra Pradesh, India

[11] Univ Oxford, Clin Trials Serv Unit, Oxford, England

[12] Natl Univ Singapore, Singapore 117548, Singapore

[13] Univ Cape Town, Hatter Inst Cardiovasc Res Africa, ZA-7925 Cape Town, South Africa

[14] Univ Sao Paulo, Fac Med, Sao Paulo, Brazil

[15] Univ Indonesia, Natl Cardiovasc Ctr, Jakarta, Indonesia

[16] Univ Nacl Ctr Prov Buenos Aires, Buenos Aires, DF, Argentina

[17] Ctr Hosp Univ Poitiers, Poitiers, France

[18] Monash Univ, Ctr Cardiovasc Res & Educ Therapeut, Melbourne, Vic 3004, Australia

[19] Univ Oxford, Bodleian Healthcare Lib, Oxford, England

[20] Peking Univ, George Inst Global Hlth, Beijing 100871, Peoples R China

[21] Univ Glasgow, Glasgow, Lanark, Scotland

来源：

PLOS MEDICINE | 2014年 / 11卷 / 08期

关键词：

NATIONAL REGISTRY; RISK-FACTORS; PREVALENCE; EPIDEMIOLOGY; PROGNOSIS; DISEASE; MORTALITY; PATTERN; PREDOMINANCE; DYSFUNCTION;

D O I：

10.1371/journal.pmed.1001699

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Background: Heart failure places a significant burden on patients and health systems in high-income countries. However, information about its burden in low-and middle-income countries (LMICs) is scant. We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs. Methods and Findings: Medline, Embase, Global Health Database, and World Health Organization regional databases were searched for studies from LMICs published between 1 January 1995 and 30 March 2014. Additional unpublished data were requested from investigators and international heart failure experts. We identified 42 studies that provided relevant information on acute hospital care (25 LMICs; 232,550 patients) and 11 studies on the management of chronic heart failure in primary care or outpatient settings (14 LMICs; 5,358 patients). The mean age of patients studied ranged from 42 y in Cameroon and Ghana to 75 y in Argentina, and mean age in studies largely correlated with the human development index of the country in which they were conducted (r=0.71, p<0.001). Overall, ischaemic heart disease was the main reported cause of heart failure in all regions except Africa and the Americas, where hypertension was predominant. Taking both those managed acutely in hospital and those in non-acute outpatient or community settings together, 57% (95% confidence interval [Cl]: 49%-64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% Cl: 28%-41%) with beta blockers, and 32% (95% Cl: 25%-39%) with mineralocorticoid receptor antagonists. Mean inpatient stay was 10 d, ranging from 3 d in India to 23 d in China. Acute heart failure accounted for 2.2% (range: 0.3%-7.7%) of total hospital admissions, and mean in-hospital mortality was 8% (95% Cl: 6%-10%). There was substantial variation between studies (p<0.001 across all variables), and most data were from urban tertiary referral centres. Only one population-based study assessing incidence and/or prevalence of heart failure was identified. Conclusions: The presentation, underlying causes, management, and outcomes of heart failure vary substantially across LMICs. On average, the use of evidence-based medications tends to be suboptimal. Better strategies for heart failure surveillance and management in LMICs are needed.

引用

页数：41

共 78 条

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