马拉维Neno的分散的心力衰竭管理,马拉维
Bright G D Mailosi1, Todd Ruderman1, Sheila L Klassen2,3,4
1Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi.
Global heart
|June 19, 2023
概括
在马拉维农村地区,非医生提供者成功地使用聚焦心脏超声波 (FOCUS) 来诊断和管理心力衰竭 (HF),改善患者的治疗结果. 这种模式显示出在资源有限的非洲环境中扩大医疗保健准入的前景.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 全球健康 全球健康
背景情况:
- 心血管疾病 (CVD) 是马拉维的主要死亡原因.
- 马拉维农村地区的心力衰竭 (HF) 护理很少,主要由非医生管理.
- 在非洲农村人口中,高风的具体原因和患者结局在很大程度上仍未被描述.
研究的目的:
- 描述马拉维农村环境中的临床特征,高频率诊断类别和患者结果.
- 评估非医生提供者用于HF诊断和管理的聚焦心脏超声波 (FOCUS) 的有效性.
- 评估这种护理模式对患者症状和临床状况的影响.
主要方法:
- 2018年11月至2021年3月,非医生医疗保健提供者在马拉维Neno的一家门诊慢性病诊所使用FOCUS进行HF诊断和纵向随访.
- 一个回顾性图表审查分析了HF诊断类别,临床状态的变化和结果.
- 心脏病学家审查了所有可用的超声波图像,以确认诊断.
主要成果:
- 该研究包括178名患有HF的患者 (平均年龄67岁,58%为女性),平均随访时间为11.5个月;78%的人还活着,正在接受护理.
- 高血压心脏病 (36%),心肌病 (26%),以及类风湿性/膜性/先天性心脏病 (12.3%) 是超声波检测发现的最常见的HF原因.
- 在随访时,纽约心脏协会 (NYHA) I类患者的比例显著从24%增加到50% (p < 0.001),流体过载和疲劳的症状减少.
结论:
- 高血压性心脏病和心肌病是马拉维农村老年人群中高血压的主要驱动因素.
- 经过培训的非医生提供者可以有效地管理HF,从而在资源有限的环境中改善症状和临床结果.
- 这种护理模式提供了一个可扩展的解决方案,以提高其他非洲农村地区的HF患者的医疗保健可访问性.
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