A Medico-Socio-Economic Analysis of TeleEKG in Ivory Coast.

Background: TeleEKG is gradually being integrated into the care offered to the most isolated Ivorian populations, however, no medico-socio-economic analysis of its impact has yet been conducted. Introduction: The aim of this study was to assess the medico-socio-economic impact of a teleEKG network in the provision of cardiology care in Ivory Coast. Methods: A retrospective study of the data transmitted by the 10 centers involved in the pilot phase of the teleEKG project from January 2015 to December 2017. Results: The average ratio between the cost to the patient of performing an electrocardiogram (EKG) according to the traditional practice and using a teleEKG was 3.8 ± 1.64. The distance avoided by the 6,045 patients was 1,074,090 km (average 177.7 km/patient). The 6,045 teleEKGs carried out over the period of the study produced a total revenue of 36,270,000 XOF (55,290 EUR) or an average revenue per site of 3,627,000 XOF (5,529 EUR). Dyspnea on exertion (22%), and hypertension (21%) were the main indications for performing the EKG, and left ventricular hypertrophy was the most common electrical anomaly detected (19.8%). Acute coronary syndrome with persistent ST segment elevation was diagnosed in 0.7% of cases (40 cases) and atrial fibrillation in 1.12% of cases (68 cases). Discussion: These results confirm the key role telemedicine can play in the treatment of heart conditions in rural populations and the economic sustainability of such telemedicine networks. Conclusions: teleEKG offers economic accessibility to cardiology care for isolated populations in Ivory Coast.

Surgical experience on chronic constrictive pericarditis in African setting: review of 35 years' experience in Cote d'Ivoire.

BACKGROUND: Surgical experience with chronic constrictive pericarditis (CCP) is rarely documented in Africa; the aim of this study is therefore to review our African experience with CCP from 1977 to 2012 in terms of clinical and surgical outcomes and risk factors of early death after pericardiectomy. METHODS: This retrospective study is related to 120 patients with CCP; there were 72 men and 48 women with an average age at 28.8±10.4 years standard deviation (SD) (8-51 years). The main etiology was tuberculosis (99%). Symptoms secondary to systemic venous congestion were always present: patient were functionally classified according New York Heart Association (NYHA) functional classification: 63 patients presented in class II NYHA and 57 in class III or IV NYHA. The diagnosis confirmed by surgical report was: sub-acute CCP (n=12; 10%), fibrous CCP (n=36; 30%), calcified CCP (n=72; 60%). A pericardiectomy including an epicardiectomy with a systematic release of the ventricles was carried out in every case. Median sternotomy was frequently performed (n=117; 97.5%). RESULTS: Fifteen early deaths (12.5%) were observed, the cause of hospital deaths was due to a low cardiac output (n=12) and to a hepatic failure (n=3). Class III or IV (NYHA) (P=0.01), mitral regurgitation (P<0.05), persistent a diastolic syndrome after surgery (P<0.05) and low cardiac index (CI) (P<0.02) were the important risk factors. Age, size of cardiac X-ray silhouette, right and left ventricular diastolic pressures, ejection fraction (EF), atrial fibrillation and pericardial calcifications had no impact on early survival. The average follow up was 4 years (1-10 years); we lost 22 patients during follow-up. Among survivors, there was no late death; the patients were in class I or II NYHA. Post-operative catheterization evaluation (n=30) shown a significant decrease of the right and left ventricular end-diastolic pressures (P<0.05), of the pulmonary capillary wedge pressure (PCWP) (P<0.05) and of the right atrial pressure (RAP) (P<0.05) and a disappearance of the lack of ventricular diastolic distensibility. CONCLUSIONS: Based on our experience, CCP surgery can be performed safely with an acceptable hospital mortality and a significant improvement of patients' functional status at long term after surgery.

Cardiac surgery in Africa: a thirty-five year experience on open heart surgery in Cote d'Ivoire.

BACKGROUND: Few centers for open heart surgery (OHS) are in Sub-Saharan Africa. Lack of OHS results is also noted. By reporting our African experience on OHS, the aim of this study was to fill the gap. METHODS: It is a retrospective study on 2,612 patients who were subject to an OHS between 1978 and 2013. Data were collected from demographical, clinical, investigative studies, surgical and outcomes parameters. RESULTS: There were 1,475 cases of rheumatic heart diseases (RHD), 126 endomyocardial fibrosis (EMF), 741 congenital heart diseases (CHDs) and 270 various affections. Related to rheumatic valvular surgery we enumerated 1,175 monovalvular (mitral n=778, aortic n=336, tricuspid n=61); 280 bivalvular (mitral + aortic n=150, mitral + tricuspid n=130) and 20 trivalvular. For RHD, average age was 26±10.1 years (4-69 years) and 60% of our patients presented a functional class III or IV according to New York Heart Association (NYHA) classification. A total of 1,481 valvular replacements (bioprostheses n=489, mechanical prostheses n=992) and 445 valvular repair were carried out with a global and late mortality surgery respectively at 7% and 8%. One hundred and twenty-six [126] cases of EMF with right sided form 39, left sided form 40, and bilateral form 47 were colligated. Average age was 12±0.6 years (2-15 years). All patients with EMF underwent surgery; an endocardectomy in all patients combined with valvular reconstruction (n=36) or valvular replacement (n=90) was carried out with a hospital mortality at 16% (n=20). Concerning CHD, the most frequent were ventricular septal defect (VSD) (n=240), atrial septal defect (ASD) (n=200), partial atrio-ventricular sepal defect (n=30) and tetralogy of Fallot (T4F) (n=220), a total correction was performed for those CHD with an early mortality at 6.4% (n=44). CONCLUSIONS: OHS in Cote d'Ivoire was successfully performed in most of our patients, the spectrum of acquired valvular heart diseases and CHDs in our country is similar to others in Sub-Saharan Africa.