Article type
Year
Abstract
Background: Cardiovascular diseases account for 10% of all disability adjusted life years lost in low to middle income countries. Ischaemic heart disease accounts for a third of this burden, with rheumatic heart disease and inflammatory heart diseases causing 5% and 8% respectively. We were concerned that clinical trials of treatments for heart diseases are seldom performed in developing countries and fail to study diseases common in these countries. Objective: To identify, from the Cochrane Heart Group Specialist Register, the number of trials in heart diseases that would be of particular value to guide treatment in developing countries.
Methods: We searched the Cochrane Heart Group register in two ways. Firstly we identified those heart diseases which contribute to the burden of heart disease in developing countries. Secondly we tried to identify trials performed in developing counties by searching by country/region and in journals published in developing countries.
Results: Out of a total of 15,500 references in our register Table 1 shows the number of references identified as related to work done in geographic regions and Table 2 the number of references to particular diseases. Our specialist register is dominated by trials in coronary heart disease 56.8% (8,797), performed in North America and Europe. Other diagnostic groups represented are heart failure 14.2% (2,196), arrhythmias 10.9% (1690), congenital heart diseases 1.9% (299), cardiomyopathies 1.9% (291), valvular heart diseases 1.9% (290), cardiac arrest 1.2% (194), other diagnoses 11.5% (1,788). Diseases of particular relevance to developing countries make up only 0.35% (55) of the register. Trials performed in developing countries make up only 2.3% (359) of specialist register. Table 1 n trials Table 2 n trials China 164 Rheumatic HD 19 S America 113 Chaga's HD 11 Africa 33 Pericarditis 7 India 21 TB 5 Asia (Other) 15 Hypertensive cardiomypathy 13 Mexico 8 Endomyocardial fibrosis 0 Cuba 5 Malnutrition/heart disease 0 Total 359 Total 55
Conclusions: Our interrogation of the Cochrane Heart Group Specialist Register shows that whilst there is a huge amount of work being done in investigating heart diseases little of this appears to be focused on the particular needs of developing countries. We suspect that our register under-estimates the number of trials carried out in developing countries owing to reporting biases. We will need to develop additional methods of finding trial reports from the developing world. Additional factors that contribute to our findings include the ease of communication/reporting within Western countries, technical and administrative constraints on performing trials in developing countries, and financial disincentives to study diseases of the poor.
Methods: We searched the Cochrane Heart Group register in two ways. Firstly we identified those heart diseases which contribute to the burden of heart disease in developing countries. Secondly we tried to identify trials performed in developing counties by searching by country/region and in journals published in developing countries.
Results: Out of a total of 15,500 references in our register Table 1 shows the number of references identified as related to work done in geographic regions and Table 2 the number of references to particular diseases. Our specialist register is dominated by trials in coronary heart disease 56.8% (8,797), performed in North America and Europe. Other diagnostic groups represented are heart failure 14.2% (2,196), arrhythmias 10.9% (1690), congenital heart diseases 1.9% (299), cardiomyopathies 1.9% (291), valvular heart diseases 1.9% (290), cardiac arrest 1.2% (194), other diagnoses 11.5% (1,788). Diseases of particular relevance to developing countries make up only 0.35% (55) of the register. Trials performed in developing countries make up only 2.3% (359) of specialist register. Table 1 n trials Table 2 n trials China 164 Rheumatic HD 19 S America 113 Chaga's HD 11 Africa 33 Pericarditis 7 India 21 TB 5 Asia (Other) 15 Hypertensive cardiomypathy 13 Mexico 8 Endomyocardial fibrosis 0 Cuba 5 Malnutrition/heart disease 0 Total 359 Total 55
Conclusions: Our interrogation of the Cochrane Heart Group Specialist Register shows that whilst there is a huge amount of work being done in investigating heart diseases little of this appears to be focused on the particular needs of developing countries. We suspect that our register under-estimates the number of trials carried out in developing countries owing to reporting biases. We will need to develop additional methods of finding trial reports from the developing world. Additional factors that contribute to our findings include the ease of communication/reporting within Western countries, technical and administrative constraints on performing trials in developing countries, and financial disincentives to study diseases of the poor.