10-Year Heart Failure Outcomes From Nurse-Driven Clinics in Rural Sub-Saharan Africa

J Am Coll Cardiol. 2019 Mar 5;73(8):977-980. doi: 10.1016/j.jacc.2018.12.028.


Nurse-led delivery care models have the potential to address the significant burden of heart failure in sub-Saharan Africa. Starting in 2006, the Rwandan Ministry of Health, supported by Inshuti Mu Buzima (Partners In Health-Rwanda), decentralized heart failure diagnosis and care delivery in the context of advanced nurse-led integrated noncommunicable clinics at rural district hospitals. Here, the authors describe the first medium-term survival outcomes from the district level in rural sub-Saharan Africa based on their 10-year experience providing care in rural Rwanda. Kaplan-Meier methods were used to determine median time to event for: 1) composite event of known death from any cause, lost to follow-up, or transfer to estimate worst-case mortality; and 2) known death only. Five-year event-free rates were 41.7% for the composite outcome and 64.3% for known death. While death rates are encouraging, efforts to reduce loss to follow-up are needed.

Keywords: Sub-Saharan Africa; heart failure; integrated care delivery; outcomes; survival analysis.

Publication types

  • Review

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Delivery of Health Care / methods*
  • Heart Failure / epidemiology
  • Heart Failure / nursing*
  • Hospitals, District*
  • Humans
  • Morbidity / trends
  • Practice Patterns, Nurses'*
  • Rural Population*