Heart failure is a substantial health burden in low- and middle-income countries

August 12, 2014

Heart failure is a major public health burden in many low- and middle-income countries (LMICs), with substantial variation in the presentation, causes, management, and outcomes of heart failure across different LMICs, according to a study published in this week's PLOS Medicine. The study, led by Kazem Rahimi and colleagues from the George Institute for Global Health, also finds that a large proportion of patients are not receiving pharmacological treatments for heart failure.

The researchers conducted a systematic review and identified 49 published studies and 4 unpublished databases covering 31 countries and 237,908 hospitalizations for heart failure. By pooling the data from these studies, they found that the average age of patients admitted for was 63 years, which ranged from 42 years in Cameroon and Ghana to 75 years in Argentina, and correlated with the (a measure of national well-being) of individual LMICs. The leading causes of heart failure differed across countries, with the most common cause in countries outside of Africa and the Americas, hypertension the most dominant cause in Africa (46%), and hypertension and ischemic heart disease similarly common in the Americas (31 and 33%, respectively). While 69% of heart failure patients in LMIC were prescribed diuretics, the three main treatments currently recommended in guidelines for managing heart failure—angiotensin converting enzyme inhibitors, beta-blockers, and mineralocorticoid receptor agonists—were prescribed at lower rates (57, 34, and 32%, respectively).

While the findings indicate that the burden of heart failure is substantial in LMICs, data from all LMICs were not available and the estimates are mostly derived from urban tertiary referral hospitals, therefore these findings may not reflect the broader picture of heart failure in the community in LMICs. The limited available data on and substantial impact of heart failure in LMIC emphasizes the need for more research attention in this area.

The authors stress the importance of this public health issue: "This review shows that heart failure places a considerable burden on health systems in LMICs, and affects a wide demographic profile of patients in these countries."

In a linked Perspective, Druin Burch examines how inconsistencies in diagnosis and selection of patients for clinical trials may contribute to treatment burden of heart failure in LMICs, saying: "The gap between suboptimal treatment of and what is achievable represents not just a failure to practice evidence-based medicine but a greater gap in knowledge and the research agenda."

Explore further: Researchers find comparable long-term outcomes between diastolic and systolic heart failure patients

More information: Callender T, Woodward M, Roth G, Farzadfar F, Lemarie J-C, et al. (2014) Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. PLoS Med 11(8): e1001699. DOI: 10.1371/journal.pmed.1001699

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1 / 5 (1) Aug 13, 2014
Sodium-Induced Disoder Syndrome
In the scientific literature and in media the salt has political, and astonishing amount pseudo-science, but the pure scientific science of salt we can find only in traces.
It's time to understand (and to teach and to use) some important but forgotten, ignored and censored knowledges, and the consequences:
1. "Anything that can go wrong not only will go wrong, it must go wrong, as decreed by the Second Law of Thermodynamics"
2. "The profound nature of the Second Law manifests itself in every aspect of human existence." "Entropy permeates all aspects of human existence."
3. "Every biochemical function requires a decrease in entropy, which can only be achieved by the infusion of energy into a life-sustaining system."
4. "Wherever we look, whatever we do, we must be acutely aware of the immutable laws of thermodynamics, especially the easily overlooked Second Law: Entropy."
1 / 5 (1) Aug 13, 2014
5. The spontaneous diffusion of sodium ions into the cells and the diffusion of potassium ions out of the cells, continuously enhances the entropy (the disorder).
6. The task of the continuously working sodium-potassium pump to keep constant the intracellular concentration of Na and K ions. These cellular pumps continuously use energy of ATP molecules.
7. Excess sodium intake = excess diffusion = excess increase of entropy = excess work for pumps = excess energy expenditure against excess entropy => excess food consumption.
8. But, all the rest of our vital processes (functional processes of the cells) receive less energy - because our capacity (to make energy from foods) is limited (see Kleiber's Law).
9. Everything work worse in our body, and this increases the incidence of all illnesses without any exception, our aging and devolution accelerate, etc.
1 / 5 (1) Aug 13, 2014
10. That is why salt (and other Na-compounds) is perfect food of entropy, and as I wrote on science20, this all is the Sodium-Induced Disorder Syndrome.
The entropy is our number one public enemy on every level (physical and mental health, and social level) globally. Our history and our entire individual life is a continuous war against entropy. The evolution of life on Earth was and is also a continuous war against entropy. But we, humans started our devolution = the entropy is growing in human genome. Even we nourish the entropy in all of our cells (by unnecessary sodium intakes), but the health scientists do not talk about this. And this is a fatal error. It's time to change that!

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