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Descriptive epidemiology and short-term outcomes of heart failure hospitalisation in rural Haiti
  1. Gene F Kwan1,2,3,
  2. Waking Jean-Baptiste4,
  3. Philip Cleophat4,
  4. Fèrnet Leandre4,
  5. Martineau Louine4,
  6. Maxo Luma4,
  7. Emelia J Benjamin1,5,
  8. Joia S Mukherjee2,3,
  9. Gene Bukhman2,3,6,
  10. Lisa R Hirschhorn3,6,7
  1. 1Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  2. 2Partners In Health, Boston, Massachusetts, USA
  3. 3Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  4. 4Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti
  5. 5Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
  6. 6Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
  7. 7Ariadne Labs, Boston, Massachusetts, USA
  1. Correspondence to Dr Gene F Kwan, Boston University Medical Center, 88 East Newton Street, D8, Boston, MA 02118, USA; genekwan{at}bu.edu

Abstract

Objective There is increasing attention to cardiovascular diseases in low-income countries. However, little is known about heart failure (HF) in rural areas, where most of the populations in low-income countries live. We studied HF epidemiology, care delivery and outcomes in rural Haiti.

Methods Among adults admitted with HF to a rural Haitian tertiary care hospital during a 12-month period (2013–2014), we studied the clinical characteristics and short-term outcomes including length of stay, inhospital death and outpatient follow-up rates.

Results HF accounted for 392/1049 (37%) admissions involving 311 individuals; over half (60%) were women. Mean age was 58.8 (SD 16.2) years for men and 48.3 (SD 18.8) years for women; 76 (41%) women were <40 years of age. Median length of stay was 10 days (first and second quartiles 7, 17), and inhospital mortality was 12% (n=37). Ninety nine (36%) of the 274 who survived their primary hospitalisation followed-up at the hospital's outpatient clinic, and 18 (6.6%) were readmitted to the same hospital within 30 days postdischarge. Decreased known follow-up (p<0.01) and readmissions (p=0.03) were associated with increased distance between patient residence and hospital. Among the one-quarter (81) patients with echocardiograms, causes of HF included: non-ischaemic cardiomyopathy (64%), right HF (12%), hypertensive heart disease (7%) and rheumatic heart disease (5%). One-half of the women with cardiomyopathy by echocardiogram had peripartum cardiomyopathy.

Conclusions HF is a common cause of hospitalisation in rural Haiti. Among diagnosed patients, HF is overwhelming due to non-atherosclerotic heart disease and particularly affects young adults. Implementing effective systems to improve HF diagnosis and linkage to essential outpatient care is needed to reduce long-term morbidity and mortality.

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