CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 68 AFRICA Cardiovascular Topics Epidemiology and management of heart failure with reduced ejection fraction in a Tunisian university hospital Meriem Drissa, Habiba Drissa, Sana Helali, Khalil Oughlani, Amani Farah, Marwa Chebbi Abstract Introduction: Despite considerable advances in treatment, heart failure (HF) remains a serious public health problem linked to a high rate of mortality. The aim of this work was to describe the epidemiological, clinical and evolutionary features of HF in a Tunisian university hospital. Methods: This was a retrospective study including 350 hospitalised patients diagnosed with HF with reduced ejection fraction (≤ 40%) during the period between 2013 and 2017. Results: The average age was 59 ± 12 years. A male predominance was noted. The main cardiovascular risk factor was the use of tobacco (47%). The electrocardiogram showed atrial fibrillation in 41% of patients and left bundle branch block in 36% of patients. Laboratory results revealed an electrolyte disorder in 30 cases, renal insufficiency in 25% of patients and anaemia in 20%. Echocardiography revealed reduced ejection fraction, with an average of 34 ± 6% (range: 20–40%). The main causes of HF were ischaemic heart disease in 157 patients. The most commonly used medications were diuretics (90% of patients), angiotensin converting enzyme inhibitors (88%), beta-blockers (91%) and mineralocorticoid receptor antagonists (35%). Cardiac resynchronisation therapy was performed on 30 patients and cardioverter defibrillator implantation on 15 patients. The hospital mortality rate was 10% and the average hospital stay was 12 ± 5 days. During six months of follow up, 56 patients died and 126 were re-admitted. Multivariate model predictors of six-month mortality were: age [odds ratio (OR): 8, p = 0.003], ischaemic HF (OR: 1.63, p = 0.01) and diabetes (OR: 21, p = 0.004) Conclusion: This study illustrates the main characteristics of HF in our population. These include relatively young age, a predominance of males, ischaemic heart disease as the main aetiology, insufficient care strategies and a poor prognosis. Keywords: heart failure, epidemiology, aetiology, treatment, Tunisia Submitted 24/5/18, accepted 19/11/18 Published online 3/5/23 Cardiovasc J Afr 2023; 34: 68–72 www.cvja.co.za DOI: 10.5830/CVJA-2018-070 Heart failure (HF) is a serious public health problem leading to increased morbidity and mortality rates worldwide.1,2 Its fast spread over the last few years has been largely linked to aging populations. However, remarkable improvements in HF treatment have increased life expectancy for HF patients and decreased myocardial infarction cases.3 It is important to determine the different diseases leading to HF in order to be able to adjust the diagnosis, and therapeutic and preventative approaches.1 The type of cardiac structural abnormality and triggering factors causing acute decompensation must also be determined. Over the last 20 years, great efforts have been made to improve HF management. These include the use of drugs that interfere with neurohormonal activation, device therapy for selected patients, and multidisciplinary disease management. Despite these advances in therapy and diagnosis, the prognosis of patients with HF remains poor, with increasing mortality rates. There are sufficient data concerning HF characteristics in developed countries while other world regions, including Tunisia, lack sufficient information. The main objective of this work was, therefore, to describe the epidemiological and clinical profile of patients, while providing data about the outcome and management approach in a Tunisian university hospital. The study also aimed to determine the predictors of six-month mortality and re-admission rates. Methods This was a retrospective study including 380 hospitalised chronic HF patients in the adult cardiology department of the Rabta Hospital in Tunis during the period 2013 to 2017. Fig. 1 shows a flow chart of the enrolled patients. Patient consent was obtained and the study was approved by the ethics committee of the Rabta Hospital. We excluded isolated right HF patients (n = 10), those with HF with intermediate ejection fraction (40% < EF < 50%) (n = 15) and patients with HF with preserved ejection fraction (EF ≥ 50%) (n = 5) The final study group encompassed 350 patients with reduced EF (< 40%). Data were extracted from the medical records of the patients. Department of Cardiology, Rabta Hospital, Tunis, Tunisia Meriem Drissa, MD Habiba Drissa, MD, akramhorizon@yahoo.fr Sana Helali, MD Khalil Oughlani, MD Amani Farah, MD Marwa Chebbi, MD
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