Gene F Kwan's research while affiliated with Harvard Medical School and other places
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Publications (110)
Background
In Haiti, cardiovascular disease is a leading cause of morbidity and mortality, with congenital and rheumatic heart disease comprising a large portion of disease burden. However, domestic disparities in cardiac care access and their impact on clinical outcomes remain poorly understood. We analyzed population-level sociodemographic variab...
• RHD is a common cause of heart failure in sub-Saharan Africa. • Task shifting by training rural providers in POCUS improves cardiac imaging access. • POCUS in low-resource settings can determine presence of structural heart disease. • There are specific POCUS device considerations for use in low-resource settings. • POCUS use in rural low-resourc...
Background
The electrocardiogram (ECG) is the most relied upon tool for cardiovascular diagnosis, especially in low-resource settings because of its low cost and straightforward usability. It is imperative that internal medicine (IM) and emergency medicine (EM) specialists are competent in ECG interpretation. Our study was designed to improve profi...
Introduction: Heart failure (HF) is a leading cause of hospitalizations in rural Haiti. However, few patients hospitalized for HF return for outpatient care. The factors that contribute to chronic HF care access are poorly understood.
Objective: To investigate the facilitators and barriers to accessing care for chronic HF from the patients’ perspec...
Background: The World Health Organization (WHO) has approved the use of two new drugs, namely Bedaquiline (Bdq) and Delamanid (Dlm), for treatment of Drug Resistant Tuberculosis (DR-TB). One of the concerns raised with the use of these drugs was QT-interval prolongation. This condition could be serious and life threatening. Hence, knowing the magni...
Background:
The World Health Organization (WHO) has approved the use of two new drugs, namely Bedaquiline (Bdq) and Delamanid (Dlm), for treatment of Drug Resistant Tuberculosis (DR-TB). One of the concerns raised with the use of these drugs was QT-interval prolongation. This condition could be serious and life threatening. Hence, knowing the magn...
Background
The health of populations living in extreme poverty has been a long-standing focus of global development efforts, and continues to be a priority during the Sustainable Development Goal era. However, there has not been a systematic attempt to quantify the magnitude and causes of the burden in this specific population for almost two decade...
Introduction
To address workforce shortages and expand access to care, we developed a telemedicine program incorporating existing infrastructure for delivery of cardiovascular care in Gulu, Northern Uganda. Our study had three objectives: 1) assess feasibility and clinical impact 2) evaluate patient/parent satisfaction and 3) estimate costs.
Metho...
Health sector priorities and interventions to prevent and manage noncommunicable diseases and injuries (NCDIs) in low- and lower-middle-income countries (LLMICs) have primarily adopted elements of the World Health Organization Global Action Plan for NCDs 2013-2020. However, there have been limited efforts in LLMICs to prioritize among conditions an...
Key Findings n National Noncommunicable Disease and Injury (NCDI) Poverty Commissions were established in 16 low-and lower-middle-income countries (LLMICs) to define local NCDI epidemiology, determine an expanded set of priority NCDI conditions, and recommend cost-effective, equitable health-sector interventions. n Commissions prioritized an averag...
Background:
Despite declines in deaths from rheumatic heart disease (RHD) in Africa over the past 30 years, it remains a major cause of cardiovascular morbidity and mortality on the continent. We present an investment case for interventions to prevent and manage RHD in the African Union (AU).
Methods:
We created a cohort state-transition model t...
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disea...
Background
Non-communicable diseases (NCDs) cause a large burden of disease globally. Some infectious diseases cause an increased risk of developing specific NCDs. Although the NCD burden from some infectious causes has been quantified, in this study, we aimed to more comprehensively quantify the global burden of NCDs from infectious causes.
Metho...
Background
Adherence to regular outpatient visits is vital to managing noncommunicable diseases (NCDs), a growing burden in low and middle-income countries. We characterized visit adherence among patients with NCDs in rural Haiti, hypothesizing higher poverty and distance from the clinic were associated with lower adherence.
Methods
We analyzed el...
Context and objectives
Non-communicable diseases and injuries (NCDIs) comprise a large share of mortality and morbidity in low-income countries (LICs), many of which occur earlier in life and with greater severity than in higher income settings. Our objective was to assess availability of essential equipment and medications required for a broad ran...
Background:
In many developing countries, rheumatic heart disease (RHD) is diagnosed at an advanced stage and requires surgery for patient survival. However, access to cardiac surgery in this context is limited and often provided through partnerships, requiring centralized patient data systems for monitoring and follow-up.
Objectives:
This study...
Introduction:
In many low-income countries, Emergency Medicine is underdeveloped and faces many operational challenges including emergency department (ED) overcrowding and prolonged patient length of stays (LOS). In high-resource settings, protocolized ED observation unit (EDOU) care reduces LOS while preserving care quality. EDOUs are untested in...
Background:
Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti.
Objectives:
We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associ...
Previous congenital heart disease estimates came from few data sources, were geographically narrow,
and did not evaluate congenital heart disease throughout the life course. Completed as part of the Global Burden of
Diseases, Injuries, and Risk Factors Study 2017, this study aimed to provide comprehensive estimates of congenital
heart disease morta...
Background
Integrated clinical strategies to address non-communicable disease (NCDs) in sub-Saharan Africa have largely been directed to prevention and treatment of common conditions at primary health centres. This study examines the cost of organising integrated nurse-driven, physician-supervised chronic care for more severe NCDs at an outpatient...
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 noncommunica...
Background
Understanding racial differences in outcomes for atrial fibrillation (AF) may guide interventions to diminish health inequities.
Methods and Results
In a retrospective, cross-sectional study of adults hospitalized with a principal diagnosis of AF using the 2001-2012 National Inpatient Sample, we assessed racial differences for in-hospit...
Background:
Heart failure is a significant cause of morbidity and mortality in sub-Saharan Africa. Our understanding of the heart failure burden in this region has been limited mainly to registries from urban referral centers. Starting in 2006, a nurse-driven strategy was initiated to provide echocardiography and decentralized heart failure care w...
Background
In sub-Saharan Africa, continued clinical follow-up, after cardiac surgery, is only available at urban referral centres. We implemented a decentralised, integrated care model to provide longitudinal care for patients with advanced rheumatic heart disease (RHD) at district hospitals in rural Rwanda before and after heart surgery.
Methods...
Background: Noncommunicable diseases (NCDs) are a major and growing cause of death and disability in low-income countries, and contribute a substantial portion of outpatient clinic visits. Poverty can be a major barrier to accessing healthcare in rural low-income countries. The objective of this study is to describe the demographics and socioeconom...
Background: The burden of cardiovascular diseases (CVDs) remains unclear in many regions of the world.
Objectives: The GBD (Global Burden of Disease) 2015 study integrated data on disease incidence, prevalence, and mortality to produce consistent, up-to-date estimates for cardiovascular burden.
Methods: CVD mortality was estimated from vital regi...
Primarily affecting the young, rheumatic heart disease (RHD) is a neglected chronic disease commonly causing premature morbidity and mortality among the global poor. Standard clinical prevention and treatment is based on studies from the early antimicrobial era, as research investment halted soon after the virtual eradication of the disease from de...
Errata for corrected authorship, affiliations and funding statements.
Effective combination antiretroviral therapy (ART) has enabled human immunodeficiency virus (HIV) infection to evolve from a generally fatal condition to a manageable chronic disease. This transition began two decades ago in high-income countries and has more recently begun in lower income, HIV endemic countries (HIV-ECs). With this transition, the...
The supplementary results offer additional results tables and figures, as well as more detailed
methodological figures.
Progress towards the Sustainable Development Goals.
Background: Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Inj...
This methods appendix provides further methodological detail for the health-related Sustainable Development Goals (SDGs). The appendix is organized into broad sections following the structure of the main paper. The supplementary results offer additional results tables and figures, as well as more detailed methodological figures.
BACKGROUND:
In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).
ME...
This appendix provides methodological detail, supplemental figures, and more detailed results for disability‐adjusted life years and healthy life expectancy. The appendix is organized into broad sections following the structure of the main paper.
Background: Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Developmen...
Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in contex...
Background:
Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2...
We greatly appreciate the positive comments regarding our article1 in the letter from Antignac et al. We agree that there is a dearth of published information about the quality of noncommunicable disease medicines including cardiovascular.
In 2011, contamination of a cardiovascular medicine in Lahore, Pakistan, caused nearly 200 deaths among up to...
The poorest billion people are distributed throughout the world, though most are concentrated in rural sub-Saharan Africa and South Asia. Cardiovascular disease (CVD) data can be sparse in low- and middle-income countries beyond urban centers. Despite this urban bias, CVD registries from the poorest countries have long revealed a predominance of no...
Cardiovascular diseases (CVD) represent the highest burden of disease globally. Medicines are a critical intervention used to prevent and treat CVD. This review describes access to medication for CVD from a health system perspective and strategies that have been used to promote access, including providing medicines at lower cost, improving medicati...
