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

Thomas Callender, Mark Woodward, Gregory Roth, Farshad Farzadfar, Jean Christophe Lemarie, Stephanie Gicquel, John Atherton, Shadi Rahimzadeh, Mehdi Ghaziani, Maaz Shaikh, Derrick Bennett, Anushka Patel, Carolyn S P Lam, Karen Sliwa, Antonio Barretto, Bambang Budi Siswanto, Alejandro Diaz, Daniel Herpin, Henry Krum, Thomas EliaszAnna Forbes, Alastair Kiszely, Rajit Khosla, Tatjana Petrinic, Devarsetty Praveen, Roohi Shrivastava, Du Xin, Stephen Macmahon, John McMurray, Kazem Rahimi

Research output: Contribution to journalArticle

Abstract

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 We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs.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 Additional unpublished data were requested from investigators and international heart failure experts.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 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.

Original languageEnglish (US)
Article numberA011
JournalPLoS Medicine
Volume11
Issue number8
DOIs
StatePublished - 2015
Externally publishedYes

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Meta-Analysis
Heart Failure
Confidence Intervals
Outpatients
Databases
Mineralocorticoid Receptor Antagonists
Cameroon
Ghana
Argentina
Human Development
Angiotensin-Converting Enzyme Inhibitors
Tertiary Care Centers
Myocardial Ischemia
Inpatients
India
China
Primary Health Care
Cohort Studies
Cross-Sectional Studies
Research Personnel

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Callender, T., Woodward, M., Roth, G., Farzadfar, F., Lemarie, J. C., Gicquel, S., ... Rahimi, K. (2015). Heart failure care in low- and middle-income countries: A systematic review and meta-analysis. PLoS Medicine, 11(8), [A011]. https://doi.org/10.1371/journal.pmed.1001699

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; Rahimi, Kazem.

In: PLoS Medicine, Vol. 11, No. 8, A011, 2015.

Research output: Contribution to journalArticle

Callender, T, Woodward, M, Roth, G, Farzadfar, F, Lemarie, JC, Gicquel, S, Atherton, J, Rahimzadeh, S, Ghaziani, M, Shaikh, M, Bennett, D, Patel, A, Lam, CSP, Sliwa, K, Barretto, A, Siswanto, BB, Diaz, A, Herpin, D, Krum, H, Eliasz, T, Forbes, A, Kiszely, A, Khosla, R, Petrinic, T, Praveen, D, Shrivastava, R, Xin, D, Macmahon, S, McMurray, J & Rahimi, K 2015, 'Heart failure care in low- and middle-income countries: A systematic review and meta-analysis', PLoS Medicine, vol. 11, no. 8, A011. https://doi.org/10.1371/journal.pmed.1001699
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. / Heart failure care in low- and middle-income countries : A systematic review and meta-analysis. In: PLoS Medicine. 2015 ; Vol. 11, No. 8.
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abstract = "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 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.",
author = "Thomas Callender and Mark Woodward and Gregory Roth and Farshad Farzadfar and Lemarie, {Jean Christophe} and Stephanie Gicquel and John Atherton and Shadi Rahimzadeh and Mehdi Ghaziani and Maaz Shaikh and Derrick Bennett and Anushka Patel and Lam, {Carolyn S P} and Karen Sliwa and Antonio Barretto and Siswanto, {Bambang Budi} and Alejandro Diaz and Daniel Herpin and Henry Krum and Thomas Eliasz and Anna Forbes and Alastair Kiszely and Rajit Khosla and Tatjana Petrinic and Devarsetty Praveen and Roohi Shrivastava and Du Xin and Stephen Macmahon and John McMurray and Kazem Rahimi",
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T1 - Heart failure care in low- and middle-income countries

T2 - 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 - 2015

Y1 - 2015

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 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.

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 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.

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