title: Presentation and mortality of patients hospitalised with acute heart failure in Botswana.
abstract: BACKGROUND
  Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana.
  
  
  METHODS
  Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed.
  
  
  RESULTS
  The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay.
  
  
  CONCLUSIONS
  AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV.
authors.affiliation: Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana. Email: jmwita@gmail.com.
authors.forename: Julius Chacha
authors.initials: JC
authors.lastname: Mwita
authors.affiliation: Department of Cardiology, North Tees and Hartlepool NHS Foundation Trust, UK.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Dewhurst
authors.affiliation: Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana.
authors.forename: Mgaywa G
authors.initials: MG
authors.lastname: Magafu
authors.affiliation: Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana.
authors.forename: Monkgogi
authors.initials: M
authors.lastname: Goepamang
authors.affiliation: Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana.
authors.forename: Bernard
authors.initials: B
authors.lastname: Omech
authors.affiliation: Department of Internal Medicine, University of Botswana, Gaborone, Botswana.
authors.forename: Koketso Lister
authors.initials: KL
authors.lastname: Majuta
authors.affiliation: Department of Internal Medicine, University of Botswana, Gaborone, Botswana.
authors.forename: Marea
authors.initials: M
authors.lastname: Gaenamong
authors.affiliation: Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana.
authors.forename: Tommy Baboloki
authors.initials: TB
authors.lastname: Palai
authors.affiliation: Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana.
authors.forename: Mosepele
authors.initials: M
authors.lastname: Mosepele
authors.affiliation: Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana.
authors.forename: Yohana
authors.initials: Y
authors.lastname: Mashalla
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001902:Botswana / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D015995:Prevalence; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain