TY - JOUR
T1 - Heart failure care in low- and middle-income countries: a systematic review and meta-analysis
AU - Callender, Thomas
AU - Woodward, Mark
AU - Roth, Gregory
AU - Farzadfar, Farshad
AU - Lemarie, Jean-Christophe
AU - Gicquel, Stephanie
AU - Atherton, John
AU - Rahimzadeh, Shadi
AU - Ghaziani, Mehdi
AU - Shaikh, Maaz
AU - Bennett, Derrick
AU - Patel, Anushka
AU - Lam, Carolyn S P
AU - Sliwa, Karen
AU - Barretto, Antonio
AU - Siswanto, Bambang Budi
AU - Diaz, Alejandro
AU - Herpin, Daniel
AU - Krum, Henry
AU - Eliasz, Thomas
AU - Forbes, Anna
AU - Kiszely, Alastair
AU - Khosla, Rajit
AU - Petrinic, Tatjana
AU - Praveen, Devarsetty
AU - Shrivastava, Roohi
AU - Xin, Du
AU - MacMahon, Stephen
AU - McMurray, John
AU - Rahimi, Kazem
PY - 2014/8
Y1 - 2014/8
N2 - 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 We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs.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 Additional unpublished data were requested from investigators and international heart failure experts.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 nonacute 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-hospitalmortalitywas 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 stud
AB - 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 nonacute 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-hospitalmortalitywas 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 stud
U2 - 10.1371/journal.pmed.1001699
DO - 10.1371/journal.pmed.1001699
M3 - Article
SN - 1549-1676
VL - 11
JO - PLoS Medicine
JF - PLoS Medicine
IS - 8
M1 - e1001699
ER -
