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Review
. 2024 Mar 27;19(1):33.
doi: 10.5334/gh.1313. eCollection 2024.

Decentralization and Integration of Advanced Cardiac Care for the World's Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease

Sheila L Klassen #  1   2 , Emmy Okello #  3 , Jose M E Ferrer  4 , Faraz Alizadeh  5   6 , Prebo Barango  7 , Pilly Chillo  8 , Yamikani Chimalizeni  9 , Wubaye Walelgne Dagnaw  10 , Jean-Luc Eiselé  11 , Lauren Eberly  12 , Anu Gomanju  13   14 , Neil Gupta  1   15 , Bhagawan Koirala  16 , Jacques Kpodonu  17 , Gene Kwan  18   19   20 , Bright G D Mailosi  21 , Lilian Mbau  22 , Reuben Mutagaywa  23   24 , Colin Pfaff  10 , Daniel Piñero  25 , Fausto Pinto  26 , Emmanuel Rusingiza  27   28 , Usman Abiola Sanni  29   30 , Amy Sanyahumbi  31   32 , Urmila Shakya  33   34 , Sanjib Kumar Sharma  35 , Kunjang Sherpa  36 , Isaac Sinabulya  37 , Emily B Wroe  1 , Gene Bukhman #  1   2   20 , Ana Mocumbi #  38   39
Affiliations
Review

Decentralization and Integration of Advanced Cardiac Care for the World's Poorest Billion Through the PEN-Plus Strategy for Severe Chronic Non-Communicable Disease

Sheila L Klassen et al. Glob Heart. .

Erratum in

Abstract

Rheumatic and congenital heart disease, cardiomyopathies, and hypertensive heart disease are major causes of suffering and death in low- and lower middle-income countries (LLMICs), where the world's poorest billion people reside. Advanced cardiac care in these counties is still predominantly provided by specialists at urban tertiary centers, and is largely inaccessible to the rural poor. This situation is due to critical shortages in diagnostics, medications, and trained healthcare workers. The Package of Essential NCD Interventions - Plus (PEN-Plus) is an integrated care model for severe chronic noncommunicable diseases (NCDs) that aims to decentralize services and increase access. PEN-Plus strategies are being initiated by a growing number of LLMICs. We describe how PEN-Plus addresses the need for advanced cardiac care and discuss how a global group of cardiac organizations are working through the PEN-Plus Cardiac expert group to promote a shared operational strategy for management of severe cardiac disease in high-poverty settings.

Keywords: advanced cardiac disease; decentralization; heart failure; low-income country.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Cardiac service provision at each level of the health system
Figure 1
Cardiac service provision at each level of the health system. HTN, hypertension; INR, international normalized ratio; PEN, Package of Essential Noncommunicable Interventions for Primary Care; RHD, rheumatic heart disease.
Advantages and disadvantages of decentralization at different health system levels
Figure 2
Advantages and disadvantages of cardiac care delivery at different levels of decentralization within the health system. INR, international normalized ratio; NCDs, noncommunicable diseases.
PEN-Plus Heart Failure Management Protocol
Figure 3
PEN-Plus Heart Failure Management Protocol. ACE, angiotensin converting enzyme; BP, blood pressure; HF, heart failure; HTN, hypertension; IVC, inferior vena cava; LV, left ventricle; PLAX, parasternal long axis; RV, right ventricle *specific medications used will depend on availability on local formularies. This protocol is used primarily for teenagers and older. Adapted from Bukhman et al. [51].
NCDI Poverty Commission Countries and Phases of PEN-Plus Expansion
Figure 4
NCDI Poverty Commission Countries and Phases of PEN-Plus Expansion.
See this image and copyright information in PMC

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