Abstract 233: Diagnostic and Treatment Capacity for Heart Failure in Sub-Saharan Africa: an Analysis of Uganda and Kenya

Abstract

Background: There is increasing recognition that heart failure is a significant component of disease burden in Sub-Saharan Africa (SSA) and that better strategies for heart failure management are needed. However, relatively little is known about the capacity to diagnose and treat heart failure in this region. Objectives: In this study, we seek to better understand the health system’s capacity to diagnose and treat heart failure in Uganda and Kenya, in order to inform policy planning and interventions. Methods: We analyzed data from a nationally-representative survey of health facilities in Uganda and Kenya, conducted by the Institute for Health Metrics and Evaluation (IHME) as part of the Access, Bottlenecks, Costs, and Equity (ABCE) project. A structured survey instrument was administered at each facility between 2011 and 2012. In this study we examine the availability of cardiac diagnostic technologies, medications for heart failure, and emergency transportation to an inpatient facility. A package of medications for heart failure with reduced ejection fraction (HFrEF) was defined from local formulary guidelines as including beta-blocker (propranolol or atenolol), ACE inhibitor (captopril or lisinopril), and furosemide. Facility-level data was analyzed by platform type (hospital vs health center), ownership (public vs private), inpatient care availability, and location (urban, semi-urban, or rural). Results: We analyzed 197 health facilities in Uganda and 143 in Kenya after excluding dispensaries, pharmacies, and HIV counseling centers. Among facilities responding to this survey question, functional and staffed ECG was available in 24% of facilitiesin Uganda and 36% of facilities in Kenya. However, this survey question was left unanswered by approximately 70% of the facilities in each country. In regards to treatment capabilities, 37% of Ugandan and 24% of Kenyan facilities reported availability of a basic package of heart failure medications on the day the survey was administered. This was driven predominantly by the low availability of ACE inhibitors, which were available in only 41% of Ugandan and 29% of Kenyan facilities. Of the facilities with medication availability, 26% of Ugandan and 32% of Kenyan facilities had a significant stock out (8+ days) of at least one of the medications in the prior quarter. Of the facilities that did not offer inpatient care, 41% of Ugandan and 66% of Kenyan facilities were prepared for emergency transportation. Conclusion: Few facilities in Uganda and Kenya were prepared to perform necessary tests to diagnose and manage heart failure. Less than half of the facilities in both countries had the medications needed to treat HFrEF. Further investment in cardiac care will be required by these developing health systems if they are to address the growing burden of heart failure.