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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 5, September/October 2014
AFRICA
219
Results
Overall, there were 150 men (52.6%) and 135 (47.4%) women
(Table 1). The mean age was 56.3
±
15.6 years (57.0
±
13.6 and
55.4
±
17.6 years for men and women, respectively) with 46%
aged
≥
60 years. Around one-third had no formal education,
two-thirds were married and most (75.8%) were urban residents.
The majority of the subjects were in NHYA class III (75.4%).
The women were more likely not to have had formal education
(43.7 vs 26.0%,
p
=
0.029), more likely not to be a smoker (96.3
vs 68.7%,
p
<
0.001), and less likely to be a current alcohol user
(2.2 vs 9.3%,
p
<
0.001). Alternatively, men had higher rates of
hypertension (85.3 vs 77.0%) and chronic obstructive pulmonary
disease (COPD) (7.3 vs 6.7%).
Table 2 shows the laboratory profile, aetiological risk
factors and discharge medications. Serum urea and creatinine
concentrations were significantly higher in men than women.
Except for peripartum cardiomyopathy (PPCM), the
aetiological risk factors were similar in men and women.
Hypertensive heart disease was found in 75.8% of patients,
dilated cardiomyopathy in 8.4%, cor pulmonale in 5.6%,
pericardial diseases in 3.2% and rheumatic heart disease in
2.5%. PPCM, thyroid heart disease, coronary artery disease and
endomyocardial fibrosis were found in 2.1, 1.1, 0.4, 0.4 and 0.7%
of patients, respectively.
The discharge medications were similar in men and women
except for beta-blockers, which were prescribed more in men.
Table 3 depicts the 12-lead ECG and echocardiographic
parameters according to gender. Men had significantly higher
mean absolute QT intervals (374
±
35.0 vs 348
±
45.5 ms,
p
=
0.006), left atrial area (28.8
±
8.8 vs 25.0
±
6.4 cm
2
,
p
=
0.010),
LV internal dimension in systole, as well as absolute and indexed
LV mass (
p
=
0.001, 0.026 and 0.016, respectively). On the other,
hand women had significantly higher ejection fractions (45.1
±
20.1 vs 40.6
±
23.6,
p
=
0.007).
The mean length of hospital stay was 10.5
±
5.9 days, (11.0
±
5.4 and 10.0
±
6.3 days for women and men, respectively).
Mortality rate at 30 days was 4.2% (95% CI: 2.4–7.3) for the
whole cohort. It was 3.9% (95% CI: 1.7–8.5%) and 4.5% (95%
CI: 2.1–9.3%) for men and women, respectively. At 180 days,
the mortality rate was 7.3% (95% CI: 4.7–11.2%). This was 7.1%
(95% CI: 3.8–12.7%) and 7.5% (95% CI: 3.9–14.0%) for men and
women respectively.
Patients with pericardial diseases had the highest early
mortality rate. Hypertensive HF subjects had the best survival
rates (Figs 1–3). At 180 days, 13.9% of the subjects were
rehospitalised at least once (14.6% for women and 13.3% for
men).
Table 4 shows the univariate correlates of survival in the
cohort. Mortality was associated with female gender, being
single, HF with normal ejection fraction, lower blood pressure,
higher heart and respiratory rates, higher body temperature,
anaemia, high creatinine levels and higher total white blood
cell counts. Other factors included higher QRS duration and
corrected QT interval, larger left atrial diameter and area, higher
Table 1. Demographic and clinical profile characteristics of the cohort.
Variable
All
(
n
=
285)
Men
(
n
=
150)
Women
(
n
=
135)
p
-value
Socio-demographic variables
Age (years)
60.0
±
13.2 57.0 (13.6) 55.6 (17.3) 0.382
Age
>
60 years (%)
46.3
48.7
43.7
0.425
No education
98 (34.4)
39 (26.0)
59 (43.7)
0.028
Married (%)
156 (67.8)
92 (73.0)
64 (61.0)
0.014
Unemployed
7 (2.3)
1 (0.6)
6 (4.2)
0.007
Urban residence
216 (75.8) 113 (75.3) 103 (76.5)
0.389
Risk factors and co-morbidities
Never smoked cigarettes
233 (81.8) 103 (68.7) 103 (96.3)
<
0.001
Current alcohol use
17 (6.0)
14 (9.3)
3 (2.2)
<
0.001
Diabetes mellitus
37 (13.0)
19 (12.7)
18 (13.3)
0.735
Hypertension
232 (81.4) 128 (85.3) 134 (77)
0.103
COPD
20 (7.0)
11 (7.3)
9 (6.7)
0.923
Family history of heart
disease
25 (8.8)
9 (6.0)
16 (11.9)
0.240
Clinical/laboratory parameters
NYHA class
Class II
24 (8.4)
16 (10.7)
8 (5.9)
0.212
Class III
215 (75.4) 107 (71.3) 108 (80.0)
Class IV
46 (16.1)
27 (18.0)
19 (14.1)
BMI (kg/m
2
)
25.2
±
5.7 24.1 (5.0)
23.7 (5.5)
0.527
Systolic BP (mmHg)
131.9
±
25.1 137.9 (30.0) 133.3 (27.9) 0.253
Diastolic BP (mmHg)
85.4
±
15.9 89.0 (19.6) 85.3 (17.1) 0.156
Pulse pressure (mmHg)
46.5
±
15.7 49.0 (19.0) 47.7 (16.6) 0.527
Respiratory rate (cycles/min) 30.2
±
6.5 28.5
±
6.4 27.9
±
6.7 0.541
Pulse rate (bpm)
95.9
±
16.7 96.2
±
18.2 96.3
±
17.8 0.527
Packed cell volume (%)
35.9
±
7.8 37.5
±
7.2 36.8
±
7.7 0.541
Total white blood cell count
(
×
10
9
cells/l)
6.4
±
2.9 7.3
±
3.7 7.4
±
3.8 0.933
Serum sodium (mmol/l)
136.5
±
6.4 135.9
±
6.7 136.3
±
6.1 0.134
Serum potassium (mmol/l)
3.7
±
0.8 3.7
±
0.8 3.6
±
0.8 0.461
Total cholesterol (mg/dl)
162.5
±
53.3 157.7
±
84.0 181.2
±
64.6 0.213
Serum glucose (mg/dl)
111.7
±
53.2 115.6
±
50.6 114.0
±
58.5 0.845
Serum urea (mg/dl)*
38.5
±
30.0 50.5
±
51.4 36.1
±
29.7 0.020
Serum creatinine (mg/dl)*
1.8
±
0.4 1.7
±
2.5 1.2
±
1.4 0.093
COPD = chronic obstructive pulmonary disease.
Table 2. Aetiology of HF and discharge medications
in the 285 subjects.
Variable
All
(
n
=
285)
Men
(
n
=
150)
Women
(
n
=
135
Aetiology of HF,
n
(%)
Hypertension
216 (75.8) 119 (79.3)
97 (71.9)
Dilated cardiomyopathy
24 (8.4)
16 (10.7)
8 (5.9)
Cor pulmonale
16 (5.6)
9 (6.0)
7 (5.2)
Pericardial diseases
9 (3.2)
1 (0.7)
8 (5.9)
Rheumatic heart disease
7 (2.5)
4 (2.7)
3 (2.2)
Peripartum cardiomyopathy
6 (2.1)
0 (0.0)
6 (4.4)
Thyroid heart disease
3 (1.1)
0 (0.6)
3 (2.2)
Ischaemic heart disease
1 (0.4)
1 (0.7)
0 (0.0)
Adult congenital heart disease
1 (0.4)
0 (0.0)
1 (0.7)
Endomyocardial fibrosis
2 (6.7)
0 (0.0)
2 (0.7)
Type of heart failure
Systolic heart failure (%)
66.4
71.4
60.9
Heart failure with normal EF (%) 33.6
28.6
39.1
Medications,
n
(%)
Loop diuretics
249 (87.4) 132 (88.0) 117 (86.7)
Digoxin
219 (76.8) 114 (76.0) 105 (77.8)
ACE inhibitors/ARBs
281 (98.6) 148 (98.7) 133 (98.5)
Beta-blockers
56 (19.6)
35 (23.3)
21 (15.6)
Spironolactone
247 (86.7) 133 (87.3) 116 (85.9)
Hydrallazine–isosorbide
33 (11.7)
19 (12.9)
14 (10.4)
Amiodarone
5 (1.8)
4 (2.7)
1 (0.7)