BackgroundCardiovascular disease (CVD) remains a leading cause of morbidity and mortality worldwide, conferring a disparate burden on low-income and middle-income countries (LMICs). Haiti represents a resource-constrained setting, limited by a paucity of resources and trained cardiovascular professionals equipped to address the increasing burden of CVD.ObjectiveHere, we describe the creation of a comprehensive cardiology curriculum delivered through a virtual classroom. The curriculum was created to augment cardiovascular education in LMICs such as Haiti.MethodsOver one academic year (May 2019–2020), International Cardiology Curriculum Accessible by Remote Distance Learning-Haiti consisted of biweekly, live-streamed, synchronous didactic lectures, seminars and case presentations broadcasted to 16 internal medicine (IM) residents at Hôpital Universitaire de Mirebalais, one of only four IM training programmes in Haiti. The virtual classroom was created using commercially available videoconferencing and data-sharing platforms. Prelecture and postlecture surveys and an end of the year survey were administered to assess the impact of the curriculum.ResultsParticipant performance analysis revealed that 80% of the curriculum demonstrated a positive trend in knowledge acquisition postintervention. Based on the end of the year evaluation, 94% of participants reported that the curriculum was educational and relevant to medical practice in Haiti and 100% reported that the curriculum was good to excellent. Additionally, the curriculum was cited as an effective means of maintaining trainee education during the COVID-19 pandemic.ConclusionThis international medical education pilot study demonstrates the feasibility of augmenting cardiology education in LMICs by creating a virtual curriculum made possible by local partnerships, internet access and technology.

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’ perspectives. Methods: We conducted three group interviews and one individual interview with thirteen patients with HF. We recruited patients after discharge from a non-governmental organization-supported academic hospital in rural Haiti. We employed thematic analysis using emergent coding and categorized themes using the socioecological model. Results: Facilitators of chronic care included participants’ knowledge about the importance of HF treatment and engagement with health systems to manage symptoms. Strong social support networks helped participants access clinic visits. Participants reported low cost of care at this subsidized hospital, good medication accessibility, and trust in the healthcare system. Participants expressed the strong spiritual belief that the healthcare system is an extension of God’s influence. Barriers to chronic care included participants' misconceptions about adherence to medications and the need to take HF medications with food. Lack of social support prevented clinic access, and non-healthcare costs associated with clinic visits were prohibitive. Participants expressed low satisfaction regarding the clinic experience. Another barrier to healthcare was the belief that heart disease caused by supernatural spirits is incurable. Conclusions: We identified several facilitators and barriers to chronic HF care with implications for HF management in rural Haiti. Future interventions to improve chronic HF care should address misconceptions and foster patient support systems for visit and medication adherence. Leveraging local spiritual beliefs may promote care engagement.

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 proficiency in ECG interpretation through a competition among IM and EM residents at a teaching hospital in rural central Haiti in which over 40% of all admissions are due to CVD. Methodology The 33 participants included 17 EM residents and 16 IM residents from each residency year at the Hôpital Universitaire de Mirebalais (HUM). Residents were divided into 11 groups of 3 participants with a representative from each residency year and were given team-based online ECG quizzes to complete weekly. The format included 56 ECG cases distributed over 11 weeks, and each case had a pre-specified number of points based on abnormal findings and complexity. All ECG cases represented cardiovascular pathology in Haiti adapted from the Association of Program Directors in Internal Medicine evaluation list. The main intervention was sharing group performance and ECG solutions to all participants each week to promote competition and self-study without specific feedback or discussion by experts. To assess impact, pre- and post-intervention assessments measuring content knowledge and comfort for each participant were performed. Results Overall group participation was heterogeneous with groups participating a median of 54.5% of the weeks (range 0–100%). 22 residents completed the pre- and post-test assessments. The mean pre- and post-intervention assessment knowledge scores improved from 27.3% to 41.7% (p = 0.004). 70% of participants improved their test scores. The proportion of participants who reported comfort with ECG interpretation increased from 57.6% to 66.7% (p = 0.015). Conclusion This study demonstrates improvement in ECG interpretation through a team-based, asynchronous ECG competition approach. This method is easily scalable and could help to fill gaps in ECG learning. This approach can be delivered to other hospitals both in and outside Haiti. Further adaptations are needed to improve weekly group participation.

Introduction: Chronic non-communicable disease (NCD) care requires long-term compliance with clinic appointments. In rural Haiti, remembering appointments is a barrier to visit adherence. While short message service (SMS) text reminders can improve attendance in other settings, this has not been assessed Haiti. This quality improvement study assesses the feasibility and acceptability of using SMS reminders to promote clinic attendance in rural Haiti. Methods: We included patients at the NCD and type 1 diabetes clinics of Hôpital Universitaire de Mirebalais, Haiti. Patients with upcoming visits were sent 2 SMS reminders 3 days and 1 day before their visit. Patients who attended their clinic visit completed a survey regarding the feasibility, acceptability, and usefulness of the SMS reminders. The primary study outcome was the proportion of patients who received SMS messages. Secondary outcomes included the proportion of patients who found SMS reminders acceptable, missed clinic appointments, and could not be reached by phone. Results: Of the 96 patients with scheduled visits during the study period, we sent SMS reminders to 88 (91.2%) patients; 8 did not have recorded phone numbers. 25% of patients missed their visit and 9% were unable to be reached by phone. The 72 patients that attended their visit had a mean age of 49.5 years and 58.2% were female. Half of those who attended their visit (36) received the SMS. Of the 36 patients that received the SMS, 100% liked the reminder, 97.2% wanted to receive future messages, and 22.2% reported they would not have attended their visit without the reminder. Of the 36 patients who did not receive the SMS, 14 (38.9%) had a new phone number while 12 (33.3%) did not have access to a phone. The biggest patient-reported barriers to receiving SMS were inconsistent cellular signal (25%) and lack of access to a phone (22%). Conclusion: Sending SMS reminders was feasible and acceptable to NCD patients in rural Haiti. The messages were universally liked by the patients who received them and influenced the decision to attend their visit. For some patients, inconsistent signal and lack of phone access will need to be addressed. If implemented at full scale, SMS reminders could significantly improve appointment attendance in rural Haiti.