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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Population-Based Epidemiology of Heart Failure in a Low-Income Country: The Haiti Cardiovascular Disease Cohort
Justin R Kingery1,2,3, Nicholas L Roberts1,2, Jean Lookens Pierre4
1Weill Cornell Medicine, New York, NY (J.R.K., N.L.R., R.P., M.S., D.F., J.W.P., M. McNairy).
Insights
Heart failure (HF) prevalence in Haiti is high at 3.2%, significantly impacting younger adults. Individuals with HF face a 7.7-fold higher risk of 1-year mortality, underscoring urgent intervention needs.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Cardiovascular disease, particularly heart failure (HF), disproportionately affects low- and middle-income countries.
- Population-based epidemiological data on HF in these regions are scarce.
- This study characterizes HF epidemiology in a population-based cohort in Haiti.
Purpose of the Study:
- To determine the age-standardized prevalence of HF.
- To identify HF subtypes, risk factors, and survival rates.
- To analyze 1-year mortality among HF patients in Haiti.
Main Methods:
- Multistage cluster-area random sampling used for participant recruitment in Port-au-Prince, Haiti.
- Standardized history, physical examination, laboratory tests, and cardiac imaging were performed on 2981 participants.
- Framingham criteria defined clinical HF; survival and risk factors were analyzed using Kaplan-Meier, Cox regression, and logistic regression.
Main Results:
- The age-standardized HF prevalence was 3.2%, with a significant increase observed in adults aged 40-49.
- HF with preserved ejection fraction was the predominant subtype (71.0%).
- Key associated factors included older age, hypertension, obesity, poverty, and renal dysfunction. One-year mortality for HF patients was 6.6% compared to 0.8% in the general population.
Conclusions:
- The 3.2% age-standardized HF prevalence in Haiti is alarmingly high, exceeding modeling estimates for similar settings.
- Adults with HF were younger and had a substantially higher 1-year mortality risk (7.7 times greater).
- Further research is crucial for resource allocation and developing targeted HF interventions to reduce global health disparities.
Background:
Cardiovascular disease disproportionately affects persons living in low- and middle-income countries and heart failure (HF) is thought to be a leading cause. Population-based studies characterizing the epidemiology of HF in these settings are lacking. We describe the age-standardized prevalence, survival, subtypes, risk factors, and 1-year mortality of HF in the population-based Haiti Cardiovascular Disease Cohort.
Methods:
Participants were recruited using multistage cluster-area random sampling in Port-au-Prince, Haiti. A total of 2981 completed standardized history and exam, laboratory measures, and cardiac imaging. Clinical HF was defined by Framingham criteria. Kaplan-Meier and Cox proportional hazard regression assessed mortality among participants with and without HF; logistic regression identified associated factors.
Results:
Among all participants, the median age was 40 years (interquartile range, 27-55), and 58.2% were female. Median follow-up was 15.4 months (interquartile range, 9-22). The age-standardized HF prevalence was 3.2% (93/2981 [95% CI, 2.6-3.9]). The average age of participants with HF was 57 years (interquartile range, 45-65), and 67.7% were female. The first significant increase in HF prevalence occurred between 30 to 39 and 40 to 49 years (1.1% versus 3.7%, P=0.003). HF with preserved ejection fraction was the most common HF subtype (71.0%). Age (adjusted odds ratio, 1.36 [1.12-1.66] per 10-year increase), hypertension (2.14 [1.26-3.66]), obesity (3.35 [95% CI, 1.99-5.62]), poverty (2.10 [1.18-3.72]), and renal dysfunction (5.42 [2.94-9.98]) were associated with HF. One-year HF mortality was 6.6% versus 0.8% (hazard ratio, 7.7 [95% CI, 2.9-20.6]; P<0.0001).
Conclusions:
The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%-5-fold higher than modeling estimates for low- and middle-income countries. Adults with HF were two decades younger and 7.7× more likely to die at 1 year compared with those in the community without HF. Further research characterizing the population burden of HF in low- and middle-income countries can guide resource allocation and development of pragmatic HF prevention and treatment interventions, ultimately reducing global cardiovascular disease health disparities.
Registration:
URL: https://www.
Clinicaltrials:
gov; Unique identifier: NCT03892265.
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