Determinants of Pulse Rate change and Time-To Default from Treatment among Congestive Heart Failure Patients in Felege- Hiwot Referral Hospital, Bahir Dar, Ethiopia; comparison of separate and joint models

Abstract

Background: Globally, heart failure is a rapidly growing public health issue with an estimated prevalence of >37.7 million individuals. It is a shared chronic phase of cardiac functional impairment secondary to many etiologies. The main purpose of this study was to identify factors that affect the longitudinal changes of pulse rate and survival endpoints, time-to default among Congestive Heart Failure Patients in Felege- Hiwot Referral Hospital, Bahir Dar, Ethiopia.Methods: Hospital based retrospective studies were conducted among 302 congestive heart failure patients who were 15 years old or older and who were on treatment follow-up from the first February 2016 to thirty-one December 2018 in Felege-Hiwot Referral Hospital, Bahir Dar, Ethiopia. First, data were analyzed using linear mixed model and survival models separately, and then the joint models of both sub-models were analyzed by linked their shared unobserved random effects using a shared parameter model. Results: Out of the total 302 CHF treatment followers, 103 (34.1%) of the patients were defaulting from treatment. The mean pulse rate of female and male patients was 87.25 and 90.20, respectively. Averagely 51.12 % of blood in the left ventricle is pushed out with each heartbeat. The results for separate and joint models were quite similar to each other but not identical. However, the estimated association parameter (α) in the joint model is (HR=1.0311, 95%CI: 1.0033,1.0597, P=0.0278), providing there is evidence of a positive association between the survival and the longitudinal sub-models. Thus, defaulting is more likely to occur in patients with higher pulse rates. Patients, being male, hypertensive, CKD, pneumonic, and NYHA class IV patients were associated with a higher risk of defaulting. Age, LVIF, follow-up time in a month had a negative significant effect and NYHA class, and male gender had a positive significant effect on average evaluation of pulse rate of patients. Conclusions: The patient who are male, NYHA class IV, had low LVIF and comorbid with hypertensive, CKD, pneumonia were risk factors of pulse rate change and defaulting from treatment of CHF patients. The joint model was preferred for simultaneous analyses of repeated measurement and survival data.