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AFRICA
Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S4
Integrating the prevention and control of rheumatic heart disease into country health systems: A systematic review
Jessica Abrams*, Mark Engel
#
, David Watkins
†
, Leila Abdullahi* and Liesl Zühlke
‡
*Department of Paediatrics and Child Health, University of Cape Town, Rondebosch, South Africa.
#
Department of Medicine, University of Cape Town,
Rondebosch, South Africa.
†
Department of Medicine, University of Washington, Seattle, Washington, United States of America.
‡
Red Cross War Memorial
Children’s Hospital and the University of Cape Town, Rondebosch, South Africa
Introduction:
Rheumatic heart disease (RHD), a sequel to StrepA pharyngitis and acute rheumatic fever (ARF), is a significant cause of morbidity and
mortality amongst disadvantaged populations. Following a 2018 World Health Assembly Resolution on RHD, an evidence-based approach is needed to
guide the implementation of RHD programmes which are integrated into national health systems. We assessed the effectiveness of programmes targeting
RHD prevention and control according to the extent and nature of integration into the health system, with a view to inform best practice and identify key
knowledge gaps.
Methods:
We searched electronic databases and grey literature, complemented by hand searching, in order to identify studies reporting on prevention and
control programmes for populations at risk for StrepA pharyngitis, ARF and/or RHD. Eligible studies were published in English between 1990 and 2017. RHD
programme integration was analysed according to an established framework. Programme effectiveness data were extracted and analysed using a results-
chain framework. A meta-analysis was performed on secondary prophylaxis adherence. The quality of studies was assessed using peer-reviewed checklists
(CASP and PRISM).
Results:
The search yielded 658 publications, from which 5 observational studies met with the inclusion criteria. Studies were similar in extent and nature
(health system function). None of the programmes was completely integrated, or non-integrated. A single study reported on the impact of the programme.
Secondary prophylaxis adherence improved amongst partially integrated RHD programmes (RR, 1.18 [95% CI, 1.03 - 1.36], 3 studies, n=618). Risk of bias was
low in 2 studies, and indeterminable in the remaining 3.
Conclusion:
There is evidence that partially integrated RHD programmes are beneficial for a number of study outcomes. This review provides a starting point
for the design and implementation of future RHD programmes by outlining current best practice for integration and identifying key gaps in knowledge.
Infective endocarditis at Dr George Mukhari Academic Hospital: Correlating echocardiography findings with
intra-operative findings
Jamila Khatoon Adam* and Musawenkosi Henema
#
*Durban University of Technology, KwaZulu-Natal, Durban, South Africa.
#
Dr George Mukhari Academic Hospital, Ga-Rankuwa, Pretoria, South Africa
Introduction:
Infective endocarditis is a serious disease associated with poor prognosis, despite improvements in medical and surgical therapies. The project
aimed to compare echocardiographic findings (transthoracic echocardiographic TTE) with intra-operative findings in patients with infective endocarditis.
Methods:
The cohort consisted of 40 patients with infective endocarditis. Two techniques were used to assess the infective endocarditis: echocardiography
and intra-operative findings (visual and histology). Blood samples were cultured to demonstrate the presence of micro-organisms. The researcher performed
an echocardiogram to assess: which valve was affected, the left ventricular endiastolic diameter, the left ventricular ensystolic diameter, the shortening
fraction, the ejection fraction and the size of the vegetation/mass or abscess. For patients requiring heart surgery, the cardiac surgeon performed the valve
replacement and the intra-operative findings were assessed visually to confirm the presence of vegetation or abscess and leaflet destruction. During the
operation a biopsy sample was taken for histological examination to confirm the presence of vegetation or abscess. The researcher was blinded to the
findings in the theatre.
Results:
The histology confirmed echocardiographical and intra-operative findings. The intra-operative and echocardiography findings showed:
80% vegetation, 5% perforation, 10% pseudo-aneurysms and 5% abscesses. The prognosis of patients with poor ejection fraction (40% - 50% EF) was poorer
than those with good ejection fraction. The clinical findings of all patients confirmed infective endocarditis, 80% blood cultures were positive and 20% were
negative. There were 17.5% patients who showed poor correlation and 82% patients showed moderate correlation between echocardiographical and post-
operative findings.
Conclusion:
A total of 20% had stenosis and 32% of 80% of patients who had infective endocarditis, had regurgitation. There was an overall moderate
association (r=0.68) between echocardiography and intra-operative findings in all patients for LVES.
Use of single pill combination anti-hypertensive medications in a tertiary health institution cardiology clinic in Nigeria
Ojonojima Ajanya, Dike Ojji, Augustine Odili, Jacob Alfa, Bolaji Abdullahi, Ada Nwankwo, Anita Nnamonu, Taiwo Adedokun, Moses Durotoluwa and
Henry Oshaju
University of Abuja Teaching Hospital, Gwagwalada-Zuba, Gwagwalada, Nigeria
Introduction:
The majority of patients with hypertension require 2 or more medications to provide adequate blood pressure (BP) control. In addition,
contemporary guidelines on the management of hypertension favour the use of single pill combinations (SPCs) as they simplify the treatment regimen and
decrease the daily pill burden for patients, both of which are associated with improved adherence. In spite of this, no study in our context has assessed the
proportion of patients on SPC anti-hypertensive therapy.
Methods:
We prospectively collected detailed clinical data from 373 patients with a primary diagnosis of hypertension attending the University of Abuja
Teaching Hospital cardiology clinic between 2016 and 2017.
Results:
A total of 373 patients, with a mean age of 50.6 ± 12.3 years and mean body mass index of 31.2 ± 6.5kg/m2 on anti-hypertensive treatment were
evaluated. Baseline mean systolic and diastolic BPs were 161.1 ± 3.1mmHg and 95.4 ± 15.6mmHg, respectively. Mean pulse pressure was 56.6 ± 18.1mmHg.
A total of 212 (56.8%) patients were on a single pill combination, with 32.5% on angiotensin receptor blocker (ARB) plus hydrochlorothiazide (HCT), 18.9% on
angiotensin converting enzyme inhibitors (ACEIs) plus HCT, 9.9% on amlodipine (AML) plus ARB, 3.3% on AML plus ACEI, 3.8% on thiazide-like diuretic plus
atenolol, 29.2% on HCT plus amiloride and 2.4% on a triple combination of AML+ARB+HCT.
Conclusion:
Our study showed that over 50% of our patients were on single pill combination anti-hypertensive medications.