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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 2, March/April 2017
112
AFRICA
Presentation and mortality of patients hospitalised with
acute heart failure in Botswana
Julius Chacha Mwita, Matthew J Dewhurst, Mgaywa GMD Magafu, Monkgogi Goepamang, Bernard
Omech, Koketso Lister Majuta, Marea Gaenamong, Tommy Baboloki Palai, Mosepele Mosepele,
Yohana Mashalla
Abstract
Introduction:
Heart failure is a common cause of hospitalisa-
tion 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 dysfunc-
tion. 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%, respec-
tively. 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 mortal-
ity 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.
Keywords:
acute heart failure, in-hospital mortality, length of
hospital stay, outcomes, Botswana
Submitted 31/3/16, accepted 19/6/16
Published online 24/8/16
Cardiovasc J Afr
2017;
28
: 112–117
www.cvja.co.zaDOI: 10.5830/CVJA-2016-067
The prevalence of heart failure (HF) is increasing in Africa,
adding to the already existing burden of infectious diseases
and making HF a common cause of hospitalisation on the
continent.
1,2
HF is one of the primary reasons for regular hospital
visits and admissions, accounting for about three to 7% of
admissions in Africa.
3
In spite of advances in treatment, patients
admitted with acute heart failure (AHF) have outcomes that are
worse than many types of cancer.
4,5
In Africa, where the majority
of patients are likely to present late and with severe symptoms,
the in-hospital mortality rate of AHF ranges from nine to
12.5%, which is considerably higher than in developed countries.
6
Even after hospital discharge, case fatality rates for HF remain
high, with mortality rates of more than 25, 40 and 75% at three
months, one year and five years after diagnosis, respectively.
7-9
Although HF management has advanced in the Western
world, in many developing countries, including Botswana,
the benefits may not be evident for several reasons, including
insufficient human resources, lack of appropriate medications
and discontinuity of care. This study aimed to describe clinical
profiles and outcomes in patients with AHF admitted at Princess
Marina Hospital (PMH) in Gaborone, Botswana.
Methods
This was an observational study conducted at PMH, Botswana’s
major tertiary and referral hospital, with a catchment population
Department of Internal Medicine, University of Botswana,
Gaborone, Botswana
Julius Chacha Mwita, MD, MMed, MSc,
jmwita@gmail.comBernard Omech, MB ChB, MMed
Koketso Lister Majuta, MB BS
Marea Gaenamong, MB BS
Tommy Baboloki Palai, MB BS
Mosepele Mosepele, MD, MSc
Department of Cardiology, North Tees and Hartlepool NHS
Foundation Trust, UK
Matthew J Dewhurst, MD, MRCP
Department of Family Medicine and Public Health,
University of Botswana, Gaborone, Botswana
Mgaywa GMD Magafu, MD, MPH, PhD
Department of Internal medicine, Princess Marina Hospital,
Gaborone,Botswana
Julius Chacha Mwita, MD, MMed, MSc,
Monkgogi Goepamang, MB ChB, MRCPI
Bernard Omech, MB ChB, MMed
Tommy Baboloki Palai, MB BS
Mosepele Mosepele, MD, MSc
Department of Biomedical Sciences, University of
Botswana, Gaborone, Botswana
Yohana Mashalla, MD, PhD