title: Cardiac surgery for patients with heart failure due to structural heart disease in Uganda: access to surgery and outcomes.
abstract: OBJECTIVE
  Few data are available on heart failure (HF) in sub-Saharan Africa. We aimed to provide a current picture of HF aetiologies in urban Uganda, access to heart surgery, and outcomes.
  
  
  METHODS
  We prospectively collected clinical and echocardiographic data from 272 consecutive patients referred for suspected heart disease to a tertiary hospital in Kampala during seven non-governmental organisation (NGO) missions from 2009 to 2013. We focused the analysis on 140 patients who fulfilled standardised criteria of HF by echocardiography.
  
  
  RESULTS
  Rheumatic heart disease (RHD) was the leading cause of HF in 44 (31%) patients. Among the 50 children included (age ≤ 16 years), congenital heart disease (CHD) was the first cause of HF (30 patients, 60%), followed by RHD (16 patients, 32%). RHD was the main cause of HF (30%) among the 90 adults. All 85 patients with RHD and CHD presented with an indication for heart surgery, of which 74 patients were deemed fit for intervention. Surgery was scheduled in 38 patients with RHD [86%, median age 19 years (IQR: 12-31)] and in 36 patients with CHD [88%, median age 4 years (IQR 1-5)]. Twenty-seven candidates (32%) were operated on after a median waiting time of 10 months (IQR 6-21). Sixteen (19%) had died after a median of 38 months (IQR 5-52); 19 (22%) were lost to follow up.
  
  
  CONCLUSIONS
  RHD still represents the leading cause of HF in Uganda, in spite of cost-efficient prevention strategies. The majority of surgical candidates, albeit young, do not have access to treatment and present high mortality rates.
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy. grimaldi.antonio@hsr.it.
authors: Antonio
authors: A
authors: Grimaldi
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy.
authors: Enrico
authors: E
authors: Ammirati
authors: Paris Cardiovascular Research Centre, INSERM U970, Paris, France.
authors: Nicole
authors: N
authors: Karam
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy.
authors: Anna Chiara
authors: AC
authors: Vermi
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda.
authors: Annalisa
authors: A
authors: de Concilio
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda.
authors: Giorgio
authors: G
authors: Trucco
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda.
authors: Francesco
authors: F
authors: Aloi
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy.
authors: Francesco
authors: F
authors: Arioli
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy.
authors: Filippo
authors: F
authors: Figini
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy.
authors: Santo
authors: S
authors: Ferrarello
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy.
authors: Francesco Maria
authors: FM
authors: Sacco
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda.
authors: Renato
authors: R
authors: Grottola
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda.
authors: Paul G
authors: PG
authors: D'Arbela
authors: Cardiovascular and Thoracic Department, San Raffaele Hospital, Milan, Italy.
authors: Ottavio
authors: O
authors: Alfieri
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Paris Cardiovascular Research Centre, INSERM U970, Paris, France.
authors: Eloi
authors: E
authors: Marijon
authors: Division of Cardiology, Department of Medicine, Makerere University, Kampala, Uganda.
authors: Juergen
authors: J
authors: Freers
authors: St Raphael of St Francis, Nsambya Hospital, Kampala, Uganda; Paris Cardiovascular Research Centre, INSERM U970, Paris, France.
authors: Mariana
authors: M
authors: Mirabel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D004719:Endomyocardial Fibrosis / Q000150:complications / Q000601:surgery; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007223:Infant; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000601:surgery*; D062606:Tertiary Care Centers; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult