Understanding Linkage to Care for Patients With Heart Failure in Rural Haiti

Abstract

Heart failure is a final common pathway of many cardiovascular diseases (CVDs), which together represent the leading causes of death and DALYs worldwide. The limited existing data on heart failure in low-income countries demonstrate a set of etiologies distinct from high-income countries and a significant burden of disease caused by these etiologies. In this study, we focus on post-discharge outpatient follow-up characteristics for patients admitted to a hospital in rural Haiti with heart failure to better understand factors influencing retention in chronic disease management and ultimately improve the heart failure care delivery model in rural Haiti. This study is a retrospective cohort analysis of patients (≥18 years old) admitted to Mirebalais University Hospital (HUM) with a primary diagnosis of heart failure between October 2013 and September 2014. Data on heart failure etiology, inpatient mortality rates, readmission rates, post-discharge “linkage” (30-day) and “retention” (60-day) to outpatient heart failure follow-up care at HUM, and demographic data (age, sex, and distance from HUM as approximated by referral zones) were collected and analyzed in this study. A total of 311 patients met eligibility criteria. The average age of patients admitted with heart failure was 53, with nearly 1 out of 3 patients admitted under the age of 40 years. Of the 88% of patients who survived admission, 37% (n=101) returned for outpatient follow-up at HUM within 30 days of discharge, and 48% of these patients (n=48) returned for a second follow-up appointment within 60 days post-discharge. Stratifying post-discharge patients into 4 geographic zones of ascending distance from HUM demonstrated decreasing “linkage” to care rates with distance from the HUM clinic (45%, 39%, 35%, and 25%, respectively). Distance from HUM represents one likely factor influencing the low 30-, 60-, and 90-day outpatient follow-up rates observed in this study. This observation fits into a broader set of literature on chronic disease management in rural Haiti indicating that structural barriers to care, such as the economic burdens associated with increasing distance from outpatient care, require close attention and intervention to improve chronic disease management for conditions like heart failure in rural Haiti and other similar settings globally.