Meeting the Challenge of Cardiovascular Disease in Africa

Transcription

1 Global Health Lecture Series 22 April 2015 Meeting the Challenge of Cardiovascular Disease in Africa Ed Havranek, MD Denver Health Medical Center University of Colorado School of Medicine

2 Acknowledgments Zimbabwe: James Hakim, Jonathan Matenga Colorado: Tom Campbell, Larry Allen, Tom Maddox, Joe Schuller, David Katz, David Kao, Dan Bessesen, Alex Benson

3 Medical Education Partnership Initiative (MEPI) Ethiopia Nigeria Uganda Zambia Botswana Kenya Tanzania Mozambique Zimbabwe South Africa

4 Figure 7 Regions sized by burden of disease Regions sized by healthcare workforce The Lancet 2010; 376:

5 Zimbabwe Historical Context The British Empire Rhodesia Robert Mugabe

6 Zimbabwe Historical Context 2000 Land redistribution begins. Inflation Economic downturn accelerates Contested election. Power sharing Hyperinflation. Cholera epidemic Zimbabwean dollar withdrawn

7 Zimbabwe Historical Context First 10 Medical Schools Senegal 1918 South Africa Uganda 1923 Nigeria 1948 Cote d Ivoire 1962 Zimbabwe 1963 Angola 1963 Adult Literacy Rates Zimbabwe 84.5% Lesotho 79.4% Cameroon 62.5% Uganda 58.4% Nigeria 54.9% Benin 32.6% Burkina Faso 17.6% Niger 13.2%

8 CHF, HTN, RHD Initiative Strategy (CHRIS) Statement of the Problem 2010 Cardiology manpower and infrastructure in Zimbabwe severely limited medical school faculty shortage (vacancy rate >60%) 2 physicians with advanced training in cardiology no invasive cardiology or open heart surgery. Non communicable disease is highly prevalent in southern Africa

9 Contribution of Changes in Population Growth, Population Aging, and Rates of Age-Specific Cardiovascular Death to Changes in Cardiovascular Mortality, Roth GA et al. N Engl J Med 2015;372:

10 Contribution of Changes in Population Growth, Population Aging, and Rates of Age-Specific Cardiovascular Death to Changes in Cardiovascular Mortality, Roth GA et al. N Engl J Med 2015;372:

11 Clinical Epidemiology 1 st 10 general medical admissions 4/7/15 Age Gender Diagnosis Underlying Condition(s) 1 42 M Stroke Hypertension 2 24 F GI Bleed Jaundice/hepatitis 3 46 F Subacute meningitis HIV, DM 4 79 F Heart failure Hypertension 5 36 M Nephrotic syndrome HIV 6 33 F Dyspnea at rest 2 wks post partum 7 40 M Mitral stenosis, new AF HIV 8 59 M Myocardial infarction Hypertension 9 20 F? sepsis HIV M TTP HIV

12 Clinical Epidemiology 1 st 10 general medical admissions 4/7/15 Age Gender Diagnosis Underlying Condition(s) 1 42 M Stroke Hypertension 2 24 F GI Bleed Jaundice/hepatitis 3 46 F Subacute meningitis HIV, DM 4 79 F Heart failure Hypertension 5 36 M Nephrotic syndrome HIV 6 33 F Dyspnea at rest 2 wks post partum 7 40 M Mitral stenosis, new AF HIV 8 59 M Myocardial infarction Hypertension 9 20 F? sepsis HIV M TTP HIV

13 Cardiovascular Disease in Zimbabwe Uncontrolled hypertension Hypertensive heart disease Stroke Peripartum Cardiomyopathy 1:1000 in South Africa, 1:4000 in US 1 Rheumatic heart disease Global annual mortality 233k (HIV 1.5M) 2 1 Sliwa et al. Lancet 2006; 368: Essop et al. Circ 2014; 130: 2181

14 Cardiology Education in Zimbabwe More intensive mentoring of selected postgraduates Clinical skills Research skills

15 Cardiology Education in Zimbabwe Objective: develop a small group of junior faculty with basic region specific qualifications in cardiology Methods: 1 month rotation in Cape Town 2 week attachment in Denver Didactic and clinical teaching from visiting faculty 8 wks/yr Completion of a clinical/outcomes research project in cardiology Concentrated exposure to cardiology inpts/outpts Teaching skills workshops

16 Cardiology Education in Zimbabwe Clinical skills Echocardiography ECG and arrhythmia detection Pacemaker implantation Outpatient management

17 Cardiology Education in Zimbabwe Research skills Patient registries o Inpatient stroke o Pediatric RHD o Peripartum cardiomyopathy o Inpatient CHF 30 d mortality Atrial fibrillation Ventricular arrhythmias Surveys o Rheumatic heart disease in schoolchildren

18 Cardiology Education in Zimbabwe Cardiovascular physiology lectures for 2d year medical students

19 Cardiology Education in Zimbabwe Clinical cardiology lectures for 5 th year medical students

20 Cardiology Education in Zimbabwe Outcomes to date PG Pediatric cardiology Senior registrar. 1 yr fellowship in SA July GF Adult cardiology Lecturer in medicine. Pacemaker implantation. AM Adult neurology Senior registrar. Lecturer in EG Adult cardiology Registrar. CM Adult cardiology Registrar. TZ Adult cardiology Registrar. TC Adult cardiology MMed GM Endocrine/diabetes MMed GJ Endocrine/diabetes MMed FM Adult Pulmonary MMed EM Adult Pulmonary MMed

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