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Heart Failure, a Growing Global Health Concern: A Systematic Review of the Epidemiology in a Poor Resource Setting Country, Haiti
S92 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 in HF-related CV mortality rates with highest rates and greatest increases observed in the South and Midwest. Black men in each region have the highest HF-related CV mortality rates and saw the greatest increases between 2011 and 2017. Urgent action is needed to focus public health efforts on modifiable risk exposures in regions and subgroups with greatest burden of HF.
identify and screen 167 potentially eligible publications through the databases. Based on our inclusion and exclusion criteria, 2 studies for a total of 558 patients were included in this analysis: one (1) prospective cohort study and (1) one retrospective cohort study. Conclusion: Non-ischemic cardiomyopathy was the leading cause of heart failure and women are predominantly affected with the caveat of not having any catheterization laboratory in the country as a diagnostic tool. Tailored multilevel interventions are needed to decrease health disparities and help in the diagnosis, classification and management of heart failure in poor resource settings like Haiti.
Incidence and prevalence of HF in studies. n: number of patients (%) Type of study
Country, Region
Malbranche prospective et al study Kwan et al. retrospective study
246 Increased eGFR Variability is Observed in Patients with HFrEF Compared to no HF or HFpEF in the Setting of Chronic Kidney Disease Aaron M. Hein1, Julia J. Scialla1,2, Linda K. Shaw2, Karen Chiswell2, Patrick H. Pun1,2, Robert J. Mentz1,2; 1Duke University Medical Center, Durham, NC; 2Duke Clinical Research Institute, Durham, NC Introduction: Patients with chronic kidney disease (CKD) with increased variability in estimated glomerular filtration rate (eGFR) have increased mortality compared to those with a stable eGFR trend. In those with CKD and heart failure (HF) with reduced (HFrEF) or preserved ejection fraction (HFpEF), who experience distinct hemodynamic and neurohormonal fluctuations, eGFR variability has not been characterized. Understanding of eGFR variability in these patients may help better understand a vulnerable population with poor outcomes. Hypothesis: eGFR variability is increased in patients with CKD and either HFrEF or HFpEF relative to patients without HF, and those with HFrEF will experience the greatest eGFR variability. Methods: A retrospective analysis of the Duke Databank for Cardiovascular Disease included participants with left ventricular ejection fraction (LVEF) data undergoing left heart catheterization from 2003-2013 with an eGFR<60 mL/min/1.73m2 as determined by the CKD-EPI equation. eGFR variability for the subsequent 24-month period was determined as the residual standard deviation (SD) from the regression line of eGFR versus time fit. eGFR variability was calculated for each individual participant who had at least 3 outpatient creatinine values, with any 2 of those outpatient creatinine values at least 3 months apart. HFrEF was defined as LVEF<40% with NYHA class II-IV symptoms, and HFpEF was defined as LVEF>40% with NYHA II-IV symptoms. Patients with no history of HF or NYHA class I symptoms were the comparator group. Associations between eGFR variability, HF phenotype, and pre-selected covariates such as age, race, and sex were analyzed using multivariable regression. Results: 4707 participants met study criteria. The median (IQR) eGFR was 45.5 (33.7, 55.3) mL/min/1.73m2, and a median of 9 (6, 15) eGFR measurements per participant were used to determine variability, resulting in a median residual SD of 6.2 (3.9, 9.2). After adjustment for covariates, the presence of HFrEF (n=1024, 22%) was associated with increased eGFR variability (b=2.03, 95% CI 1.69-2.36, p<.0001) compared to the absence of HF (n=2776, 59%), and with increased variability compared to HFpEF (n=907, 19%) (b=1.73, 95% CI 1.31-2.15, p<.0001). Patients with HFpEF had numerically increased eGFR variability relative to the absence of HF that did not meet the pre-specified threshold for statistical significance (b=0.30, 95% CI -0.05-0.65, p=0.10). Conclusions: In patients with CKD, patients with HFrEF have elevated eGFR variability compared to those without HF and those with HFpEF. Further study to better understand any effects of eGFR variability on clinical outcomes in these HF populations is warranted.
247 Heart Failure, a Growing Global Health Concern: A Systematic Review of the Epidemiology in a Poor Resource Setting Country, Haiti Michel Ibrahim1, Sandrine Lebrun2; 1Boston Medical Center, Boston, MA; 2Lenox Hill Hospital, Boston, NY Background: The epidemiology of HF (Heart Failure) has been extensively researched in the western world, its incidence and prevalence in the developing world has not been well characterized. Haiti is a one of the poorest countries in the western hemisphere and notably with a total 4 cardiologists for a population of 8 million. We report a systematic review of the evidence on the incidence and prevalence of Heart Failure and their etiologies in Haiti over the last 20 years. Our goal is to strengthen current knowledge on the epidemiology of HF in a resource poor setting. This will be helpful in making further recommendations regarding future investigations in the development of a more effective tailored approach to Haiti’s population that can very well serve in other similar settings. Methods: A systematic review in accordance with PRISMA guidelines was performed. The literature search was carried up until January 9, 2018, referring to PubMed, Medline and EMBASE. Results: We could
All Sample Setting subgroups size Male
Port-au-Prince, Urban all Haiti patients Mirebalais, Rural all Haiti patients
247 311
Female
n: 93 (37.7%) n:125 (40.2%)
n:154 (62.4%) n:186 (59.8%)
Outcomes table
Malbranche et al. Kwan et al.
Total patients
Mortality (%)
30 day re-admission
Lost to follow up
247 311
50 (20.2%) 37 (11.2%)
7(2.8%) 18(6.6%)
32 0
248 Characteristics of Incident Heart Failure over 11 Years in Korea: Analysis from National Health Insurance Database Chan Joo Lee1, Jung-Woo Son2, Jinseub Hwang3, Jaewon Oh1, Seok-Min Kang1, Dong-Ju Choi4, Byung-Su Yoo2; 1Yonsei University College of Medicine, Seoul, Republic of Korea; 2Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea; 3Daegu University, Daegu, Republic of Korea; 4Seoul National University College of Medicine, Seongnam, Republic of Korea Background: We assume that the prevalence of HF in Korea as well as western country is increasing because of mainly rapid aging of the population. However, there are limited studies on the prevalence through long-term period. The purpose of this study was to analyze the epidemiology of heart failure and to better understand comorbidities and risk factors in Korea. Methods: The study used data from 2002 to 2014 of the National Health Insurance Service that covers most Korean citizens. Heart failure was defined with International Classification of Diseases 10th revision codes. Primary outcome was composite of all-cause death and re-hospitalization due to heart failure. Multivariable Cox-regression analysis was performed to find the factors affecting the primary outcome. Results: The prevalence of heart failure was 1.42% in 2004 and steadily increased to 1.98% in 2014. From 2004 to 2014, 3,445,256 patients with heart failure occurred. The incidence of heart failure was 6.1/ 1000 person-years in 2004 and remained at similar levels, reaching 5.4/1000 personyears in 2014. In 2014, the prevalence of HF was 7.6% in subjects aged 75 years or older, while it was 7.5% and 3.6% in those aged 65-74 years and 55-64 years, respectively. The nationwide prevalence of HF in subjects aged 75 years or older increased approximately 1.3-fold, from 2002 to 2014. The factors that increase the risk of death and readmission for these patients were age, diabetes, history of MI, cerebral infarction, chronic kidney disease, and chronic liver disease. Conclusion: This study is valuable in that it describes the epidemiology of heart failure using a big-sized Korean national data. Our study shows an increase in the prevalence and provides basic clinical information of HF in Korea during decades.
identify and screen 167 potentially eligible publications through the databases. Based on our inclusion and exclusion criteria, 2 studies for a total of 558 patients were included in this analysis: one (1) prospective cohort study and (1) one retrospective cohort study. Conclusion: Non-ischemic cardiomyopathy was the leading cause of heart failure and women are predominantly affected with the caveat of not having any catheterization laboratory in the country as a diagnostic tool. Tailored multilevel interventions are needed to decrease health disparities and help in the diagnosis, classification and management of heart failure in poor resource settings like Haiti.
Incidence and prevalence of HF in studies. n: number of patients (%) Type of study
Country, Region
Malbranche prospective et al study Kwan et al. retrospective study
246 Increased eGFR Variability is Observed in Patients with HFrEF Compared to no HF or HFpEF in the Setting of Chronic Kidney Disease Aaron M. Hein1, Julia J. Scialla1,2, Linda K. Shaw2, Karen Chiswell2, Patrick H. Pun1,2, Robert J. Mentz1,2; 1Duke University Medical Center, Durham, NC; 2Duke Clinical Research Institute, Durham, NC Introduction: Patients with chronic kidney disease (CKD) with increased variability in estimated glomerular filtration rate (eGFR) have increased mortality compared to those with a stable eGFR trend. In those with CKD and heart failure (HF) with reduced (HFrEF) or preserved ejection fraction (HFpEF), who experience distinct hemodynamic and neurohormonal fluctuations, eGFR variability has not been characterized. Understanding of eGFR variability in these patients may help better understand a vulnerable population with poor outcomes. Hypothesis: eGFR variability is increased in patients with CKD and either HFrEF or HFpEF relative to patients without HF, and those with HFrEF will experience the greatest eGFR variability. Methods: A retrospective analysis of the Duke Databank for Cardiovascular Disease included participants with left ventricular ejection fraction (LVEF) data undergoing left heart catheterization from 2003-2013 with an eGFR<60 mL/min/1.73m2 as determined by the CKD-EPI equation. eGFR variability for the subsequent 24-month period was determined as the residual standard deviation (SD) from the regression line of eGFR versus time fit. eGFR variability was calculated for each individual participant who had at least 3 outpatient creatinine values, with any 2 of those outpatient creatinine values at least 3 months apart. HFrEF was defined as LVEF<40% with NYHA class II-IV symptoms, and HFpEF was defined as LVEF>40% with NYHA II-IV symptoms. Patients with no history of HF or NYHA class I symptoms were the comparator group. Associations between eGFR variability, HF phenotype, and pre-selected covariates such as age, race, and sex were analyzed using multivariable regression. Results: 4707 participants met study criteria. The median (IQR) eGFR was 45.5 (33.7, 55.3) mL/min/1.73m2, and a median of 9 (6, 15) eGFR measurements per participant were used to determine variability, resulting in a median residual SD of 6.2 (3.9, 9.2). After adjustment for covariates, the presence of HFrEF (n=1024, 22%) was associated with increased eGFR variability (b=2.03, 95% CI 1.69-2.36, p<.0001) compared to the absence of HF (n=2776, 59%), and with increased variability compared to HFpEF (n=907, 19%) (b=1.73, 95% CI 1.31-2.15, p<.0001). Patients with HFpEF had numerically increased eGFR variability relative to the absence of HF that did not meet the pre-specified threshold for statistical significance (b=0.30, 95% CI -0.05-0.65, p=0.10). Conclusions: In patients with CKD, patients with HFrEF have elevated eGFR variability compared to those without HF and those with HFpEF. Further study to better understand any effects of eGFR variability on clinical outcomes in these HF populations is warranted.
247 Heart Failure, a Growing Global Health Concern: A Systematic Review of the Epidemiology in a Poor Resource Setting Country, Haiti Michel Ibrahim1, Sandrine Lebrun2; 1Boston Medical Center, Boston, MA; 2Lenox Hill Hospital, Boston, NY Background: The epidemiology of HF (Heart Failure) has been extensively researched in the western world, its incidence and prevalence in the developing world has not been well characterized. Haiti is a one of the poorest countries in the western hemisphere and notably with a total 4 cardiologists for a population of 8 million. We report a systematic review of the evidence on the incidence and prevalence of Heart Failure and their etiologies in Haiti over the last 20 years. Our goal is to strengthen current knowledge on the epidemiology of HF in a resource poor setting. This will be helpful in making further recommendations regarding future investigations in the development of a more effective tailored approach to Haiti’s population that can very well serve in other similar settings. Methods: A systematic review in accordance with PRISMA guidelines was performed. The literature search was carried up until January 9, 2018, referring to PubMed, Medline and EMBASE. Results: We could
All Sample Setting subgroups size Male
Port-au-Prince, Urban all Haiti patients Mirebalais, Rural all Haiti patients
247 311
Female
n: 93 (37.7%) n:125 (40.2%)
n:154 (62.4%) n:186 (59.8%)
Outcomes table
Malbranche et al. Kwan et al.
Total patients
Mortality (%)
30 day re-admission
Lost to follow up
247 311
50 (20.2%) 37 (11.2%)
7(2.8%) 18(6.6%)
32 0
248 Characteristics of Incident Heart Failure over 11 Years in Korea: Analysis from National Health Insurance Database Chan Joo Lee1, Jung-Woo Son2, Jinseub Hwang3, Jaewon Oh1, Seok-Min Kang1, Dong-Ju Choi4, Byung-Su Yoo2; 1Yonsei University College of Medicine, Seoul, Republic of Korea; 2Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea; 3Daegu University, Daegu, Republic of Korea; 4Seoul National University College of Medicine, Seongnam, Republic of Korea Background: We assume that the prevalence of HF in Korea as well as western country is increasing because of mainly rapid aging of the population. However, there are limited studies on the prevalence through long-term period. The purpose of this study was to analyze the epidemiology of heart failure and to better understand comorbidities and risk factors in Korea. Methods: The study used data from 2002 to 2014 of the National Health Insurance Service that covers most Korean citizens. Heart failure was defined with International Classification of Diseases 10th revision codes. Primary outcome was composite of all-cause death and re-hospitalization due to heart failure. Multivariable Cox-regression analysis was performed to find the factors affecting the primary outcome. Results: The prevalence of heart failure was 1.42% in 2004 and steadily increased to 1.98% in 2014. From 2004 to 2014, 3,445,256 patients with heart failure occurred. The incidence of heart failure was 6.1/ 1000 person-years in 2004 and remained at similar levels, reaching 5.4/1000 personyears in 2014. In 2014, the prevalence of HF was 7.6% in subjects aged 75 years or older, while it was 7.5% and 3.6% in those aged 65-74 years and 55-64 years, respectively. The nationwide prevalence of HF in subjects aged 75 years or older increased approximately 1.3-fold, from 2002 to 2014. The factors that increase the risk of death and readmission for these patients were age, diabetes, history of MI, cerebral infarction, chronic kidney disease, and chronic liver disease. Conclusion: This study is valuable in that it describes the epidemiology of heart failure using a big-sized Korean national data. Our study shows an increase in the prevalence and provides basic clinical information of HF in Korea during decades.