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HF care varies in low- and middle-income countries
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The presentation, causes, management, treatment and outcomes of HF vary substantially across low- and middle-income countries, according to a new report.
Researchers conducted a systematic review and identified 49 published studies and four unpublished databases covering 31 countries and 237,908 hospitalizations for HF. After pooling the data, the mean age of patients admitted for acute HF was 63 years, and ranged from 42 years in Cameroon and Ghana to 75 years in Argentina. The mean age upon hospital admission was more than a decade younger than the mean age of admission in high-income countries. Further, the age upon admission for HF correlated with the human development index, a measure of national well-being, of individual low- and middle-income countries, according to a press release.
Ischemic heart disease was the most commonly reported cause of HF in all low- and middle-income countries included in the study, with the exception of Africa and the Americas, where hypertension was the predominant cause.
The researchers also assessed treatment of HF patients managed acutely in-hospital and also in nonacute outpatient or community settings in low- and middle-income countries. Overall, 57% of the patients received treatment with an ACE inhibitor, 34% with a beta-blocker and 32% with a mineralocorticoid receptor agonist. About 69% of patients used diuretics.
“On average, the use of evidence-based medications tends to be suboptimal,” the researchers wrote.
The mean length of hospital stay was 10 days, and ranged from 3 days in India to 23 days in China.
The mean in-hospital mortality rate was 8% across countries.
“We found that heart failure is already a major burden to populations and health services in [low- and middle-income countries], where it makes up an average of 2.2% of hospital admissions, affecting more men than women," the researchers wrote. "Reflecting the broad range of countries included and their differing levels of socioeconomic development, there are wide variations in patient characteristics and the causes of heart failure and its management."
They concluded that better strategies for HF surveillance and management are needed in the regions studied.
Disclosure: The researchers report no relevant financial disclosures.
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