Spectrum of cardiovascular diseases in six main referral hospitals of Ethiopia

2019

Preprint

Background In population studies of heart failure (HF), diabetes was shown to be an independent risk factor but the evidence regarding Diabetes Mellitus (DM) having incremental effect in incidence of HF in patients with ischemic heart disease (IHD) is scarce. Our study aimed to assess the incidence of HF in diabetic IHD patients compared to non-diabetic IHD patients. Methods A retrospective cohort study was conducted among 306 patients with IHD followed-up at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The IHD patients who did not have HF at baseline were followed for 24 months beginning from November 30, 2015. We assessed the incidence of HF in patients with diabetic IHD versus the non-diabetic IHD. Cox proportional hazards models were used to assess the association between diabetic IHD and HF after controlling for important covariates. Results Mean age was 56.8 years and male patients accounted for 69%. Prevalence of DM was 31.4% (n=96). During the 24 months follow-up period, 196 (64.1%) had incident HF. Predictors of incident HF were female sex [COR 2.2(1.3-3.8), p=0.006], DM [COR 1.8 (1.1-3.0), p = .04], older age [t (304) = 2.5, p = 0.01, two tailed], bigger left atrial size [t (196) = 2.9, p = 0.005, two-tailed], and lower hemoglobin [t (232) = - 2.3, p = 0.02, two-tailed]. On multivariate Cox regression, DM was significantly associated with incident HF [Hazard Ratio = 2.04, 95% CI: 1.32-3.14, p = 0.001]. Furthermore, when the patients were stratified by hypertension (HTN), DM was associated with worse prognosis, the strongest association being in those with co-existing DM and HTN [HR = 2.57,95% CI =1.66-3.98, p<0.0001] followed by the presence of DM without HTN [HR 2.27, 95% CI = 1.38-3.71, p=0.001]. Conclusion DM is the strongest predictor of incident HF in patients with IHD. It is worse when DM is combined with HTN.

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Incidence of Heart Failure among Diabetic Patients with Ischemic Heart Disease: A Cohort Study

2019

Preprint

“…Moreover, the prevalence of IHD and associated morbidities thought to be increasing because of the rising adverse behavioral and lifestyle changes that are associated with the rising urbanization and epidemiologic transition. In Ethiopia, the proportion of IHD has dramatically increased from 88 to 960 per 100,000 patients with cardiovascular disease over the last 30 years [3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

“…Etiologies and clinical characteristics of HF were studied in Sub-Saharan Africa even though there are no population studies that provide evidence on its incidence or prevalence [19]. In Ethiopian setting where there is a change in the trend of underlying causes of heart failure with a dramatically increasing prevalence of IHD and a continually increasing prevalence of DM [5,6], it is imperative to study the effect of DM on the incidence of HF in patients with IHD. Besides, evidence regarding the incremental impact of DM on HF in patients with IHD is scarce.…”

Section: Introductionmentioning

confidence: 99%

Incidence of heart failure among diabetic patients with ischemic heart disease: a cohort study

2020

BMC Cardiovasc Disord

Background: In population studies of heart failure (HF), diabetes has been shown to be an independent risk factor. However, the evidence evaluating diabetes mellitus (DM) as an independent risk factor in incident HF in patients with ischemic heart disease (IHD) is scarce. Our study aimed to assess the incidence of HF in diabetic IHD patients compared to non-diabetic IHD patients in Ethiopia.Methods: A retrospective cohort study was conducted among 306 patients with IHD followed-up at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The IHD patients who did not have HF at baseline were followed for 24 months beginning from November 30, 2015. We assessed the incidence of HF in patients with diabetic IHD versus the non-diabetic IHD. Cox proportional hazards models were used to assess the association between diabetic IHD and HF after controlling for important covariates. Hypertension was examined as a possible effect modifier as well.Results: The mean age was 56.8 years, 69% were male, and 31% were diabetic. During the 24 months follow-up period, 196 (64.1%) had incident HF. On multivariate Cox regression, DM was significantly associated with incident HF [Hazard Ratio = 2.04, 95% confidence interval (CI): 1.32-3.14, p = 0.001]. Furthermore, when the patients were stratified by hypertension (HTN), DM was associated with worse prognosis, the strongest association being in those with co-existing DM and HTN [HR = 2.57,95% CI =1.66-3.98, p < 0.0001] followed by the presence of DM without HTN [HR 2.27, 95% CI = 1.38-3.71, p = 0.001] (compared to those with neither).Conclusion: DM is the strongest predictor of incident HF, compared to other traditional risk factors, in Ethiopian patients with IHD. Those with both DM and HTN are at the highest risk.

“…Etiologies and clinical characteristics of HF were studied in Sub-Saharan Africa even though there are no population studies that provide evidence on its incidence or prevalence (19). In Ethiopian settings, where there is a change in the trend of underlying causes of heart failure with an increasing prevalence of IHD and DM (5,6), it is imperative to study the effect of DM on the incidence of HF in patients with IHD to uncover potential etiologies and treatments. In addition, overall evidence regarding the incremental impact of DM on HF in patients with IHD is scarce.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Heart Failure among Diabetic Patients with Ischemic Heart Disease: A Cohort Study

2020

Preprint

Background: In population studies of heart failure (HF), diabetes mellitus (DM) has been shown to be an independent risk factor. However, the evidence evaluating it as an independent risk factor in incident HF in patients with ischemic heart disease (IHD) is scarce. Our study aimed to assess the incidence of HF in diabetic IHD patients compared to non-diabetic IHD patients in Ethiopia. Methods: A retrospective cohort study was conducted among 306 patients with IHD followed-up at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia. The IHD patients who did not have HF at baseline were followed for 24 months beginning from November 30, 2015. We assessed the incidence of HF in patients with diabetic IHD versus the non-diabetic IHD. Cox proportional hazards models were used to assess the association between diabetic IHD and HF after controlling for important covariates. Hypertension was examined as a possible effect modifier as well. Results: The mean age was 56.8 years, 69% were male, and 31% were diabetic. During the 24 months follow-up period, 196 (64.1%) had incident HF. On multivariate Cox regression, DM was significantly associated with incident HF [Hazard Ratio = 2.04, 95% confidence interval (CI): 1.32-3.14, p = 0.001]. Furthermore, when the patients were stratified by hypertension (HTN) status, DM was associated with worse prognosis, and the strongest association was in those with co-existing DM and HTN [HR = 2.57,95% CI =1.66-3.98, p<0.0001], followed by the presence of DM without HTN [HR 2.27, 95% CI = 1.38-3.71, p=0.001] (compared to those with neither). Conclusion: DM is the strongest predictor of incident HF, compared to other traditional risk factors, in Ethiopian patients with IHD. Those with both DM and HTN are at the highest risk. Key Words: Ischemic heart disease; Heart failure; Incidence; Diabetes Mellitus; Retrospective cohort study