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Diagnosis and Management of Acute Heart Failure in Sub-Saharan Africa

  • Global Cardiovascular Health (GY Bukhman, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Acute heart failure (AHF) is a common emergency presentation in Sub-Saharan Africa (SSA). In the current review, we present the most recent data on the epidemiology of AHF in SSA and discuss recommended approaches to management in resource-limited settings, with a particular focus on primary and secondary facilities (e.g., health centers and district hospitals), where these patients often present.

Recent Findings

AHF in SSA is most often due to hypertension, cardiomyopathies, and rheumatic heart disease. The etiology of AHF may be different in rural as compared with urban settings. Diagnostic tools for AHF are often lacking in SSA, especially at the first-level facilities. Point-of-care ultrasound (POCUS) and biomarker tests, such as brain natriuretic peptide (BNP), offer promise in helping to mitigate diagnostic challenges. POCUS can also help distinguish among types of heart failure and prompt the correct treatment strategy. Many of the drugs and equipment commonly used to treat AHF in resource-rich settings are lacking in SSA. However, some adaptations of commonly available materials may provide temporary alternatives.

Summary

The epidemiology of AHF in SSA differs from that of high-income settings. Management of AHF at the first-level facility in SSA is an important and understudied problem. Simplified diagnostic and treatment algorithms rooted in knowledge of the local epidemiology should be developed and tested as part of broader efforts to combat cardiovascular disease in SSA.

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Authors and Affiliations

  1. Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis St., Boston, MA, 02115, USA

    Alice Kidder Bukhman, Mindy C. Lipsitz, Patricia C. Henwood & Shada A. Rouhani

  2. University Teaching Hospital of Kigali, Kigali, Rwanda

    Vizir Jean Paul Nsengimana & Damas Dukundane

  3. Point-of-Care Ultrasound in Resource Limited Environments, Boston, MA, USA

    Patricia C. Henwood & Damas Dukundane

  4. Department of Pediatrics, Faculty of Medicine, University of Botswana, Gaborone, Botswana

    Endale Tefera

  5. Partners In Health, Boston, MA, USA

    Shada A. Rouhani & Gene Y. Bukhman

  6. Divisions of Cardiovascular Medicine and Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA

    Gene Y. Bukhman

  7. Program in Global NCDs and Social Change, Harvard Medical School, Boston, MA, USA

    Gene Y. Bukhman

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  1. Alice Kidder Bukhman
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Alice Kidder Bukhman, Vizir Jean Paul Nsengimana, Mindy C. Lipsitz, Endale Tefera, Shada A. Rouhani, Damas Dukundane, and Gene Y. Bukhman declare that they have no conflict of interest.

Patricia C. Henwood reports non-financial support from Philips Healthcare, non-financial support from FujiFilm SonoSite, non-financial support from The Butterfly Network, personal fees from Global Good, and other from Point-of-care Ultrasound in Resource-limited Environments (PURE).

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Bukhman, A.K., Nsengimana, V.J.P., Lipsitz, M.C. et al. Diagnosis and Management of Acute Heart Failure in Sub-Saharan Africa. Curr Cardiol Rep 21, 120 (2019). https://doi.org/10.1007/s11886-019-1200-2

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