12 / 66
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 6, November/December 2019
320
AFRICA
Conclusion
Low educational level, longer distance from medical facility, less
frequent follow-up visits, and warfarin from public institutions
were found to be significantly associated with sub-optimal
control of INR in our study. These findings may help to develop
initiatives such as implementing regular outreach clinics, training
health workers in remote areas with task shifting, supplying
INR self-determination devices, or other innovative ways that
may be found to be feasible and effective. It may also be worth
considering the feasibility, affordability and effectiveness of
NOACs for such patients in our setting.
We thank the staff members of the paediatric and adult cardiac clinics and
the children’s Heart Fund Cardiac Centre for allowing us to conduct this
study and assisting with the data collection. We are also grateful to all those
practitioners who care for these patients over the years.
References
1.
Vongpatanasin W, Hillis LD, Lange RA. Prosthetic heart valves.
N Engl
J Med
1996;
335
: 407–416.
2.
Cannegieter SC, Rosendaal FR, Briët E. Thromboembolic and bleed-
ing complications in patients with mechanical heart valve prostheses.
Circulation
1994;
89
: 635–641.
3.
Butchart EG, Gohlke-Bärwolf C, Antunes MJ,
et al.
Recommendations
for the management of patients after heart valve surgery.
Eur Heart J
2005;
26
: 2463–2471.
4.
Kontozis L, Skudicky D, Hopley MJ, Sareli P. Long-term follow-up of
St. Jude Medical prosthesis in a young rheumatic population using low-
level warfarin anticoagulation: an analysis of the temporal distribution
of causes of death.
Am J Cardiol
1998;
81
: 736–739.
5.
Deviri E SP, Wisenbaugh T, Cronje SL. Obstruction of mechanical heart
valve prostheses: clinical aspects and surgical management.
J Am Coll
Cardiol
1991;
17
: 646–650.
6.
Alpert JS. The thrombosed prosthetic valve: current recommendations
based on evidence from the literature.
J Am Coll Cardiol
2003;
41
:
659–660.
7.
Wilson WR, Geraci JE, Danielson GK,
et al
. Anticoagulant therapy
and central nervous system complications in patients with prosthetic
valve endocarditis.
Circulation
1978;
57
: 1004–1007.
8.
Little SH, Massel DR. Antiplatelet and anticoagulation for patients with
prosthetic heart valves.
Cochrane Database Syst Rev
2003: CD003464.
9.
Mve Mvondo C, Pugliese M, Ambassa JC, Giamberti A, Bovio E,
Dailor E. Mechanical Heart valve replacement in a low-middle income
region in the modern era: mid-term results from a sub-Saharan center.
Thorac Cardiovasc Surg
2018 Jul 18. doi: 10.1055/s-0038-1666873. [Epub
ahead of print].
10. Tefera E. Treatment of children with rheumatic heart disease in sub-
Saharan Africa by overseas’ medical missions: challenges left behind.
J
Cardiol Clin Res
2014;
2
: 1016.
11. Vahanian A, Alfieri O, Andreotti F,
et al
. Guidelines on the manage-
ment of valvular heart disease: The joint task force on the management
of valvular heart disease of the European Society of Cardiology (ESC)
and the European Association for Cardio-Thoracic Surgery (EACTS).
Eur Heart J
2012;
33
: 2451–2496.
12. Bowry ADK, Shrank WH, Lee JL, Stedman M, Choudhry NK.
A systematic review of adherence to cardiovascular medications in
resource limited settings.
J Gen Intern Med
2011;
26
: 1479–1491.
13. Buchanan-Leel B, Levetan BN, Lombard CJ, Commerford PJ. Fixed-
dose versus adjusted-dose warfarin in patients with prosthetic heart
valves in a peri-urban impoverished population.
J Heart Valve Dis
2002;
11
: 583–589.
14. Mvondo CM, Pugliese M, Giamberti A,
et al
. Surgery for rheumatic
mitral valve disease in sub-saharan African countries: why valve repair
is still the best surgical option.
Pan Afr Med J
2016;
24
: 307.
15. Rusingiza EK, El-Khatib Z, Hedt-Gauthier B,
et al.
Outcomes for
patients with rheumatic heart disease after cardiac surgery followed at
rural district hospitals in Rwanda.
Heart
2018;
104
: 1707–1713.
16. Pirmohamed M. Warfarin: almost 60 years old and still causing prob-
lems.
Br J Clin Pharmacol
2006;
62
: 509–511.
… continued from page 315
References
1.
Brink AJ. Editorial: CVJSA e-journal publication.
Cardiovasc J Sth Afr
2003;
14
(2): 57–58.
2.
Brink AJ. New impact factor and PubMed Central service from the
Cardiovascular Journal of Africa
.
Cardiovasc J Afr
2012;
23
(7): 364.
3.
Brink PA. Article visibility: journal impact factor and availability of full
text in PubMed Central and open access.
Cardiovasc J Afr
2013;
24
(8):
295–296.
4.
Brink P. Measuring publication impact, and publishing and funding
models.
Cardiovasc J Afr
2016;
27
(6): 335.
5.
Roldan-Valadez E, Salazar-Ruiz SY, Ibarra-Contreras R, Rios C.
Current concepts on bibliometrics: a brief review about impact
factor, Eigenfactor score, CiteScore, SCImago Journal Rank, Source-
Normalised Impact per Paper, H-index, and alternative metrics.
Ir J
Med Sci
2019;
188
(3): 939–951.
6.
2017 Journal impact factor, Journal Citation Reports. Clarivate
Analytics 2018.
7.
2016 Journal impact factor, Journal Citation Reports. Clarivate
Analytics 2017.
8.
WORLD POPULATION [Internet]. Worldometers 2019. [cited 2019
Dec 15]. Available from:
https://www.worldometers.info/