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J Am Coll Cardiol. 2019 Mar 5;73(8):977-980. doi: 10.1016/j.jacc.2018.12.028.

10-Year Heart Failure Outcomes From Nurse-Driven Clinics in Rural Sub-Saharan Africa.

Author information

1
Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
2
Department of Pediatrics, Pediatric Cardiology Unit, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda.
3
Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
4
Inshuti Mu Buzima, Rwinkwavu, Rwanda.
5
Ministry of Health, Kigali, Rwanda.
6
Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Section of Cardiology, Department of Medicine, Boston Medical Center, Boston, Massachusetts.
7
Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Partners in Health, Boston, Massachusetts; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: gene_bukhman@hms.harvard.edu.

Abstract

Nurse-led delivery care models have the potential to address the significant burden of heart failure in sub-Saharan Africa. Starting in 2006, the Rwandan Ministry of Health, supported by Inshuti Mu Buzima (Partners In Health-Rwanda), decentralized heart failure diagnosis and care delivery in the context of advanced nurse-led integrated noncommunicable clinics at rural district hospitals. Here, the authors describe the first medium-term survival outcomes from the district level in rural sub-Saharan Africa based on their 10-year experience providing care in rural Rwanda. Kaplan-Meier methods were used to determine median time to event for: 1) composite event of known death from any cause, lost to follow-up, or transfer to estimate worst-case mortality; and 2) known death only. Five-year event-free rates were 41.7% for the composite outcome and 64.3% for known death. While death rates are encouraging, efforts to reduce loss to follow-up are needed.

KEYWORDS:

Sub-Saharan Africa; heart failure; integrated care delivery; outcomes; survival analysis

PMID:
30819366
DOI:
10.1016/j.jacc.2018.12.028

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