External Source:
Heart failure management in an integrated NCD clinic | JACC: Heart Failure | Voume 1, Issue 3, pp. 230-236 This article is behind a paywall.

“A public health system strategy employing portable echocardiography and simplified algorithms for diagnosis and initial management of heart failure has been developed in several rural districts in Rwanda since 2006. Heart failure treatment is accomplished in integrated NCD clinics that allow sharing of staff and resources in managing a group of chronic conditions endemic in rural sub-Saharan Africa.”


Heart failure contributes significantly to noncommunicable disease burden in sub-Saharan Africa. Specialized care is provided primarily at referral hospitals by physicians, limiting patients’ access. Simplifying clinical strategies can facilitate decentralization of quality care to the district hospital level and improve care delivery. Heart failure services were established within integrated advanced NCD clinics in 2 rural district hospitals in Rwanda. Nurses, supervised by physicians, were trained to use simplified diagnostic and treatment algorithms including echocardiography with diagnoses confirmed by a cardiologist. Data on 192 heart failure patients treated between November 2006 and March 2011 were reviewed from an electronic medical record. In rural Rwanda, the causes of heart failure are almost exclusively nonischemic even though patients often present with advanced symptoms. Training nurses, supervised by physicians, in simplified protocols and basic echocardiography is one approach to integrated, decentralized care for this vulnerable population.

Treatment protocols, costing models, and service provision methods are included or explained.