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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018
46
AFRICA
Short-term rehospitalisation or death and determinants
after admission for acute heart failure in a cohort of
African patients in Port Harcourt, southern Nigeria
Maclean R Akpa, Okechukwu Iheji
Abstract
Background:
Heart failure (HF) is a major health burden glob-
ally and contributes significantly to morbidity and mortality
related to cardiovascular disease. The aim of this study was
to determine the outcome, and factors determining these
outcomes in patients admitted for acute HF and followed up
for six months.
Methods:
This was a hospital-based, prospective study.
Subjects included consecutive patients with a confirmed
diagnosis of acute HF admitted to the medical wards of the
University of Port Harcourt Teaching Hospital (UPTH) in
Nigeria over one year. All had a full physical examination and
relevant investigations, including echocardiography. Subjects
were followed up for six months and reassessed for outcome/
endpoint, which was rehospitalisation or death. Factors that
predicted these outcomes were also determined.
Results:
There were 160 subjects, 84 females and 76 males, age
range 20 to 87 years, mean age 52.49
±
13.89 years. Sixteen
subjects (10.0%) were lost to follow up, 66 (41.3%) showed
clinical improvement, 57 (35.6%) were rehospitalised, while
21 (13.1%) died. Determinants of rehospitalisation were New
York Heart Association (NYHA) class, heart failure type,
haemoglobin level at presentation and estimated glomeru-
lar filtration rate (eGFR). Determinants of mortality were
NYHA class and haemoglobin level at presentation.
Conclusion:
Heart failure rehospitalisation and mortality
rates of 35.6 and 13.1%, respectively, were high compared to
developed countries.
Keywords:
heart failure, outcomes, rehospitalisation, mortality
Submitted 17/8/16, accepted 12/8/17
Cardiovasc J Afr
2018;
29
: 46–50
www.cvja.co.zaDOI: 10.5830/CVJA-2017-038
Heart failure (HF) is the end stage of most diseases of the heart
and a major cause of morbidity and mortality. Thomas Lewis
aptly captured the high premiumplaced onHF as far back as 1933
when he remarked, ‘The very essence of cardiovascular practice
is the early detection of heart failure’.
1
The worldwide prevalence
and incidence rates of HF are approaching epidemic levels, as
evidenced by the increasing number of HF hospitalisations and
HF-attributable mortalities, as well as the high costs associated
with the care of HF patients.
2
Worldwide, HF affects almost 23 million people,
2
with nearly
five million people in the United States
3
and up to three million
people in the United Kingdom being affected.
4
It is estimated to
account for about 5% of admissions to hospital medical wards,
with over 100 000 annual admissions in the United Kingdom.
1
The financial burden of HF in most countries is very substantial.
In the United States about $37.2 billion was spent directly or
indirectly on HF management in 2009, with $20.1 billion of the
expenditure largely related to hospitalisation.
5
In Africa, HF has become a dominant form of cardiovascular
disease, with great social and economic consequences due to its
high prevalence and mortality rate, and the impact on young,
economically active individuals.
5
The peak incidence of HF in
African patients remains in the fifth decade,
6
and hospital case
fatality rates range from nine to 12.5%.
7
This high death rate
ranks HF among the major causes of death of cardiovascular
origin in Africa.
7
In Port Harcourt, Niger delta region of
Nigeria, HF was the third commonest non-communicable
cause of admission (next to diabetes and its complications
and cerebrovascular disease) and contributed 9.6% of patients
admitted to the medical wards over a five-year period.
8,9
The prognosis of HF is uniformly poor. The one-year
mortality rate in patients with severe HF (NYHA class IV) is
between 30 and 70%, and in patients with HF in NYHA classes
I–III, the annual mortality rate is five to 10%.
10,11
Other important
variables that have been found to influence the outcome in HF
patients include co-morbidities, estimated glomerular filtration
rate (eGFR) and haemoglobin level, left ventricular function, as
well as treatment or interventions received.
12-15
Identifying the predictors of rehospitalisation and mortality
among HF patients is vital in helping physicians to risk stratify
their HF patients and chart the best possible post-discharge
plan.
16
There is however a dearth of data on the outcome profile
of patients admitted with HF in the Niger delta region of
Nigeria. The aim of this study was to determine the short-term
(six-month) outcome and factors influencing these outcomes
in patients admitted with acute HF in Port Harcourt, southern
Nigeria.
Methods
The was a hospital-based, prospective study carried out in the
medical wards of the University of Port Harcourt Teaching
Hospital (UPTH), Port Harcourt, Niger delta region of Nigeria.
Cardiovascular Division, Department of Internal Medicine,
Faculty of Clinical Sciences, University of Port Harcourt,
Port Harcourt, Nigeria
Maclean R Akpa, MB BS, FWACP; FRCP (Lond), akpamac@yahoo.
com;
macakpa12@gmail.com;
maclean.akpa@uniport.edu.ngCardiovascular Division, Department of Internal Medicine,
University of Port Harcourt Teaching Hospital, Port
Harcourt, Nigeria
Okechukwu Iheji, MB BCh, FWACP