AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 8 Submission ID: 2 FACTORS ASSOCIATED WITH NON-UPTAKE OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR AMONG ELIGIBLE PATIENTS IN KENYA OLUOCH EMMANUEL BENGE1, MZEE LEONARD NGUNGA1, MOHAMED HASHAM VARWANI1, JASMIT SHAH1 1. AGA KHAN UNIVERSITY HOSPITAL, NAIROBI Background The safety and efficacy of Implantable Cardioverter-Defibrillator (ICD) implantation in both primary and secondary prevention of Sudden Cardiac Death (SCD) in at-risk populations is well established. ICD implantation rates remain low particularly in Africa with a paucity of data regarding factors associated with non-uptake and reasons for implant refusal. The study’s aim was to characterize these factors and identify reasons for ICD refusal. Understanding these factors and reasons for non-implantation will provide the opportunity to optimize ICD uptake among eligible patients hence reducing sudden cardiac arrest. Methods This was a retrospective study of heart failure patients seen from 2018 to 2020. Demographics, etiology of heart failure, comorbidities, NYHA functional class, primary physician, and insurance status were abstracted. Logistics regression models were used to compare the ICD recipient and ICD non-recipient groups to determine predictors for non-uptake. Results Of the 206 ICD device-eligible patients, only 69 (33.5%) had an ICD implantation. Compared to ICD recipients, ICD non-recipients were more likely to be of African race (91.2%vs. 79.7%; p=0.019) and rural dwellers (18.7% vs 8.2%; p=0.031). In multivariate analysis, factors independently associated with non-uptake were lack of private insurance (42.3% vs 63.8%; p=0.005), non-cardiology physician (16.1% vs 5.8%; p=0.045), and non-ischemic cardiomyopathy (54.7% vs 36.4% p=0.014). The most common reason for refusal of ICD implantation was the inability to pay for the device. Conclusion ICDs are underutilized in Kenya. Certain patient and practice factors including lack of private insurance, non-cardiology primary physician, and non-ischemic cardiomyopathy, were independently associated with non-uptake of ICD. The findings of this study hold significance in enhancing the utilization of ICDs in sub-Saharan Africa. Submission ID: 3 DIAGNOSIS OF CHILDREN ADMITTED OVER A 5-YEAR PERIOD WITH CONGENITAL HEART DISEASE AT KENYATTA NATIONAL HOSPITAL B. OMBABA OSANO, D. KIMONGE, E. KIMANI, E. CHESIRE, N. GACHARA, C. YUKO-JOWI Background Congenital Heart disease (CHD) are clinically significant structural heart disease present at birth. CHD is found in 8-12 babies per 1,000 live births. Common CHDs include atrial septal defects, ventricular septal defects, Patent Ductus Arteriosus, pulmonary stenosis, coarctation of aorta and tetralogy of Fallot. The number of patients with their CHDs admitted at KNH hasn’t been documented. Objective: To establish the clinical diagnosis of children admitted in KNH with CHD from 1st January 2016 to December 2021. Methodology Retrospective review of patient records for period 1st January 2016 to December 2021. We collected data for all patients diagnosed with congenital heart disease for patients aged below 18 years who had ever been admitted at Kenyatta National Hospital. Descriptive statics were generated for social demographic and the clinical diagnosis. Continuous data was summarized with appropriate measures of central tendency and distribution. Results We reviewed 1,247 medical records for children with CHDs. A majority (1,102 -88.4%) were aged three years or below. There were slightly more males (730 - 58.5%). Most of the children were referred for cardiac evaluation (858 - 68.8%). Nairobi county had the highest number of patients (509 - 40.8%). The common presenting were respiratory symptoms (difficulties in breathing – 906, 72.7%, cough – 57, 17.3% and difficulties in feeding/breastfeeding – 169, 13.6%). The common acyanotic CHDs were PDA (435 - 34.9%), VSD (365 – 29.2%) and ASD (267 – 21.4%) while the common cyanotic CHDs were ToF (92 - 7.3%) and DORV (18 - 1.4%). Conclusion The common CHDs seen were VSD, PDA and ASD for acyanotic while ToF and DORV were the common cyanotic CHDs. Submission ID: 4 TREADING THE PATIENT PATHWAY: HEALTHY HEART AFRICA APPROACH TO AWARENESS, SCREENING, DIAGNOSIS AND TREATMENT OF HYPERTENSION AT FAITH-BASED HEALTH FACILITIES IN KENYA. 1RAPHAEL KINUTHIA, 1JACINTA MUTEGI, 1ANGELA MWANZA, 1ANASTACIA RUURI, 1PAULINE KIHORO, 1PAULINE MUE, 1JANET NZAI, 2MARGARET KIGWE, 2NELSON OTIENO 1. KENYA CONFERENCE OF CATHOLIC BISHOPS – HEALTH DEPARTMENT, P.O BOX 13475, 00800, NAIROBI 2. HEALTHY HEART AFRICA – ASTRAZENECA MEA SUB SAHARAN AFRICA, P.O BOX 10107, 00100, NAIROBI Background AstraZeneca’s HHA program launched in 2014, is a sustainability access program designed to contribute to prevention and control of hypertension and decreasing the burden of cardiovascular diseases in Africa. HHA is delivered in partnership with MOH-Kenya and Kenya Conference of Catholic Bishops and aspires to reach 10 million people with elevated blood pressure across Sub-Saharan Africa by 2025. Methods Focusing on strengthening the patient pathway, CHVs and relevant healthcare providers were trained in awareness creation and education with provision of IEC materials, hypertension protocols and registers to track patient journey and outcomes. Screening is done by CHVs at the community or Healthcare Providers at triage to identify, refer and link patients with elevated blood pressure for diagnosis and treatment. Psychosocial support groups are formed for adherence and retention. Results From January 2016 to February 2023, 10,779,740 people were screened, 2,183,241 (20.3%) were found with elevated blood pressure 615,397 (28.2%) individuals with elevated blood pressure were referred. 421,736 (85.6%) were newly diagnosed with hypertension and linked to care, 208,000 (46.7%) initiated on treatment. Conclusion HHA pathway demonstrated successful implementation of hypertension interventions within the primary care setting in Kenya. The initiative was able to identify high numbers of hypertensive patients for care. HHA approach, demonstrates mechanisms to attain early detection, prevention and treatment of hypertension in Kenya.
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