Outcomes for patients with rheumatic heart disease after cardiac surgery followed at rural district hospitals in Rwanda

被引:34
作者
Rusingiza, Emmanuel K. [1 ,2 ]
El-Khatib, Ziad [3 ,4 ,5 ,6 ]
Hedt-Gauthier, Bethany [3 ]
Ngoga, Gedeon [4 ]
Dusabeyezu, Symaque [4 ,6 ]
Tapela, Neo [4 ]
Mutumbira, Cadet [2 ]
Mutabazi, Francis [2 ]
Harelimana, Emmanuel [2 ]
Mucumbitsi, Joseph [7 ]
Kwan, Gene F. [3 ,8 ,9 ,10 ]
Bukhman, Gene [3 ,9 ,10 ]
机构
[1] Univ Rwanda, Coll Med & Hlth Sci, Kigali, Rwanda
[2] Minist Hlth, Kigali, Rwanda
[3] Harvard Med Sch, Dept Global Hlth & Social Med, Boston, MA USA
[4] Partners Hlth Inshuti Mu Buzima, Kigali, Rwanda
[5] Karolinska Inst, Dept Publ Hlth Sci, Stockholm, Sweden
[6] Univ Quebec Abitibi Temiscamingue, World Hlth Programme, Rouyn Noranda, PQ, Canada
[7] King Faisal Hosp, Kigali, Rwanda
[8] Boston Univ, Sch Med, Sect Cardiovasc Med, Boston, MA 02118 USA
[9] Brigham & Womens Hosp, Dept Global Hlth Equ, 75 Francis St, Boston, MA 02115 USA
[10] Partners Hlth, Boston, MA USA
关键词
cardiac surgery; health care delivery; global health care delivery; ANTICOAGULATION; REGISTRY; CHILDREN;
D O I
10.1136/heartjnl-2017-312644
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background In sub-Saharan Africa, continued clinical follow-up, after cardiac surgery, is only available at urban referral centres. We implemented a decentralised, integrated care model to provide longitudinal care for patients with advanced rheumatic heart disease (RHD) at district hospitals in rural Rwanda before and after heart surgery. Methods We collected data from charts at non-communicable disease (NCD) clinics at three rural district hospitals in Rwanda to describe the outcomes of 54 patients with RHD who received cardiac valve surgery during 2007-2015. Results The majority of patients were adults (46/54; 85%), and 74% were females. The median age at the time of surgery was 22years in adults and 11years in children. Advanced symptomsNew York Heart Association class III or IVwere present in 83% before surgery and only 4% afterwards. The mitral valve was the most common valve requiring surgery. Valvular surgery consisted mostly of a single valve (56%) and double valve (41%). Patients were followed for a median of 3years (range 0.2-7.9) during which 7.4% of them died; all deaths were patients who had undergone bioprosthetic valve replacement. For patients with mechanical valves, anticoagulation was checked at 96% of visits. There were no known bleeding or thrombotic events requiring hospitalisation. Conclusion Outcomes of postoperative patients with RHD tracked in rural Rwanda health facilities were generally good. With appropriate training and supervision, it is feasible to safely decentralise follow-up of patients with RHD to nurse-led specialised NCD clinics after cardiac surgery.
引用
收藏
页码:1707 / +
页数:7
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