CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 17 AFRICA Submission ID: 22 THE USE OF TELE - ECG & POINT OF CARE ULTRASOUND IN PRIMARY CARE, FOR EARLY DETECTION AND REFERRAL OF CARDIOVASCULAR PATIENTS IN SIAYA COUNTY. A PROCESS PAPER. OWUOR JARED2, KAREKEZI CATHERINE2, GITONGA CAROLINE3, ADEMA IRENE3, YONGA GERALD1 1. UON 2. NCDAK 3. PHILIPS FOUNDATION Background NCDs and CVDs burden are rapidly increasing in Kenya. CVDs account for a substantial portion of hospital admissions (25%) and cause a notable number of deaths (13%), as revealed by autopsy results. To address this challenge, strengthening the capacity of primary healthcare providers and introducing innovative technologies at Level III facilities hold promise for reducing the burden by up to 80%. Methods A mixed methods design, including a two-arm, quasi-experimental approach, was employed. Furthermore, ongoing support through on-site and real-time remote mentorship as well as evidence-based programmatic interventions, was implemented in five selected facilities. Strategic partnerships were established to strengthen the facilities with functional equipment and technologies. Persons living with NCDs (PLWNCDs) were also empowered through advocacy training to influence policies and advocate for their needs and selfmanagement. Results 32 Level III healthcare providers were trained in performing pointof-care 12-lead ECGs and interpreting echocardiograms. Utilizing the MoyoAfya protocol, a total of 979 patients were screened, with 228 undergoing ECGs and 165 receiving echocardiograms. This screening led to direct benefits for 23% of individuals through ECG and 16% through echocardiogram scans, who would have otherwise been missed. The project gained significant media attention, featuring in BBC Storyworks films and local media. Ongoing costbenefit analysis of the MoyoAfya CVD care model and PLWNCDs’ advocacy efforts show promising prospects, backed by strong support from the County Assembly Speaker and the Governor. Conclusion There is transformative impact of collaborative efforts in advancing early detection and management of CVDs and NCDs in resourceconstrained settings. Portable Tele-ECG and Tele-Echo technologies in low-level facilities has great potential for improved healthcare access and outcomes. The project’s sustainability and continued success is pivoted on current momentum and capitalizing on the accomplishments achieved thus far, exploring opportunities for expansion to benefit more eligible patients, regions, and healthcare facilities. Submission ID: 23 STRUCTURE AND COST-EFFECTIVENESS OF INTEGRATED CARE MODELS FOR THE PREVENTION AND MANAGEMENT OF CARDIOMETABOLIC MULTIMORBIDITY: A SYSTEMATIC LITERATURE REVIEW ELVIS O. A. WAMBIYA1,2, JAMES OGUTA1,2, ROBERT AKPARIBO1, DUNCAN GILLESPIE1, PETE DODD1 1. SCHOOL OF HEALTH AND RELATED RESEARCH (SCHARR), UNIVERSITY OF SHEFFIELD. SHEFFIELD, S1 4DA, UNITED KINGDOM 2. AFRICAN NETWORK OF RESEARCH SCIENTISTS, NAIROBI, KENYA Background The increasing burden of multimorbidity, especially in low- and middle-income countries (LMICs), calls for adaptive health systems interventions. Integrated care models are recommended as they improve efficiency in the prevention and management of chronic disease multimorbidity and are considered cost effective. We conducted a systematic review to identify the structure and healtheconomic impacts of integrated care models for cardiometabolic multimorbidity. Methods A systematic search was conducted in Medline, Web of Science, EMBASE, CINAHL, Psychinfo, Econlit, Scopus, and the Cochrane register of controlled trials, for articles in English on model-based economic evaluations of integrated care models for cardiometabolic multimorbidity. Integrated care was operationalised based on Wagner et al. (2001)’s chronic care model (CCM) and Singer et al. (2011)’s framework for measuring integrated care for patients with multiple/ complex chronic conditions. Concordant and discordant cardiometabolic multimorbidity were considered, and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Results Out of the 5416 unique records identified from title and abstract screening, sixteen full-text articles were finally included. More studies were conducted in Europe (6) and Asia (4) as compared to other continents including Australia (2), America (2), and Africa (2). The integrated care models focused on multiple-disease screening, while others were personnel-focused (e.g., pharmacist-led, nurseled integrated care), used comprehensive disease management, and a quality improvement collaborative approach. The primary disease in eleven of the studies was either hypertension or diabetes, and most of the studies addressed concordant multimorbidity with related complications such as MI, stroke, CHD, heart failure. The main discordant comorbidities were cancers and HIV. Integrated care models were found to be cost-effective for cardiometabolic multimorbidity at the chosen willingness-to-pay thresholds. Conclusions Different strategies are implemented in integrated care models for chronic disease multimorbidity, and the structures vary by setting. While integrated models have been found cost-effective, evidence is needed on the cost-effectiveness of different strategies within the same context especially in LMICs where limited evidence exists. Submission ID: 24 OUTCOME AFTER COX-MAZE IV PROCEDURE FOR ATRIAL FIBRILLATION IN RHEUMATIC HEART DISEASE PATIENTS: EXPERIENCE FROM TENWEK HOSPITAL (A PRELIMINARY REPORT) AREGA F. LETA (MD), AGNETA ODERA (MD), YONAS A. TEFERI (MD), DIANA SANG (MD), IAN MUTAI (MD), EVALINE CHEMUTAI Background Rheumatic heart disease (RHD) is a leading cause of Atrial fibrillation (AF), particularly in young patients. The Cox-maze IV (CM-IV) procedure is a surgical treatment option for AF that aims to restore normal sinus rhythm (NSR). However, the sinus rhythm conversion rate of the Cox-maze IV procedure in patients with RHD is not well established. This is a preliminary report on the CM-IV procedure in patients with RHD at Tenwek Hospital, Kenya. Methods This is an ongoing intervention-based study of patients with RHD who underwent the CM-IV procedure at Tenwek Hospital. All patients underwent bi-atrial cryo-ablation during concomitant valve surgery followed by oral amiodarone for 6 weeks for rhythm control. Patient follow-up was conducted by means of chart review, physician examination, and electrocardiographic documentation. All patients had a minimum of 3 months of follow-up. Data were entered, analyzed, and reported employing non-parametric statistical methods with SPSS software package 26.
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