title: Descriptive epidemiology and short-term outcomes of heart failure hospitalisation in rural Haiti.
abstract: OBJECTIVE
  There is increasing attention to cardiovascular diseases in low-income countries. However, little is known about heart failure (HF) in rural areas, where most of the populations in low-income countries live. We studied HF epidemiology, care delivery and outcomes in rural Haiti.
  
  
  METHODS
  Among adults admitted with HF to a rural Haitian tertiary care hospital during a 12-month period (2013-2014), we studied the clinical characteristics and short-term outcomes including length of stay, inhospital death and outpatient follow-up rates.
  
  
  RESULTS
  HF accounted for 392/1049 (37%) admissions involving 311 individuals; over half (60%) were women. Mean age was 58.8 (SD 16.2) years for men and 48.3 (SD 18.8) years for women; 76 (41%) women were <40 years of age. Median length of stay was 10 days (first and second quartiles 7, 17), and inhospital mortality was 12% (n=37). Ninety nine (36%) of the 274 who survived their primary hospitalisation followed-up at the hospital's outpatient clinic, and 18 (6.6%) were readmitted to the same hospital within 30 days postdischarge. Decreased known follow-up (p<0.01) and readmissions (p=0.03) were associated with increased distance between patient residence and hospital. Among the one-quarter (81) patients with echocardiograms, causes of HF included: non-ischaemic cardiomyopathy (64%), right HF (12%), hypertensive heart disease (7%) and rheumatic heart disease (5%). One-half of the women with cardiomyopathy by echocardiogram had peripartum cardiomyopathy.
  
  
  CONCLUSIONS
  HF is a common cause of hospitalisation in rural Haiti. Among diagnosed patients, HF is overwhelming due to non-atherosclerotic heart disease and particularly affects young adults. Implementing effective systems to improve HF diagnosis and linkage to essential outpatient care is needed to reduce long-term morbidity and mortality.
authors.affiliation: Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA Partners In Health, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Gene F
authors.identifier: http://orcid.org/0000-0002-0929-6800
authors.initials: GF
authors.lastname: Kwan
authors.affiliation: Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.
authors.forename: Waking
authors.initials: W
authors.lastname: Jean-Baptiste
authors.affiliation: Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.
authors.forename: Philip
authors.initials: P
authors.lastname: Cleophat
authors.affiliation: Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.
authors.forename: Fèrnet
authors.initials: F
authors.lastname: Leandre
authors.affiliation: Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.
authors.forename: Martineau
authors.initials: M
authors.lastname: Louine
authors.affiliation: Zanmi Lasante and Hôpital Universitaire de Mirebalais, Mirebalais, Haiti.
authors.forename: Maxo
authors.initials: M
authors.lastname: Luma
authors.affiliation: Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.affiliation: Partners In Health, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Joia S
authors.initials: JS
authors.lastname: Mukherjee
authors.affiliation: Partners In Health, Boston, Massachusetts, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Gene
authors.initials: G
authors.lastname: Bukhman
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA Ariadne Labs, Boston, Massachusetts, USA.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006205:Haiti / Q000453:epidemiology; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data