title: Prevalence of erectile dysfunction in systolic heart failure patients in a developing country: Tbilisi, Georgia, Eastern Europe.
abstract: BACKGROUND
  In the past decade, there has been an increasing amount of published information regarding erectile dysfunction (ED) and heart failure (HF) in economically advanced, westernized populations. However, there is a paucity of data regarding ED and HF in developing countries. The country of Georgia is categorized as a lower-middle-income country (LMIC) with an emerging and developing economy.
  
  
  OBJECTIVE
  To examine the prevalence of ED in patients with HF from a developing and LMIC and assess the association with depression.
  
  
  METHODS
  We conducted an observational, cross-sectional study that included male patients 18 years of age or older with an ejection fraction ≤40% by echocardiogram in a heart failure disease management program in Tbilisi, Georgia. The Sexual Health Inventory for Men (SHIM) survey was used to categorize men according to degree of ED. Baseline clinical characteristics known to be associated with ED, such as New York Heart Association functional classification, were also documented.
  
  
  METHODS
  The SHIM survey and the nine-question Patient Health Questionnaire.
  
  
  RESULTS
  The prevalence of ED was found to be 61.7%. Patients with ED were generally older, had more peripheral vascular disease, and had greater levels of depression than those without ED.
  
  
  CONCLUSIONS
  There is a high prevalence of ED in patients with HF living in Tbilisi, Georgia. In comparison to previously published data on HF populations, our Georgian population showed lesser degrees of ED. More research is needed to better explain the causality for lower prevalence of ED, but explanations may include lower degrees of diabetes and aspects of treatment such as beta-blocker medication. Health care providers in LMICs should screen all of their male HF patients for ED and provide appropriate therapy.
authors.affiliation: Department of Cardiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA. khebert1@gmail.com
authors.forename: Kathy
authors.initials: K
authors.lastname: Hebert
authors.forename: Jatin
authors.initials: J
authors.lastname: Anand
authors.forename: Pat
authors.initials: P
authors.lastname: Trahan
authors.forename: Maria
authors.initials: M
authors.lastname: Delgado
authors.forename: Joseph
authors.initials: J
authors.lastname: Greene
authors.forename: Elyse
authors.initials: E
authors.lastname: Julian
authors.forename: Jason
authors.initials: J
authors.lastname: Cuomo
authors.forename: Ilia
authors.initials: I
authors.lastname: Gogichaishvili
authors.forename: Nino
authors.initials: N
authors.lastname: Nozadze
authors.forename: Andre
authors.initials: A
authors.lastname: Dias
authors.forename: Lee
authors.initials: L
authors.lastname: Arcement
mesh_terms: D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D003906:Developing Countries; D007172:Erectile Dysfunction / Q000453:epidemiology*; D005846:Georgia (Republic) / Q000453:epidemiology; D054143:Heart Failure, Systolic / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D015995:Prevalence; D011795:Surveys and Questionnaires