{"doi":"10.5334/gh.1210","title":"Decentralized Heart Failure Management in Neno, Malawi","abstract":"Background: Cardiovascular disease (CVD) is a major cause of death in Malawi. In rural districts, heart failure (HF) care is limited and provided by non-physicians. The causes and patient outcomes of HF in rural Africa are largely unknown. In our study, non-physician providers performed focused cardiac ultrasound (FOCUS) for HF diagnosis and longitudinal clinical follow-up in Neno, Malawi. Objectives: We described the clinical characteristics, HF categories, and outcomes of patients presenting with HF in chronic care clinics in Neno, Malawi. Methods: Between November 2018 and March 2021, non-physician providers performed FOCUS for diagnosis and longitudinal follow-up in an outpatient chronic disease clinic in rural Malawi. A retrospective chart review was performed for HF diagnostic categories, change in clinical status between enrollment and follow-up, and clinical outcomes. For study purposes, cardiologists reviewed all available ultrasound images. Results: There were 178 patients with HF, a median age of 67 years (IQR 44 - 75), and 103 (58%) women. During the study period, patients were enrolled for a mean of 11.5 months (IQR 5.1-16.5), after which 139 (78%) were alive and in care. The most common diagnostic categories by cardiac ultrasound were hypertensive heart disease (36%), cardiomyopathy (26%), and rheumatic, valvular or congenital heart disease (12.3%).At follow-up, the proportion of New York Heart Association (NYHA) class I patients increased from 24% to 50% (p < 0.001; 95% CI: 31.5 - 16.4), and symptoms of orthopnea, edema, fatigue, hypervolemia, and bibasilar crackles all decreased (p < 0.05). Conclusion: Hypertensive heart disease and cardiomyopathy are the predominant causes of HF in this elderly cohort in rural Malawi. Trained non-physician providers can successfully manage HF to improve symptoms and clinical outcomes in limited resource areas. Similar care models could improve healthcare access in other rural African settings.","journal":"Global Heart","year":2023,"id":360806,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":9,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7754,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1112604,"name":"Todd Ruderman","orcid":"0000-0002-6355-1649","position":1,"is_corresponding":false},{"id":658288,"name":"Sheila Klassen","orcid":"0000-0002-7065-6668","position":2,"is_corresponding":false},{"id":530450,"name":"Chiyembekezo Kachimanga","orcid":"0000-0003-3507-9591","position":3,"is_corresponding":false},{"id":1112605,"name":"Moses Banda Aron","orcid":"0000-0001-6625-217X","position":4,"is_corresponding":false},{"id":1112606,"name":"Medson Boti","orcid":"0000-0003-2844-0641","position":5,"is_corresponding":false},{"id":1112607,"name":"Kenwood Kumwenda","orcid":"0009-0005-3904-3782","position":6,"is_corresponding":false},{"id":254252,"name":"Gene Bukhman","orcid":"0000-0003-4500-7903","position":7,"is_corresponding":false},{"id":515115,"name":"Adamson S. Muula","orcid":"0000-0003-4412-9773","position":8,"is_corresponding":false},{"id":689770,"name":"Ndaziona Peter Kwanjo Banda","orcid":"0000-0002-3958-0888","position":9,"is_corresponding":false},{"id":22621,"name":"Gene F. Kwan","orcid":"0000-0002-0929-6800","position":10,"is_corresponding":false},{"id":596129,"name":"Bright Mailosi","orcid":"0000-0001-9089-0163","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T01:14:06.433417Z","pmid":"37334396","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}