Management, clinical outcomes, and its predictors among heart failure patients admitted to tertiary care hospitals in Ethiopia: prospective observational study

Abstract

Background: Heart failure is a global pandemic, as it affects approximately 64.34 million people worldwide with a $346.17 billion global economic burden. The prevalence of heart failure has increased from 43.4 to 46.5% in the last 10 years in lower and middle-income countries. Most of the studies conducted in Ethiopia were retrospective cross-sectional, with limited study participants, and conducted in a single setting that commonly addresses the prevalence and pattern of heart failure rather than clinical outcome, associated factors, and specific management in different areas. Hence, this study aimed to assess management, clinical outcomes and their predictors among heart failure patients admitted to tertiary care hospitals in Ethiopia.

Methods: A prospective observational study design was conducted on heart failure patients admitted at two tertiary care hospitals in Ethiopia from September 2020 to May 2021. Using semi-structured questionnaires relevant data were collected from patients' medical records and face-to-face interviewing. Data were analyzed using SPSS version 23.0. A multivariate Cox regression model was performed to identify independent predictors of 90-day all-cause mortality. Variables with P values < 0.05 were considered statistically significant.

Results: Out of 283 patients enrolled in this study, 52.3% were male and the mean (± SD) age was 52.4 ± 17.9 years. The most common medications prescribed during hospitalization and discharge were diuretics (98.9% vs 95.6%), angiotensin I converting enzyme inhibitors/angiotensin II receptor blockers (48.8% vs 67.3%), and beta-blockers (46.6% vs 64.7%), respectively. In the present study, the 90-day all-cause mortality was 10.2%. Hypertension (HR = 3.7, 95% CI 1.2-11.6), cardiogenic shock (HR = 8.7, 95% CI 3.2-20.8), alcohol drinking (HR = 2.8, 95% CI 1.1-7.8), absence of angiotensin I converting enzyme inhibitors/angiotensin II receptor blockers (HR = 0.02, 95% CI 0.0-0.2), and reduced ejection fraction (HR = 1.5, 95% CI 1.1-3.8) were predictors of 90-day all-cause mortality.

Conclusion: High 90-day all-cause mortality was observed among heart failure patients in the present study. In the current study, the majority of heart failure patients were treated with diuretics. Alcohol drinking, hypertension, cardiogenic shock, reduced ejection fraction, and absence of angiotensin I converting enzyme inhibitors/angiotensin II receptor blockers drugs were predictors of poor treatment outcomes for whom restriction of alcohol consumption, early management of hypertension, reduced ejection fraction, cardiogenic shock, and providing angiotensin I converting enzyme inhibitors/angiotensin II receptor blockers drugs for all heart failure patients would be recommended to improve these poor treatment outcomes.

Keywords: All-cause mortality; Ethiopia; Heart failure; Outcomes.

Fig. 1

Strobe flow chart of study and sampling population

Fig. 2

List of common co-morbid diseases that co-exist with HF patients admitted to JUMC and AURH, Ethiopia between September 01, 2020 and March 01, 2021. AF-atrial fibrillation, CKD-chronic kidney disease, DM-diabetic Mellitus, HIV/AIDS-human immune deficiency virus and/or acquired immune deficiency syndrome, HTN-hypertension, LD-liver disease, TB-tuberculosis

Fig. 3

Underlying causes of heart failure patients admitted to JUMC and AURH, Ethiopia between September 01, 2020 and March 01, 2021. CRVHD-chronic valvular heart disease, DCM-dilated cardiomyopathy, DVHD-degenerative valvular heart disease, HHD-hypertensive heart disease, IE-infective endocarditis, IHD-ischemic heart disease, PHTN-pulmonary hypertension, LVH-left ventricular hypertrophy

Fig. 4

Classification of heart failure based on ejection fraction admitted to JUMC and AURH, Ethiopia between September 01, 2020 and March 01, 2021. HFmrEF-heart failure with mid-range ejection fraction, HFpEF-heart failure with preserved ejection fraction, HFrEF-heart failure with a reduced ejection fraction

Fig. 5

Kaplan Meier survival curves at 90-day all-cause mortality for patients with preserved, mid-range, and reduced ejection fraction of heart failure patients admitted to JUMC and AURH, Ethiopia between September 01, 2020, to March 01, 2021