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The reality of heart failure in Latin America
Edimar Alcides Bocchi1, Alexandra Arias, Hugo Verdejo
1Heart Institute (InCor) of São Paulo University Medical School, São Paulo, Brazil. dcledimar@incor.usp.br
Insights
Latin America faces a dual burden of heart failure (HF) risk factors and unique etiologies like Chagas
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Heart failure (HF) epidemiology and health service provision in Latin America (LA) are not well understood.
- LA countries exhibit lower gross national income and health expenditure per capita.
- HF risk factors in LA include those found in developed and developing nations, with higher prevalence of systemic hypertension (SH), rheumatic fever, and Chagas' disease (C'D).
Purpose of the Study:
- To review heart failure data in Latin America to inform health service planning.
- To delineate HF epidemiology and assess the adequacy of health services in LA.
Main Methods:
- Systematic search of electronic databases and the World Health Organization website for HF data in LA.
- Analysis of HF risk factors, etiologies, and outcomes in the Latin American region.
Main Results:
- Key HF etiologies in LA include idiopathic dilated cardiomyopathy, C'D, ischemic heart disease, SH, valvular disease, and alcohol-related causes.
- Systemic hypertension (SH) and Chagas' disease (C'D) are significant contributors to HF in LA.
- The prognosis for C'D-related HF is poorer than for other etiologies; decompensated HF is a primary cause of cardiovascular hospitalization.
Conclusions:
- Latin America faces a unique challenge with HF, combining risk factors of developed nations with prevalent SH, C'D, and rheumatic fever.
- Lower economic resources necessitate novel strategies for effective HF prevention and treatment in LA.
- Urgent development of new strategies is essential for managing the growing burden of heart failure in Latin America.
Abstract:
Heart failure (HF) data in Latin America (LA) were reviewed to guide health service planning in the prevention and treatment of HF. The HF epidemiology and the adequacy of relevant health service provision related to HF in LA are not well delineated. A systematic search of the electronic databases and the World Health Organization website was undertaken for HF in LA. LA countries have reduced gross income and lower total expenditure on health per capita. LA is a heterogeneous region with HF risk factors of developed and nondeveloped countries, including lower risk of raised blood glucose levels, obesity, tobacco, and aging, whereas systemic hypertension (SH), rheumatic fever, and Chagas' disease (C'D) are higher in LA. Main etiologies of HF in LA are idiopathic dilated cardiomyopathy (from 1.3% to 37%), C'D (from 1.3% to 21%), ischemic (from 68% to 17%), SH (from 14% to 76%), valvular (from 3% to 22%), and alcohol related (from 1.1% to 8%). The prognosis of C'D HF is worse than for other etiologies. Chronic HF is the cause of death in 6.3% of cases. Decompensated HF is the main cause of cardiovascular hospitalization. The prevalence of systolic HF varies from 64% to 69%. LA is under the awful paradox of having the HF risk factors and HF epidemiology of developed countries with the added factors of SH, C'D, and rheumatic fever. Overall, in the scenario of lower total expenditure on health per capita and lower gross national income per capita, new strategies are essential for prevention and treatment of HF in LA.
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