Clinical characteristics and prognosis of patients admitted for heart failure: A 5-year retrospective study of African patients.
BACKGROUND
Mortality associated with heart failure (HF) remains high. There are limited clinical data on mortality among HF patients from African populations. We examined the clinical characteristics, long-term outcomes, and prognostic factors of African HF patients with preserved, mid-range or reduced left ventricular ejection fraction (LVEF).


RESULTS
We conducted a retrospective longitudinal cohort study of individuals aged ≥18years discharged from first HF admission between January 1, 2009 and December 31, 2013 from the Cardiac Clinic, Directorate of Medicine of the Komfo Anokye Teaching Hospital, Ghana. A total of 1488 patients diagnosed of HF were included in the analysis. Of these, 345 patients (23.2%) had reduced LVEF (LVEF<40%) [HFrEF], 265(17.8%) with mid-range LVEF (40%≥LVEF<50%) [HFmEF] and 878 (59.0%) had preserved LVEF (LVEF≥50%) [HFpEF]. Kaplan-Meier curves and log-rank test demonstrated better prognosis for HFpEF compared to HFrEF and HFmEF patients. An adjusted Cox analysis showed a significantly lower risk of mortality for HFpEF (hazard ratio (HR); 0.74; 95% confidence interval (CI) 0.57-0.94) p=0.015). Multivariate analyses showed that age, higher New York Heart Association (NYHA) functional class, lower LVEF, chronic kidney disease, atrial fibrillation, anemia, diabetes mellitus and absence of statin and aldosterone antagonist treatment were independent predictors of mortality in HF. Although, prognostic factors varied across the three groups, age was a common predictor of mortality in HFpEF and HFmEF.


CONCLUSIONS
This study identified the clinical characteristics, long-term mortality and prognostic factors of African HF patients with reduced, mid-range and preserved ejection fractions in a clinical setting.
School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia; Accident and Emergency Directorate, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana. Electronic address: kwadwo.oseibonsu@monash.edu.
Kwadwo Osei
KO
Bonsu
Directorate of Medicine, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana; Department of Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Electronic address: ikeowusu@yahoo.com.
Isaac Kofi
IK
Owusu
Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology. Electronic address: kchiefb@yahoo.co.uk.
Kwame Ohene
KO
Buabeng
School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia. Electronic address: daniel.reidpath@monash.edu.
Daniel D
DD
Reidpath
School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Selangor DE, Malaysia. Electronic address: amudha.kadirvelu@monash.edu.
Amudha
A
Kadirvelu
D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005869:Ghana / Q000453:epidemiology; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors
African patients; Heart failure; Preserved ejection fraction; Prognosis; Reduced ejection fraction