Cardiovascular Journal of Africa: Vol 25 No 5 (September/October 2014)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 5, September/October 2014

AFRICA

217

Short-term outcomes after hospital discharge in patients

admitted with heart failure in Abeokuta, Nigeria:

Data from the Abeokuta Heart Failure Registry

Okechukwu S Ogah, Simon Stewart, Ayodele O Falase, Joshua O Akinyemi, Gail D Adegbite,

Albert A Alabi, Amina Durodola, Akinlolu A Ajani, Karen Sliwa

Abstract

Background:

Compared to other regions of the world, there

is a paucity of data on the short-term outcome of acute heart

failure (AHF) in Africa’s most populous country, Nigeria. We

examined the six-month outcomes (including case fatalities)

in 285 of 309 AHF subjects admitted with HF to a tertiary

hospital in Abeokuta, Nigeria.

Methods:

The study cohort of 285 subjects comprised 150

men (52.6%) and 135 women (47.4%) with a mean age of 56.3

15.6 years and the majority in NYHA class III (75%).

Results:

There were a number of differences according to the

subject’s gender; men being older and more likely to present

with hypertensive heart disease (with greater left ventricular

mass) while also having greater systolic dysfunction. Mean

length of stay was 10.5

5.9 days. Mean follow up was 205

days, with 23 deaths and 20 lost to follow up. At 30 days,

4.2% (95% CI: 2.4–7.3%) had died and by 180 days this had

increased to 7.5% (95% CI: 4.7–11.2%); with those subjects

with pericardial disease demonstrating the highest initial

mortality rate. Over the same period, 13.9% of the cohort was

re-admitted at least once.

Conclusions:

The characteristics of this AHF cohort in

Nigeria were different from those reported in high-income

countries. Cases were relatively younger and presented with

non-ischaemic aetiological risk factors for HF, especially

hypertensive heart disease. Moreover, mortality and re-admis-

sion rates were relatively lower, suggesting region-specific

strategies are required to improve health outcomes.

Keywords:

heart failure, mortality, outcome, Abeokuta, Nigeria

Submitted 29/10/13, accepted 1/7/14

Cardiovasc J Afr

2014;

: 217–223

www.cvja.co.za

DOI: 10.5830/CVJA-2014-040

Heart failure (HF) has emerged as a global epidemic in at-risk

populations, including those living in high-income countries

and, as recently described, in low- to middle-income regions of

the world, such as sub-Saharan Africa.

1-4

While there are well-

established HF registries to capture both the characteristics

and health outcomes among those hospitalised with AHF in

Europe,

5,6

North America,

7,8

and the Asia–Pacific region,

3,9,10

there are few reports from sub-Saharan Africa.

This includes

Nigeria (the most populous country in the region), where HF has

emerged as a potentially large public health problem.

Although there have been many therapeutic gains in the

management of chronic HF,

leading to improved overall survival

rates,

there has been very little parallel success (pending further

evaluation of the recently reported RELAX trial

with regard

to AHF). This is particularly important when one considers the

high proportion of patients who still require hospitalisation for

acute HF, and associated high levels of in-patient case fatality

and poor short- to medium-term health outcomes.

Given the paucity of data describing health outcomes in

unselected patients hospitalised with AHF in Nigeria (and

indeed the wider sub-Saharan Africa), we examined short- (30

days) to medium-term outcomes (180 days) in consecutive

subjects with AHF recruited into the Abeokuta HF registry

over a period of six months. Standardised data collected via the

registry were used to both describe the baseline characteristics

of the cohort and identify correlates of mortality during the

six-month follow up.

Division of Cardiology, Department of Medicine, University

College Hospital, Ibadan, Nigeria

Okechukwu S Ogah, MBBS, FWACP, FESC, FACC,

osogah56156@yahoo.com

Ayodele O Falase, MBBS, MD, FWACP, FRCP

Soweto Cardiovascular Research Unit, Faculty of Health

Sciences, University of the Witwatersrand, Johannesburg,

South Africa

Okechukwu S Ogah, MBBS, FWACP, FESC, FACC

NHMRC Centre of Research Excellence to Reduce,

Inequality in Heart Disease Baker IDI Heart and Diabetes

Institute, Melbourne, Australia

Simon Stewart, PhD, FESC, FAHA

Karen Sliwa, MD, PhD, FESC, FACC

Department of Epidemiology and Medical Statistics,

College of Medicine, University of Ibadan, Nigeria

Joshua O Akinyemi, BSc, MSc

Karen Sliwa, MD, PhD, FESC, FACC

Department of Medicine, Sacred Heart Hospital, Lantoro,

Abeokuta, Nigeria

Gail D Adegbite, MBBS

Albert A Alabi, MBBS

Department of Medicine, Federal Medical Centre,

Abeokuta, Nigeria

Amina Durodola, MBBS

Akinlolu A Ajani, MBBS

Hatter Institute for Cardiovascular Research in Africa

and IIDMM, Department of Medicine, Faculty of Health

Sciences, University of Cape Town, South Africa

Karen Sliwa, MD, PhD, FESC, FACC