PLoS Medicine (Aug 2014)

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,
  • Stéphanie 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 Eliasz,
  • Anna Forbes,
  • Alastair Kiszely,
  • Rajit Khosla,
  • Tatjana Petrinic,
  • Devarsetty Praveen,
  • Roohi Shrivastava,
  • Du Xin,
  • Stephen MacMahon,
  • John McMurray,
  • Kazem Rahimi

DOI
https://doi.org/10.1371/journal.pmed.1001699
Journal volume & issue
Vol. 11, no. 8
p. e1001699

Abstract

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BackgroundHeart 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 We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs.Methods and findingsMedline, Embase, Global Health Database, and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 Additional unpublished data were requested from investigators and international heart failure experts.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, pConclusionsThe 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. Please see later in the article for the Editors' Summary.