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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 5, September/October 2014
204
AFRICA
Cardiac surgery for patients with heart failure due to
structural heart disease in Uganda: access to surgery
and outcomes
Antonio Grimaldi, Enrico Ammirati, Nicole Karam, Anna Chiara Vermi, Annalisa De Concilio,
Giorgio Trucco, Francesco Aloi, Francesco Arioli, Filippo Figini, Santo Ferrarello, Francesco Maria Sacco,
Renato Grottola, Paul G D’Arbela, Ottavio Alfieri, Eloi Marijon, Juergen Freers, Mariana Mirabel
Abstract
Objective:
Few data are available on heart failure (HF) in
sub-Saharan Africa. We aimed to provide a current picture
of HF aetiologies in urban Uganda, access to heart surgery,
and outcomes.
Methods:
We prospectively collected clinical and echocar-
diographic data from 272 consecutive patients referred for
suspected heart disease to a tertiary hospital in Kampala
during seven non-governmental organisation (NGO) missions
from 2009 to 2013. We focused the analysis on 140 patients
who fulfilled standardised criteria of HF by echocardiography.
Results:
Rheumatic heart disease (RHD) was the leading
cause of HF in 44 (31%) patients. Among the 50 children
included (age
≤
16 years), congenital heart disease (CHD) was
the first cause of HF (30 patients, 60%), followed by RHD (16
patients, 32%). RHD was the main cause of HF (30%) among
the 90 adults. All 85 patients with RHD and CHD presented
with an indication for heart surgery, of which 74 patients
were deemed fit for intervention. Surgery was scheduled in 38
patients with RHD [86%, median age 19 years (IQR: 12–31)]
and in 36 patients with CHD [88%, median age 4 years (IQR
1–5)]. Twenty-seven candidates (32%) were operated on after
a median waiting time of 10 months (IQR 6–21). Sixteen
(19%) had died after a median of 38 months (IQR 5–52); 19
(22%) were lost to follow up.
Conclusions:
RHD still represents the leading cause of HF in
Uganda, in spite of cost-efficient prevention strategies. The
majority of surgical candidates, albeit young, do not have
access to treatment and present high mortality rates.
Keywords:
heart failure, rheumatic heart disease, congenital heart
disease, echocardiography, heart surgery
Submitted 23/3/14, accepted 13/6/14
Cardiovasc J Afr
2014;
25
: 204–211
www.cvja.co.zaDOI: 10.5830/CVJA-2014-034
Improvement in the control of infectious diseases and
malnutrition associated with changes in lifestyle has led to a
new epidemiological pattern in many low- and middle-income
countries. Non-communicable diseases, mainly cardiovascular
disorders, have emerged as major causes of morbidity and
mortality in most sub-Saharan African countries.
1
Hospital-
based studies indicate that heart failure (HF) accounts for 3–7%
of all admissions to African hospitals.
2,3-7
Although there has been increasing interest in the epidemiology
of cardiovascular diseases in the African continent,
7-9
recent data
from Uganda are scarce
7,10
but most needed to guide public
health policies. Most registers originate from South Africa and
cannot be transposed to poorer sub-Saharan countries.
2,11
Echocardiography is a mainstay in the assessment of HF.
Unfortunately, access to echocardiography remains limited in
many African countries due to cost and lack of skilled health
workers, thereby leading to little data on cardiovascular diseases.
12
We report on the distinctive patterns of HF through a
prospective, cross-sectional, hospital-based study in patients
referred for suspected heart disease in urban Kampala, Uganda,
St Raphael of St Francis, Nsambya Hospital, Kampala,
Uganda
Antonio Grimaldi, MD,
grimaldi.antonio@hsr.itEnrico Ammirati, MD
Anna Chiara Vermi, MD
Annalisa De Concilio, MD
Giorgio Trucco, MD
Francesco Aloi, MD
Francesco Arioli, MD
Filippo Figini, MD
Santo Ferrarello, MD
Francesco Maria Sacco, MD
Renato Grottola
Paul G D’Arbela, MD
Eloi Marijon, MD
Mariana Mirabel, MD
Cardiovascular and Thoracic Department, San Raffaele
Hospital, Milan, Italy
Antonio Grimaldi, MD
Enrico Ammirati, MD
Anna Chiara Vermi, MD
Francesco Arioli, MD
Filippo Figini, MD
Santo Ferrarello, MD
Francesco Maria Sacco, MD
Ottavio Alfieri, MD
Paris Cardiovascular Research Centre, INSERM U970,
Paris, France
Nicole Karam, MD
Eloi Marijon, MD
Mariana Mirabel, MD
Division of Cardiology, Department of Medicine, Makerere
University, Kampala, Uganda
Juergen Freers, MD