Burden, predictors and short-term outcomes of peripartum cardiomyopathy in a black African cohort.

BACKGROUND: Peripartum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with acute heart failure during the peripartum period. It is common in patients of African ancestry. Currently, there is paucity of data on the burden, predictors and outcomes of PPCM in Uganda. This study aimed to investigate the prevalence, predictors and six-month outcomes of PPCM in an adult cohort attending a tertiary specialised cardiology centre in Kampala, Uganda. METHODS: This study consecutively enrolled 236 women presenting with features of acute heart failure in the peripartum period. Clinical evaluation and echocardiography were performed on all the enrolled women. PCCM was defined according to recommendations of the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Poor outcome at six months of follow-up was defined as presence of any of the following: death of a mother or her baby, New York Heart Association (NYHA) functional class III-IV or failure to achieve complete recovery of left ventricular function (left ventricular ejection fraction ≤55%). RESULTS: The median age, BMI and parity of the study participants was 31.5 (25.5-38.0) years, 28.3 (26.4-29.7) and 3 (2-4) respectively. The prevalence of PPCM was 17.4% (n = 41/236). Multiple pregnancy was the only predictor of PPCM in this study population (OR 4.3 95% CI 1.16-16.05, p = 0.029). Poor outcome at six-months was observed in about 54% of the patients with PPCM (n = 4, 9.8% in NYHA functional class III-IV and n = 22, 53.7% with LVEF <55%). No maternal or foetal mortality was documented. CONCLUSION: PPCM is relatively common in Uganda and is associated with multiple pregnancy. Poor outcomes especially absence of complete recovery of left ventricular function are also common. Large studies to further investigate long-term maternal and foetal outcomes in Uganda are justified.

Prevalence and characteristics of primary left-sided valve disease in a cohort of 15,000 patients undergoing echocardiography studies in a tertiary hospital in Uganda.

BACKGROUND: Although rheumatic heart disease remains the leading cause of valve heart disease (VHD) in developing countries, other forms of valve disease have been over shadowed and not regarded as a public health problem. However, several facts suggest that the role of non-rheumatic VHD as a significant cardiovascular disease should be reconsidered. We aimed to assess the prevalence and characteristics of different forms of primary left sided valve diseases from a series of 15,009 echocardiographic studies. METHODS: This was a retrospective review of echocardiographic reports for studies performed between January 2012 and December 2013 (24 months) at Uganda Heart Institute. All patients with primary left-sided valve disease were classified into one of five major diagnostic categories and in each diagnostic category; patients were sub-classified into stages A-D of primary valve disease as defined by the American College of Cardiology. RESULTS: Three thousand five hundred eighty-two echocardiography reports qualified for final data analysis. The "sclerotic valve changes with normal valve function", a Stage A sub-class of "degenerative valve disease" overwhelmingly overshadowed all the other diagnostic categories in this stage. "Rheumatic Heart Disease", "Degenerative Valve Disease", "Bicuspid Aortic Valve", "Mitral Valve Prolapse" and "Endomyocardial Fibrosis" diagnostic categories accounted for 53.0%, 41.8%, 2.2%, 1.4% and 1.7% respectively in stages B-D of primary VHD. Rheumatic heart disease disproportionately affected the young, productive age groups. It was the major risk factor for infective endocarditis; and was the indication for valve surgery in 44 of 50 patients who had undergone valve replacement procedures. CONCLUSIONS: We acknowledge that rheumatic heart disease remains a leading cause of progressive and severe primary left-sided valve disease among young adults in Uganda. But we bring to light the contemporary footprints of other forms of primary valve disease that require coordinated multidisciplinary approach to research, education and clinical management to ensure improved patient outcomes.

The Health Systems Barriers and Facilitators for RHD Prevalence: An Epidemiological Meta-Analysis From Uganda and Tanzania.

BACKGROUND: Rheumatic heart disease (RHD) is an important and preventable cause of cardiovascular disease. OBJECTIVES: As part of a recent RHD initiative in Uganda and Tanzania, we systematically reviewed group A streptococcal disease (GAS), acute rheumatic fever (ARF), and RHD in these countries. METHODS: Using a systematic review and meta-analysis/meta-synthesis, we searched PubMed, Embase, and grey literature for quantitative and qualitative studies conducted in Uganda and Tanzania that included individuals affected by GAS, ARF, and RHD. We pre-specified 3 sets of outcomes: 1) disease epidemiology; 2) barriers and facilitators to health care; and 3) stakeholder identification and engagement. Study descriptors, outcomes, and interest, and quality assessments were recorded. For the first objective, we conducted random-effects meta-analyses. For the second objective, we produced a narrative synthesis of themes. No studies contained data on the third objective. RESULTS: Of 293 records identified, 12 met our inclusion criteria (9 for objective 1 and 3 for objective 2). Most quantitative studies were at moderate or high risk of bias, and only 1 of 2 qualitative studies was high quality. We estimated the prevalence of RHD to be 17.9 (95% confidence interval [CI]: 4.0 to 41.2) per 1,000 individuals. The most frequent nonfatal sequelae were heart failure, pulmonary hypertension, and atrial fibrillation. Case-fatality rates in medical and surgical wards were 17% (95% CI: 13% to 21%) and 27% (95% CI: 18% to 36%), respectively. Barriers and facilitators to GAS and RHD care were identified in the domains of individual knowledge, family support, provider communication and knowledge, and system design. CONCLUSIONS: RHD remains endemic in Tanzania and Uganda, and symptomatic RHD is associated with high rates of morbidity and mortality. We have identified critical data gaps in the areas of GAS and ARF epidemiology as well as health care utilization patterns and their determinants.