PMID- 37334396 OWN - NLM STAT- MEDLINE DCOM- 20230620 LR - 20230621 IS - 2211-8179 (Electronic) IS - 2211-8160 (Print) IS - 2211-8160 (Linking) VI - 18 IP - 1 DP - 2023 TI - Decentralized Heart Failure Management in Neno, Malawi. PG - 35 LID - 10.5334/gh.1210 [doi] LID - 35 AB - BACKGROUND: Cardiovascular disease (CVD) is a major cause of death in Malawi. In rural districts, heart failure (HF) care is limited and provided by non-physicians. The causes and patient outcomes of HF in rural Africa are largely unknown. In our study, non-physician providers performed focused cardiac ultrasound (FOCUS) for HF diagnosis and longitudinal clinical follow-up in Neno, Malawi. OBJECTIVES: We described the clinical characteristics, HF categories, and outcomes of patients presenting with HF in chronic care clinics in Neno, Malawi. METHODS: Between November 2018 and March 2021, non-physician providers performed FOCUS for diagnosis and longitudinal follow-up in an outpatient chronic disease clinic in rural Malawi. A retrospective chart review was performed for HF diagnostic categories, change in clinical status between enrollment and follow-up, and clinical outcomes. For study purposes, cardiologists reviewed all available ultrasound images. RESULTS: There were 178 patients with HF, a median age of 67 years (IQR 44 - 75), and 103 (58%) women. During the study period, patients were enrolled for a mean of 11.5 months (IQR 5.1-16.5), after which 139 (78%) were alive and in care. The most common diagnostic categories by cardiac ultrasound were hypertensive heart disease (36%), cardiomyopathy (26%), and rheumatic, valvular or congenital heart disease (12.3%).At follow-up, the proportion of New York Heart Association (NYHA) class I patients increased from 24% to 50% (p < 0.001; 95% CI: 31.5 - 16.4), and symptoms of orthopnea, edema, fatigue, hypervolemia, and bibasilar crackles all decreased (p < 0.05). CONCLUSION: Hypertensive heart disease and cardiomyopathy are the predominant causes of HF in this elderly cohort in rural Malawi. Trained non-physician providers can successfully manage HF to improve symptoms and clinical outcomes in limited resource areas. Similar care models could improve healthcare access in other rural African settings. CI - Copyright: (c) 2023 The Author(s). FAU - Mailosi, Bright G D AU - Mailosi BGD AUID- ORCID: 0000-0001-9089-0163 AD - Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi. FAU - Ruderman, Todd AU - Ruderman T AUID- ORCID: 0000-0002-6355-1649 AD - Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi. FAU - Klassen, Sheila L AU - Klassen SL AUID- ORCID: 0000-0002-7065-6668 AD - Partners In Health, Boston, MA, 02199, USA. AD - Center for Integration Science, Division of Global Health Equity and Division of Cardiovascular Medicine, Brigham and Women's Hospital, USA. AD - Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. FAU - Kachimanga, Chiyembekezo AU - Kachimanga C AUID- ORCID: 0000-0003-3507-9591 AD - Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi. FAU - Aron, Moses Banda AU - Aron MB AUID- ORCID: 0000-0001-6625-217X AD - Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi. FAU - Boti, Medson AU - Boti M AUID- ORCID: 0000-0003-2844-0641 AD - Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi. FAU - Kumwenda, Kenwood AU - Kumwenda K AUID- ORCID: 0009-0005-3904-3782 AD - Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi. FAU - Bukhman, Gene AU - Bukhman G AUID- ORCID: 0000-0003-4500-7903 AD - Partners In Health, Boston, MA, 02199, USA. AD - Center for Integration Science, Division of Global Health Equity and Division of Cardiovascular Medicine, Brigham and Women's Hospital, USA. AD - Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. FAU - Muula, Adamson S AU - Muula AS AUID- ORCID: 0000-0003-4412-9773 AD - Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi. FAU - Banda, Ndaziona P K AU - Banda NPK AUID- ORCID: 0000-0002-3958-0888 AD - Kamuzu College of Health Sciences, Malawi. FAU - Kwan, Gene F AU - Kwan GF AUID- ORCID: 0000-0002-0929-6800 AD - Partners In Health, Boston, MA, 02199, USA. AD - Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. AD - Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA USA 02118, USA. LA - eng GR - U24 HL136791/HL/NHLBI NIH HHS/United States GR - K23 HL140133/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20230616 PL - England TA - Glob Heart JT - Global heart JID - 101584391 SB - IM MH - Humans MH - Female MH - Aged MH - Adult MH - Middle Aged MH - Male MH - Retrospective Studies MH - Malawi/epidemiology MH - *Heart Failure/diagnosis/epidemiology/therapy MH - *Cardiomyopathies MH - Health Services Accessibility PMC - PMC10275181 OTO - NOTNLM OT - Focused cardiac ultrasound OT - Heart Failure OT - Malawi OT - Task-shifting COIS- The content in this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors report no relationships that could be construed as a conflict of interest. EDAT- 2023/06/19 06:42 MHDA- 2023/06/20 06:42 PMCR- 2023/06/16 CRDT- 2023/06/19 03:06 PHST- 2022/11/22 00:00 [received] PHST- 2023/05/12 00:00 [accepted] PHST- 2023/06/20 06:42 [medline] PHST- 2023/06/19 06:42 [pubmed] PHST- 2023/06/19 03:06 [entrez] PHST- 2023/06/16 00:00 [pmc-release] AID - 10.5334/gh.1210 [doi] PST - epublish SO - Glob Heart. 2023 Jun 16;18(1):35. doi: 10.5334/gh.1210. eCollection 2023.