Heart failure care in low- and middle-income countries: a systematic review and meta-analysis

Callender, Thomas, Woodward, Mark, Roth, Gregory, Farzadfar, Farshad, Lemarie, Jean-Christophe, Gicquel, Stephanie, Atherton, John, Rahimzadeh, Shadi, Ghaziani, Mehdi, Shaikh, Maaz, Bennett, Derrick, Patel, Anushka, Lam, Carolyn S. P., Sliwa, Karen, Barretto, Antonio, Siswanto, Bambang Budi, Diaz, Alejandro, Herpin, Daniel, Krum, Henry, Eliasz, Thomas, Forbes, Anna, Kiszely, Alastair, Khosla, Rajit, Petrinic, Tatjana, Praveen, Devarsetty, Shrivastava, Roohi, Xin, Du, MacMahon, Stephen, McMurray, John and Rahimi, Kazem (2014) Heart failure care in low- and middle-income countries: a systematic review and meta-analysis. PLoS Medicine, 11 8: e1001699.1-e1001699.41. doi:10.1371/journal.pmed.1001699

Author Callender, Thomas
Woodward, Mark
Roth, Gregory
Farzadfar, Farshad
Lemarie, Jean-Christophe
Gicquel, Stephanie
Atherton, John
Rahimzadeh, Shadi
Ghaziani, Mehdi
Shaikh, Maaz
Bennett, Derrick
Patel, Anushka
Lam, Carolyn S. P.
Sliwa, Karen
Barretto, Antonio
Siswanto, Bambang Budi
Diaz, Alejandro
Herpin, Daniel
Krum, Henry
Eliasz, Thomas
Forbes, Anna
Kiszely, Alastair
Khosla, Rajit
Petrinic, Tatjana
Praveen, Devarsetty
Shrivastava, Roohi
Xin, Du
MacMahon, Stephen
McMurray, John
Rahimi, Kazem
Title Heart failure care in low- and middle-income countries: a systematic review and meta-analysis
Journal name PLoS Medicine   Check publisher's open access policy
ISSN 1549-1676
Publication date 2014-08
Sub-type Article (original research)
DOI 10.1371/journal.pmed.1001699
Open Access Status DOI
Volume 11
Issue 8
Start page e1001699.1
End page e1001699.41
Total pages 41
Place of publication San Francisco, CA, United States
Publisher Public Library of Science
Collection year 2015
Language eng
Formatted abstract
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 We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs.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 Additional unpublished data were requested from investigators and international heart failure experts.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 [CI]: 49%–64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% CI: 28%–41%) with beta-blockers, and 32% (95% CI: 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% CI: 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.
Keyword National Registry
Global Burden
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 21 times in Thomson Reuters Web of Science Article | Citations
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