Descriptive epidemiology and short-term outcomes of heart failure hospitalisation in rural Haiti

Abstract

Objective: There is increasing attention to cardiovascular diseases in low-income countries. However, little is known about heart failure (HF) in rural areas, where most of the populations in low-income countries live. We studied HF epidemiology, care delivery and outcomes in rural Haiti.

Methods: Among adults admitted with HF to a rural Haitian tertiary care hospital during a 12-month period (2013-2014), we studied the clinical characteristics and short-term outcomes including length of stay, inhospital death and outpatient follow-up rates.

Results: HF accounted for 392/1049 (37%) admissions involving 311 individuals; over half (60%) were women. Mean age was 58.8 (SD 16.2) years for men and 48.3 (SD 18.8) years for women; 76 (41%) women were <40 years of age. Median length of stay was 10 days (first and second quartiles 7, 17), and inhospital mortality was 12% (n=37). Ninety nine (36%) of the 274 who survived their primary hospitalisation followed-up at the hospital's outpatient clinic, and 18 (6.6%) were readmitted to the same hospital within 30 days postdischarge. Decreased known follow-up (p<0.01) and readmissions (p=0.03) were associated with increased distance between patient residence and hospital. Among the one-quarter (81) patients with echocardiograms, causes of HF included: non-ischaemic cardiomyopathy (64%), right HF (12%), hypertensive heart disease (7%) and rheumatic heart disease (5%). One-half of the women with cardiomyopathy by echocardiogram had peripartum cardiomyopathy.

Conclusions: HF is a common cause of hospitalisation in rural Haiti. Among diagnosed patients, HF is overwhelming due to non-atherosclerotic heart disease and particularly affects young adults. Implementing effective systems to improve HF diagnosis and linkage to essential outpatient care is needed to reduce long-term morbidity and mortality.

Figure 1

Map of Haiti. The red shade indicates the number of patients with heart failure admitted from each communal section. Blue, green and grey outlines show catchment zones 1, 2 and 3, respectively. All other areas are part of zone 4.

Figure 2

Cascade of care for patients with heart failure admitted to University Hospital Mirebalais (UHM) (October 2013–September 2014). The total number of patients (darker bars) and number with echocardiograms (lighter bars) at each stage of care are shown. Linked patients had a UHM clinic visit ≤30 days after hospital discharge. Retained patients had a second clinic visit ≤30 days after the initial postdischarge clinic visit.

Figure 3

Proportion of patients linked to care (diamond) and readmitted (square) by zone. 95% CI bars are shown. Two-sided p values for Cochran–Armitage trend test across zones 1–4 are shown.