Cardiac surgery for patients with heart failure due to structural heart disease in Uganda: Access to surgery and outcomes

Antonio Grimaldi, Enrico Ammirati, Nicole Karam, Anna Chiara Vermi, Annalisa De Concilio, Giorgio Trucco, Francesco Aloi, Francesco Arioli, Filippo Figini, Santo Ferrarello, Francesco Maria Sacco, Renato Grottola, Paul G. D'Arbela, Ottavio Alfieri, Eloi Marijon, Juergen Freers, Mariana Mirabel

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes. Methods: We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography. Results: Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31%) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60%), followed by RHD (16 patients, 32%). RHD was the main cause of HF (30%) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86%, median age 19 years (IQR: 12-31)] and in 36 patients with CHD [88%, median age 4 years (IQR 1-5)]. Twenty-seven candidates (32%) were operated on after a median waiting time of 10 months (IQR 6-21). Sixteen (19%) had died after a median of 38 months (IQR 5-52); 19 (22%) were lost to follow up. Conclusions: RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.

Original languageEnglish
Pages (from-to)204-211
Number of pages8
JournalCardiovascular Journal of Africa
Volume25
Issue number5
DOIs
Publication statusPublished - Sep 1 2014

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Uganda
Thoracic Surgery
Rheumatic Heart Disease
Heart Diseases
Heart Failure
Africa South of the Sahara
Lost to Follow-Up
Tertiary Care Centers
Echocardiography
Organizations
Costs and Cost Analysis
Mortality

Keywords

  • Congenital heart disease
  • Echocardiography
  • Heart failure
  • Heart surgery
  • Rheumatic heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac surgery for patients with heart failure due to structural heart disease in Uganda : Access to surgery and outcomes. / Grimaldi, Antonio; Ammirati, Enrico; Karam, Nicole; Vermi, Anna Chiara; De Concilio, Annalisa; Trucco, Giorgio; Aloi, Francesco; Arioli, Francesco; Figini, Filippo; Ferrarello, Santo; Sacco, Francesco Maria; Grottola, Renato; D'Arbela, Paul G.; Alfieri, Ottavio; Marijon, Eloi; Freers, Juergen; Mirabel, Mariana.

In: Cardiovascular Journal of Africa, Vol. 25, No. 5, 01.09.2014, p. 204-211.

Research output: Contribution to journalArticle

Grimaldi, A, Ammirati, E, Karam, N, Vermi, AC, De Concilio, A, Trucco, G, Aloi, F, Arioli, F, Figini, F, Ferrarello, S, Sacco, FM, Grottola, R, D'Arbela, PG, Alfieri, O, Marijon, E, Freers, J & Mirabel, M 2014, 'Cardiac surgery for patients with heart failure due to structural heart disease in Uganda: Access to surgery and outcomes', Cardiovascular Journal of Africa, vol. 25, no. 5, pp. 204-211. https://doi.org/10.5830/CVJA-2014-034
Grimaldi, Antonio ; Ammirati, Enrico ; Karam, Nicole ; Vermi, Anna Chiara ; De Concilio, Annalisa ; Trucco, Giorgio ; Aloi, Francesco ; Arioli, Francesco ; Figini, Filippo ; Ferrarello, Santo ; Sacco, Francesco Maria ; Grottola, Renato ; D'Arbela, Paul G. ; Alfieri, Ottavio ; Marijon, Eloi ; Freers, Juergen ; Mirabel, Mariana. / Cardiac surgery for patients with heart failure due to structural heart disease in Uganda : Access to surgery and outcomes. In: Cardiovascular Journal of Africa. 2014 ; Vol. 25, No. 5. pp. 204-211.
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abstract = "Objective: Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes. Methods: We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography. Results: Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31{\%}) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60{\%}), followed by RHD (16 patients, 32{\%}). RHD was the main cause of HF (30{\%}) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86{\%}, median age 19 years (IQR: 12-31)] and in 36 patients with CHD [88{\%}, median age 4 years (IQR 1-5)]. Twenty-seven candidates (32{\%}) were operated on after a median waiting time of 10 months (IQR 6-21). Sixteen (19{\%}) had died after a median of 38 months (IQR 5-52); 19 (22{\%}) were lost to follow up. Conclusions: RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.",
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T1 - Cardiac surgery for patients with heart failure due to structural heart disease in Uganda

T2 - Access to surgery and outcomes

AU - Grimaldi, Antonio

AU - Ammirati, Enrico

AU - Karam, Nicole

AU - Vermi, Anna Chiara

AU - De Concilio, Annalisa

AU - Trucco, Giorgio

AU - Aloi, Francesco

AU - Arioli, Francesco

AU - Figini, Filippo

AU - Ferrarello, Santo

AU - Sacco, Francesco Maria

AU - Grottola, Renato

AU - D'Arbela, Paul G.

AU - Alfieri, Ottavio

AU - Marijon, Eloi

AU - Freers, Juergen

AU - Mirabel, Mariana

PY - 2014/9/1

Y1 - 2014/9/1

N2 - Objective: Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes. Methods: We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography. Results: Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31%) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60%), followed by RHD (16 patients, 32%). RHD was the main cause of HF (30%) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86%, median age 19 years (IQR: 12-31)] and in 36 patients with CHD [88%, median age 4 years (IQR 1-5)]. Twenty-seven candidates (32%) were operated on after a median waiting time of 10 months (IQR 6-21). Sixteen (19%) had died after a median of 38 months (IQR 5-52); 19 (22%) were lost to follow up. Conclusions: RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.

AB - Objective: Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes. Methods: We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography. Results: Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31%) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60%), followed by RHD (16 patients, 32%). RHD was the main cause of HF (30%) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86%, median age 19 years (IQR: 12-31)] and in 36 patients with CHD [88%, median age 4 years (IQR 1-5)]. Twenty-seven candidates (32%) were operated on after a median waiting time of 10 months (IQR 6-21). Sixteen (19%) had died after a median of 38 months (IQR 5-52); 19 (22%) were lost to follow up. Conclusions: RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.

KW - Congenital heart disease

KW - Echocardiography

KW - Heart failure

KW - Heart surgery

KW - Rheumatic heart disease

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