Long-Term Outcomes and Factors Associated with Mortality in Patients with Moderate to Severe Pulmonary Hypertension in Kenya

Abstract

Background: Pulmonary hypertension is poorly studied in Africa. The long-term survival rates and prognostic factors associated with mortality in patients with moderate to severe pulmonary hypertension (PH) in Africa are not well described. Objectives:To determine the causes of moderate to severe PH in patients seen in contemporary hospital settings, determine the patients' one-year survival and the factors associated with mortality following standard care. Methods: A retrospective review of patients diagnosed with moderate to severe PH at Aga Khan University Hospital (AKUHN) from August 2014 to July 2017 was carried out. Clinical and outcome data were collected from medical records and the hospital mortality database. Telephone interviews were conducted for patients who died outside the hospital. Survival analysis was done using Kaplan-Meier, and log-rank tests were used to assess differences between subgroups. Cox regression modelling with multivariable adjustment was used to identify factors associated with all-cause mortality. Results: A total of 659 patients with moderate to severe PH were enrolled. Median follow-up time was 626 days. The survival rates of the patients at 1 and 2 years were 73.8% and 65.9%, respectively. The following variables were significantly associated with mortality: diabetes mellitus [adjusted HR 1.52, 95% CI (1.14-2.01)], WHO functional class III/IV [adjusted HR 3.49, 95% CI (2.46-4.95)], atrial fibrillation [adjusted HR 1.53, 95% CI (1.08-2.17)], severe PH [adjusted HR 1.72, 95% CI (1.30-2.27)], right ventricular dysfunction [adjusted HR 2.42, 95% CI (1.76-3.32)] and left ventricular dysfunction [adjusted HR 1.91, 95% CI (1.36-2.69)].Obesity [adjusted HR 0.68, 95% CI (0.50-0.93)] was associated with improved survival. Conclusion: Pulmonary hypertension is associated with poor long-term outcomes in African patients. Identification of prognostic factors associated with high-risk patients will assist in patient management and potentially improved outcomes.

Prevalence and etiologies of pulmonary hypertension at Somalia-Turkey Training and Research Hospital in Mogadishu

“…In contrast, this rate was 5.7% in the study conducted by Nugunga et al . in Kenya [ 7 ] and was reported as 4.2% in the study conducted by Duffels et al . in Europe [ 27 ].…”

“…Because of the variability of etiological factors, the prevalence of PH in African countries is higher than in developed countries [ 4 , 5 ]. Studies on mortality in a small number of countries on the continent have shown that PH is the leading cause of death [ 6 , 7 ]. Somalia, where our study was conducted, has a special place among African countries; in this country, there is no social security system and social state policy due to the ongoing civil war [ 8 ].…”

The Association of Body Mass Index With Mortality Among Pulmonary Hypertension Patients: A Systematic Review and Meta-Analysis of Cohort Studies

“…As mentioned above, a total of fifteen studies were selected which, all in all, reported on a total of 127,215 participants and 73,999 incident cases published from 2005 to 2020. Most of relevant studies were conducted in US ( n = 8) ( 7 , 12 , 18 , 19 , 30 , 32 , 35 , 37 ), while others were run in China ( n = 2) ( 20 , 31 ), Kenia ( n = 1) ( 34 ), France ( n = 1) ( 38 ), Italy ( n = 1) ( 33 ), Israel ( n = 1) ( 17 ), Australia and New Zealand ( n = 1) ( 36 ). All studies focused on risk estimates for males and females.…”

“…In most of these publications, important cofounders such as age ( n = 7), smoking ( n = 2), and mediators including diabetes ( n = 6), hypertension ( n = 3) were adjusted in the analysis. Among the selected essays, six of them enjoy a rather high methodological quality (score ≥7) ( 7 , 18 , 20 , 34 , 37 , 38 ), while the other nine have a low quality (<7) ( Table 2 ).…”

Diagnosis and Treatment Patterns of Chronic Thromboembolic Pulmonary Hypertension in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia: A Registry Study

“…The situation may be further complicated by lack of awareness of CTEPH among physicians and patients, particularly where resources for healthcare education are devoted to more prevalent conditions [ 51 ]. The proportion of patients with PH who have CTEPH has been reported as 16% in Egypt [ 52 ], 5% in Kenya [ 53 ], and 2% in the Pan-African Pulmonary Hypertension Cohort (PAPUCO) Registry [ 54 ]. These observations suggest that the diagnosis and management of CTEPH may be especially challenging in the African continent.…”