Characteristics, treatment and short-term survival of patients with heart failure in a cardiology private practice in Jamaica.
BACKGROUND
Randomized clinical trials have demonstrated improvement in mortality with angiotensin converting enzyme inhibitors (ACEIs), beta blockers and aldosterone antagonists. The use of these lifesaving treatments remain inadequate.


OBJECTIVE
To determine the clinical features, aetiology, treatment and short-term survival of heart failure in a cardiology private practice in Jamaica.


METHODS
This is a retrospective analysis of the medical records of 1055 consecutive patients presenting to a consultant cardiologist private practice between January 2002 and March 2003. Data were extracted from the records of the first 100 patients with heart failure.


RESULTS
Most were over 65 years of age, female, never smoked cigarettes, overweight/obese and hypertensive (82%). The most commonly prescribed medications at one month were ACEIs (91%), beta blockers (88%) and loop diuretics (55%). The main aetiologies were hypertension (54%) and ischaemic heart disease (IHD) (26%). Ninety-one per cent were in sinus rhythm and 6% in atrial fibrillation. Forty-nine per cent had echocardiograms, of these 39% had ejection fractions (EF) > 40% and 27% had EF < or = 20%. The survival at one year was 81%.


CONCLUSIONS
Hypertension was the major aetiology of heart failure followed by IHD. Medical treatment closely approached the recommended standards of major heart failure guidelines with high ACEI and beta blocker use comparable to recent heart failure trials. Short-term survival was very high.
Lalljie
G R
GR
Coastal Internal Medicine and Cardiology, Suite F-204 Baywest Centre, Harbour Street, Montego Bay, Jamaica, West Indies. glmd@hotmail.com
Lalljie
S E
SE
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002309:Cardiology / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007563:Jamaica; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists