Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Heart Failure (n=237908). Intervention: Angiotensin-converting enzyme inhibitors. Primary outcome: In-hospital mortality rate (95% CI 6%-10%, p=<0.001).

Q: What does this research mean for the field?

Heart failure accounted for 2.2% of total hospital admissions across low- and middle-income countries (LMICs), with an average in-hospital mortality of 8% and heterogeneous management practices observed. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Thomas Callender; Mark Woodward; Gregory A. Roth; Farshad Farzadfar; J. Lemarié; Stéphanie Gicquel; J. Atherton; Shadi Rahimzadeh; Mehdi Ghaziani; Maaz Shaikh; Derrick Bennett; Anushka Patel; Carolyn S.P. Lam; Karen Sliwa; Antônio Carlos Pereira Barretto; Bambang Budi Siswanto; Alejandro Díaz; D Herpin; Henry Krum; Thomas K Eliasz; Anna Forbes; Alastair Kiszely; Rajit Khosla; Tatjana Petrinic; Devarsetty Praveen; Roohi Shrivastava; Xin Du; Stephen MacMahon; John J.V. McMurray; Kazem Rahimi

doi:10.1371/journal.pmed.1001699

Key Points

This research aims to assess the management and outcomes of heart failure in low- and middle-income countries.
Conducted a systematic review of existing studies on heart failure care in LMICs.
Performed a meta-analysis to evaluate medication usage and treatment outcomes.
Analyzed variations in heart failure management practices across different LMICs.
Identified significant gaps in the use of evidence-based medications for heart failure in LMICs.
Found disparities in care approaches and outcomes that affect patient health.
Suggested the need for improved surveillance and management strategies to enhance care quality.

Study Design

Type

Systematic Review (n=237,908)

Multicenter

Yes

Structured PICO

P

Population

237,908 episodes of heart failure from 42 studies on acute hospital care (232,550 patients) and 11 studies on chronic heart failure in primary care or outpatient settings (5,358 patients) across 31 low- and middle-income countries. Mean age 63 years, 58% male.

O

Outcome

Presentation, causes, management, and outcomes (including in-hospital mortality and length of stay) of heart failure

Main Result

p-value: p=<0.001

Limitations

Substantial heterogeneity in study methodologies and patient characteristics
Limited population-level incidence and prevalence data available across different regions
Many data derived from urban tertiary referral centres may not reflect broader population characteristics.
High between-study variation
Potential for confounding in meta-regression
Differences in diagnostic criteria
Data mostly derived from urban tertiary referral centres
Limited information from some regions

Implication

Heart failure in low- and middle-income countries is characterized by high in-hospital mortality and suboptimal use of guideline-directed medical therapies, emphasizing the need for improved global management strategies.

Abstract

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Discussion

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Cite This Study

Callender et al. (2014) conducted a systematic review in Heart Failure (n=237,908). Angiotensin-converting enzyme inhibitors was evaluated on In-hospital mortality rate (95% CI 6%-10%, p=<0.001).

synapsesocial.com/papers/6961956115d481f6dda30a93 https://doi.org/10.1371/journal.pmed.1001699

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Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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