Clinical characteristics and prognosis of patients admitted for heart failure: A 5-year retrospective study of African patients

Bonsu, Kwadwo Osei; Owusu, Isaac Kofi; Buabeng, Kwame Ohene; Reidpath, Daniel D.; Kadirvelu, Amudha

doi:10.1016/j.ijcard.2017.03.014

Cited by 37 publications

(50 citation statements)

References 65 publications

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“…Five studies provided data for cardiovascular death . There were 1229/9469 (13%) deaths among HFrEF patients, 365/3760 (9.7%) among HFmrEF patients, and 735/5739 (12.8%) among HFpEF patients.…”

Section: Resultsmentioning

confidence: 99%

“…Finally, the important clinical issue beside characterization of HFmrEF patients may be the identification of predictors of deterioration and backward transition to the HFrEF category, in order to prevent further worsening and to improve prognosis. A number of the included studies in the current meta‐analysis examined the possible predictors of mortality and effect of the medications used at baseline in patients with HFmrEF . There was no consistency in their findings concerning age, gender, atrial fibrillation, or hypertension.…”

Section: Discussionmentioning

confidence: 97%

“…There was no consistency in their findings concerning age, gender, atrial fibrillation, or hypertension. Interestingly, subanalyses of the prognostic impact of medications used at baseline showed consistent mortality reduction by beta‐blockers in patients with HFmrEF; however, in the study by Koh et al ., this effect was limited to patients with IHD. Because of the presence of IHD and cardiovascular co‐morbidities, clinicians do treat HFmrEF patients as HFrEF to some extent, but in the absence of randomized controlled trials, the evidence is still too weak to treat HFmrEF patients as HFrEF guidelines recommend.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and long‐term prognosis of patients with heart failure and mid‐range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta‐analysis

2018

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AimsThis study aimed to assess by a meta‐analysis the clinical characteristics, all‐cause and cardiovascular mortality, and hospitalization of patients with heart failure (HF) with mid‐range ejection fraction (HFmrEF) compared with HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).Methods and resultsData from 12 eligible observational studies including 109 257 patients were pooled. HFmrEF patients were significantly different and occupied a mid‐position between HFrEF and HFpEF: mean age 73.6 ± 9.8 vs. 72.6 ± 9.8 and 77.6 ± 7.2 years, male gender 59% vs. 68.5% and 40%, ischaemic heart disease 49% vs. 52.6% and 39.4%, hypertension 67.3% vs. 61.5% and 76.5%, atrial fibrillation 45.2% vs. 39.6% and 46%, chronic obstructive pulmonary disease 26.4% vs. 24.9% and 30.5%, estimated glomerular filtration rate 62 ± 30 vs. 63.3 ± 23 and 59 ± 22.5, use of renin–angiotensin system inhibitors 79.6% vs. 90.1% and 68.7%, beta‐blockers 82% vs. 89% and 73.5%, and aldosterone antagonists 20.3 vs. 31.5% and 26%, P‐values < 0.05. After a mean follow‐up of 31 ± 5 months, all‐cause mortality was significantly lower in HFmrEF than in HFrEF and HFpEF (26.8% vs. 29.5% and 31%): risk ratio (RR) 0.95 [0.93–0.98; 95% confidence interval (CI)], P < 0.001, and 0.97 (0.94–0.99; 95% CI), P = 0.014, respectively. Cardiovascular mortality was lowest in HFmrEF (9.7% vs. 13% and 12.8%): RR = 0.81 (0.73–0.91), P < 0.001, and 1.10 (0.97–1.24; 95% CI), P = 0.13, respectively. HF hospitalization in HFmrEF compared to that in HFrEF and HFpEF was 23.9% vs. 27.6% and 23.3% with RR = 0.89 (0.85–0.93), P < 0.001, and RR = 1.12 (1.07–1.17), P < 0.001, respectively.ConclusionsThe results of this study support that HFmrEF is a distinct category characterized by a mid‐position between HFrEF and HFpEF and with the lowest all‐cause and cardiovascular mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Characteristics and long‐term prognosis of patients with heart failure and mid‐range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta‐analysis

2018

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“…The study with the largest population (n = 2188) was from the Global Rheumatic Heart Disease Registry (the REMEDY study); it reported an AF prevalence of 20.1% . Table presents prevalence rates of AF in patients with heart failure . The largest studies showed a prevalence of 20.8% in a multinational cohort (n = 1006) and 20.7% in Ghana (n = 1488) .…”

Section: Resultsmentioning

confidence: 99%

“…In a majority of studies, about two‐thirds of patients with AF were in heart failure of various severity . On the other hand, AF was highly prevalent in patients in heart failure . AF can cause tachy‐induced cardiomyopathy, it can accelerate the progression of heart failure and precipitate acute decompensation, and it is associated with increased mortality in patients with heart failure.…”

Section: Discussionmentioning

confidence: 99%

A review of the epidemiology of atrial fibrillation in sub‐Saharan Africa

Noubiap

Nyaga²

2019

Cardiovasc electrophysiol

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This systematic review summarizes the data on the prevalence, risk factors, complications, and management of atrial fibrillation (AF) in sub‐Saharan Africa (SSA). Bibliographic databases were searched from inception to 31 May 2019, to identify all published studies providing data on AF in populations living in SSA. A total of 72 studies were included. The community‐based prevalence of AF was 4.3% and 0.7% in individuals aged ≥40 years and aged ≥70 years, respectively. The prevalence of AF ranged between 6.7% and 34.8% in patients with ischemic stroke, between 9.5% and 46.8% in those with rheumatic heart disease (RHD), between 5% and 31.5% in patients with dilated cardiomyopathy. The main risk factors for AF were hypertension, affecting at least one‐third of patients with AF, and valvular heart disease (12.3%‐44.4%) and cardiomyopathy (~20%). Complications of AF included heart failure in about two thirds and stroke in 10% to 15% of cases. The use of anticoagulation for stroke prevention was suboptimal. Rate control was the most frequent therapeutic strategy, used in approximately 65% to 95% of AF patients, with approximately 80% of them achieving rate control. The management of AF was associated with exorbitant cost. In conclusion, AF seems to have a higher prevalence in the general population than previously thought and is mostly associated with hypertension, cardiomyopathy, and RHD in SSA. It is associated with a high incidence of heart failure and stroke. The management of AF is suboptimal in SSA, especially with a low uptake of oral anticoagulation.

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The prognosis of mid‐range ejection fraction heart failure: a systematic review and meta‐analysis

Altaie

Khalife

2018

ESC Heart Failure

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Clinical characteristics and prognosis of patients admitted for heart failure: A 5-year retrospective study of African patients

Cited by 37 publications

References 65 publications

Characteristics and long‐term prognosis of patients with heart failure and mid‐range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta‐analysis

Characteristics and long‐term prognosis of patients with heart failure and mid‐range ejection fraction compared with reduced and preserved ejection fraction: a systematic review and meta‐analysis

A review of the epidemiology of atrial fibrillation in sub‐Saharan Africa

The prognosis of mid‐range ejection fraction heart failure: a systematic review and meta‐analysis

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