Faculty of Medicine, Institute of Health and Society

Transcription

1 Faculty of Medicine, Institute of Health and Society Tsegay Tewele, PhD candidate 1 Project Title: Chronic heart failure: Anemia, Patient Perceived Burden of Treatment and Adherence to Iron Intake Pattern and Relation with Anemia in Oromia Region, Ethiopia

2 2 Outlines of Presentation Rationale Project objective Methods Study plan & Progress References

3 3 Rationale 72% deaths globally,noncommunicable diseases (NCD) in 2016 (GBD result tool `GHDx) Near to 80% of deaths occur in LMICs Cardiovascular diseases (CVD), leading causes of death (32%) in 2016 (GBD result tool `GHDx) Chronic Heart failure (CHF) is the consequences of CVD

4 4 Rationale Anemia is most common co morbid condition linked with CHF(Al-Ahmad et al., 2001; McClellan, Flanders, Langston, Jurkovitz, & Presley, 2002; Okonko & Anker, 2004) In sub-saharan Africa, it ranges from 6 to 64% (Horwich, Fonarow, Hamilton, MacLellan, & Borenstein, 2002) Death, repeated hospitalization, lose of productivity & poor quality of life Economic burden In Ethiopia, 42% of CHF had anemia (Abebe, Gebreyohannes, Bhagavathula, Tefera, & Abegaz, 2017) Consquences of anemia:

5 5 Rationale Iron supplementation is reccomended as crucial intervention (Cavill, 2003; Mancini et al., 2003, McMurray et al., 2012) However, anemia remains high o due to low prescription, poor absorption and adherence (Bansilal, Castellano, & Fuster, 2015; Yancy et al., 2013; Yusuf et al., 2011, Palleschi & Nunziata, 2017) Efforts were made: To identify facilitators for poor adherence & Implement self-care programs Despite the efforts, however, anemia still remains high (Abebe et al., 2017; Horwich et al., 2002) This could be due to: Multiple medications (pill burden) patient s perception towards- pill burden (burden of medication)

6 6 Rationale

7 7 Rationale However, relationship of patient s perceived burden of medication with: o Adeherence to iron intake & Anemia is not still uncoverd Therefore the aim of this project is to determine: o o o Prevalence of anemia in CHF Growth patern of patient s percieved burden of treatment and adherence to iron intake Relationship of patient s percieved burden of medication with adherence and anemia

8 8 Methods.setting, design, population The study will be done in referral hospitals in Oromia region, Ethiopia Multi-methods (cross sectional and cohort study) will be used sample- Cross sectional-anemia Cohort (longitudinal)-other aims Phase I(cross sectional) & II (cohort) Population-cross sectional study newly diagnosed HF adults Population-cohort newly diagnosed HF anemic adults willing to take iron 395 HF adults-cross sectional 783 HF adults-cohort Oromia-referral hospitals 30% -HF adults SRS

9 9 Methods measurement, analysis and ethics Primary outcome-anemia 0, 4, 6 m Secondary outcomeadherence 2,4, 6m Exposure-perception 0,2,4,6m Covariates-other confounders 0m Follow up duration-6 months Data analysis-descriptive and Generalized Estimation Equation (GEE) Ethics-writen informed concentsought

10 10 Study plan & progress

11 11 Acknowelgment I would like to thank: My supervisors Project coordinators SACCADE Project UiO, Helsam JU Collegues

12 12

13 13 References Abebe, T. B., Gebreyohannes, E. A., Bhagavathula, A. S., Tefera, Y. G., & Abegaz, T. M. (2017). Anemia in severe heart failure patients: does it predict prognosis? BMC Cardiovascular Disorders, 17(1), Al-Ahmad, A., Rand, W. M., Manjunath, G., Konstam, M. A., Salem, D. N., Levey, A. S., & Sarnak, M. J. (2001). Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. Journal of the American College of Cardiology, 38(4), Bansilal, S., Castellano, J. M., & Fuster, V. (2015). Global burden of CVD: focus on secondary prevention of cardiovascular disease. International Journal of Cardiology, 201 Suppl 1, S Cavill, I. (2003). Intravenous iron as adjuvant therapy: a two-edged sword? Nephrology, Dialysis, Transplantation: Official Publication of the European Dialysis and Transplant Association - European Renal Association, 18 Suppl 8, viii Global Burden of Disease Collaborative Network. (n.d.). GBD Results Tool GHDx. Retrieved June 4, 2018, from Horwich, T. B., Fonarow, G. C., Hamilton, M. A., MacLellan, W. R., & Borenstein, J. (2002). Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. Journal of the American College of Cardiology, 39(11), Mancini, D. M., Katz, S. D., Lang, C. C., LaManca, J., Hudaihed, A., & Androne, A.-S. (2003). Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure. Circulation, 107(2),

14 14 Ref McClellan, W. M., Flanders, W. D., Langston, R. D., Jurkovitz, C., & Presley, R. (2002). Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. Journal of the American Society of Nephrology: JASN, 13(7), McMurray, J. J. V., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ESC Committee for Practice Guidelines. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal, 33(14), Okonko, D. O., & Anker, S. D. (2004). Anemia in chronic heart failure: pathogenetic mechanisms. Journal of Cardiac Failure, 10(1 Suppl), S5-9. Palleschi, L., & Nunziata, E. (2017). Iron deficiency and iron deficiency anaemia in elderly patients with chronic heart failure. Geriatric Care, 3(4). Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., American Heart Association Task Force on Practice Guidelines. (2013) ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 62(16), e Yusuf, S., Islam, S., Chow, C. K., Rangarajan, S., Dagenais, G., Diaz, R., Prospective Urban Rural Epidemiology (PURE) Study Investigators. (2011). Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet (London, England), 378(9798),