Clinical Characteristics and In-Hospital Outcome of Acute Heart Failure Patients Admitted to the Medical Ward of University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Abstract

Background: Despite the growing burden of heart failure in developing countries, data describing the clinical characteristics and in-hospital outcomes of acute heart failures are limited. Therefore, this study aimed at describing the clinical characteristics and in-hospital outcomes of acute heart failure patients admitted to the medical ward of University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. Methods: A prospective observational hospital-based cross-sectional study was conducted on 226 patients with acute heart failure at the University of Gondar Comprehensive Specialized Hospital from November 2019 to October 2020. Data were collected by using a pretested data abstraction format and analyzed with Statistical Package for Social Sciences version 21. Bivariable and multivariable binary logistic regression model were fitted to identify factors associated with in-hospital outcome and reported with 95% confidence interval (CI). P-value <0.05 was considered as statistically significant. Results: The mean (± standard deviation) age of the study participant was 51.17±19.03 years and 59.3% were females. Majority, 60.6% of patients were admitted with new onset heart failure. Dyspnea (88.05%) and peripheral edema (80.5%) were the most frequent clinical findings. The in-hospital mortality was 10.6% (95% CI: 7.1-14.7). Atrial fibrillation (AOR=9.46; 95% CI: 1.49-60.29), concurrent ischemic heart disease (AOR=8.23; 95% CI: 1.15-58.89), being admitted with reduced left ventricular ejection fraction (AOR=5.36; 95% CI: 2.81-35.52), presence of orthopnea (AOR=6.63; 95% CI: 2.94-46.76), and using intranasal oxygen therapy (AOR=9.41; 95% CI: 1.35-65.82) were significantly associated with in-hospital mortality in patients with acute heart failure. Conclusion:The in-hospital mortality of acute heart failure patients was relatively higher in the study area. Therefore, specific preventative and therapeutic strategies focusing on heart failure patients with reduced left ventricular ejection fraction, atrial fibrillation, ischemic heart disease, orthopnea, and intranasal oxygen therapy are required to reduce the mortality rate.

Etiology, clinical features, comorbidities and mortality in patients with acute heart failure. Experience of a tertiary public hospital in Angola

“…The relatively young age found in our cohort is in agreement with the vast majority of studies carried out in SSA [4,10,[12][13][14][15][16][17][18][19][20][21] (Table 3), it contrasts, however with the situation in European countries, North America, and Japan, where HF is essentially a problem of the elderly (mean age at presentation 72 years) [22]. As highlighted by several authors, the younger patients with AHF in ASS may be related to the etiology of HF.…”

“…Rheumatic heart diseases and cardiomyopathies are essentially problems of youth and middle-aged individuals. Furthermore, hypertension is known to occur early in Africans and African Americans, with greater adverse consequences [4,5,22,23] The higher rate of HF in women found in the present study is consistent with that found in about half of the studies conducted in SSA [4,10,12,13,15,16,[19][20][21][24][25][26][27][28][29][30][31][32] (Table 3). Reported sex differences in different SSA regions may be related to patient selection, the burden of cardiovascular risk factors, and regional etiologic variations.…”

“…On the other hand, it is important to emphasize that classification in HFrEF and HFpEF over time has been based on different LVEF cut-off points. Preserved HFpEF can be defined as EF > 40%, [16], EF > 45%, [17,28], EF ≥ 50% [12,14,21,25,33,46] or EF ≥ 55% [19,31,47], thus limiting the comparison between studies. However, in SSA, the vast majority of studies revealed a higher proportion of patients with HFrEF (57.6-87.2%) than HFpEF [14,17,23,28,31,34], as observed in our cohort.…”

“…The in-hospital mortality rate found in the present study (23%) is in line with the in-hospital mortality rate reported in the vast majority of studies in SSA [10,13,1 6,19,20,23,26,27,29,30,33] where in-hospital mortality varies between 17.0% and 26.2%; but it is higher than that reported in European countries, where it varies between 3.8% and 14.3% [48] and in some studies carried out in SSA, where it varies between 3.8% and 14.1% [4,9,12,14,15,17,21,31,38,46].…”