Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria : data from the Abeokuta Heart Failure Registry : cardiovascular topic

Abstract

SummaryBackgroundCompared to other regions of the world, there is a paucity of data on the short-term outcome of acute heart failure (AHF) in Africa’s most populous country, Nigeria. We examined the six-month outcomes (including case fatalities) in 285 of 309 AHF subjects admitted with HF to a tertiary hospital in Abeokuta, Nigeria.MethodsThe study cohort of 285 subjects comprised 150 men (52.6%) and 135 women (47.4%) with a mean age of 56.3 ± 15.6 years and the majority in NYHA class III (75%).ResultsThere were a number of differences according to the subject’s gender; men being older and more likely to present with hypertensive heart disease (with greater left ventricular mass) while also having greater systolic dysfunction. Mean length of stay was 10.5 ± 5.9 days. Mean follow up was 205 days, with 23 deaths and 20 lost to follow up. At 30 days, 4.2% (95% CI: 2.4–7.3%) had died and by 180 days this had increased to 7.5% (95% CI: 4.7–11.2%); with those subjects with pericardial disease demonstrating the highest initial mortality rate. Over the same period, 13.9% of the cohort was re-admitted at least once.ConclusionsThe characteristics of this AHF cohort in Nigeria were different from those reported in high-income countries. Cases were relatively younger and presented with non-ischaemic aetiological risk factors for HF, especially hypertensive heart disease. Moreover, mortality and re-admission rates were relatively lower, suggesting region-specific strategies are required to improve health outcomes.

Validation of heart failure quality of life tool and usage to predict all-cause mortality in acute heart failure in Uganda: the Mbarara heart failure registry (MAHFER)

“…In addition, our results reaffirm other predictors of mortality following hospitalization with heart failure including increasing alcoholic drinks per sitting, New York Heart Association (NYHA) functional class IV heart failure [32, 33]. This is likely explained by the late presentation with advanced disease [12, 34].…”

Incidence and predictors of 6 months mortality after an acute heart failure event in rural Uganda: The Mbarara Heart Failure Registry (MAHFER)

“…However, there are no similar studies from sub-Sahara Africa for comparison of these results. In addition, we found that the cumulative incidence death among participants with New York heart association (NYHA) functional class IV at time of hospitalization was higher than that of participants with NYHA class III as has been shown by others [13,25]. This could be explained by the late presentation with advanced heart failure class given the long distances travelled to reach health facilities as well as time delays in lower level centers where diagnostic and therapeutic expertise is limited [26,27].…”

“…Also, compared to other prior studies from sub-Saharan Africa, we found a higher incidence of in-hospital mortality. This maybe attributable to the fact that prior studies were carried out in highly specialized cardiac centers with superior diagnostic, therapeutic, and human resources thus the lower in-hospital mortality rate while the current study was performed in general medicine ward of a regional hospital which is generalizable to the level of care where majority of heart failure patients seek care in low income countries such as Uganda [13,21]. Taken together, this finding expounds on the existing literature on all-cause mortality among heart failure patients in sub-Saharan Africa that, until now, reported only deaths occurring in hospitals, as such reported lower incidence of death associated with acute heart failure [12,13,20,21].…”

“…However, epidemiological studies estimating mortality rates attributable to heart failure in sub-Saharan Africa are from specialized urban centers which are not generalizable to populations from these countries as the majority live in rural areas [9,12,13]. As such reports such as those of the sub-Saharan Africa Survey of Heart Failure (THESUS-HF) [9] study that reported a 18% 6-month mortality grossly underestimate the all-cause mortality rate among heart failure patients in sub-Saharan African populations.…”

Chronic illness needing palliative care in Kinshasa hospitals, Democratic Republic of the Congo (DRC)

“…Our results confirm the findings of Ogah et al in Nigeria [ 50 ], who reported that more than two thirds of patients were lost to follow-up. Several reasons can explain why some patients leave the hospital, e.g.…”