03595nas a2200481   4500000000100000008004100001100001800042700001400060700001600074700001100090700001600101700001500117700001400132700001500146700001700161700001500178700001300193700001100206700001200217700001500229700001600244700001100260700001300271700001100284700001300295700001300308700001400321700001300335700001500348700001800363700001000381700001500391700002300406700001800429700001500447700001300462245009800475250001500573300001300588490000700601520245400608020005103062       2014                            d1 aWoodward Mark1 aBennett D1 aT Callender1 aRoth G1 aFarzadfar F1 aLemarie JC1 aGicquel S1 aAtherton J1 aRahimzadeh S1 aGhaziani M1 aShaikh M1 aLam CS1 aSliwa K1 aBarretto A1 aSiswanto BB1 aDiaz A1 aHerpin D1 aKrum H1 aEliasz T1 aForbes A1 aKiszely A1 aKhosla R1 aPetrinic T1 aShrivastava R1 aXin D1 aMcMurray J1 aPraveen Devarsetty1 aPatel Anushka1 aMacmahon S1 aRahimi K00aHeart failure care in low- and middle-income countries: a systematic review and meta-analysis  a2014/08/15  ae10016990 v113 a<p>
BACKGROUND: Heart failure places a significant burden on patients and health systems in high-income countries. However, information about its burden in low- and middle-income countries (LMICs) is scant. We thus set out to review both published and unpublished information on the presentation, causes, management, and outcomes of heart failure in LMICs. METHODS AND FINDINGS: Medline, Embase, Global Health Database, and World Health Organization regional databases were searched for studies from LMICs published between 1 January 1995 and 30 March 2014. Additional unpublished data were requested from investigators and international heart failure experts. We identified 42 studies that provided relevant information on acute hospital care (25 LMICs; 232,550 patients) and 11 studies on the management of chronic heart failure in primary care or outpatient settings (14 LMICs; 5,358 patients). The mean age of patients studied ranged from 42 y in Cameroon and Ghana to 75 y in Argentina, and mean age in studies largely correlated with the human development index of the country in which they were conducted (r = 0.71, p&lt;0.001). Overall, ischaemic heart disease was the main reported cause of heart failure in all regions except Africa and the Americas, where hypertension was predominant. Taking both those managed acutely in hospital and those in non-acute outpatient or community settings together, 57% (95% confidence interval [CI]: 49%-64%) of patients were treated with angiotensin-converting enzyme inhibitors, 34% (95% CI: 28%-41%) with beta-blockers, and 32% (95% CI: 25%-39%) with mineralocorticoid receptor antagonists. Mean inpatient stay was 10 d, ranging from 3 d in India to 23 d in China. Acute heart failure accounted for 2.2% (range: 0.3%-7.7%) of total hospital admissions, and mean in-hospital mortality was 8% (95% CI: 6%-10%). There was substantial variation between studies (p&lt;0.001 across all variables), and most data were from urban tertiary referral centres. Only one population-based study assessing incidence and/or prevalence of heart failure was identified. CONCLUSIONS: The presentation, underlying causes, management, and outcomes of heart failure vary substantially across LMICs. On average, the use of evidence-based medications tends to be suboptimal. Better strategies for heart failure surveillance and management in LMICs are needed. Please see later in the article for the Editors' Summary.
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