CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 AFRICA 69 Analysis of the following information was carried out: age, gender, co-morbidities, electrocardiography and echocardiography assessment, management approach and outcome, which included in-hospital precipitating factors of HF episode, and six-month mortality and re-admission rates. Our main focus was six-month mortality rates and re-admission episodes. Statistical analysis We calculated simple frequencies and relative frequencies (percentages) for qualitative variables, and means, medians and standard deviations for quantitative variables. We also used the chi-squared test and the student or Anova test, respectively, to compare two percentages and two averages. Multivariate analyses were conducted in order to determine the factors predicting mortality. This was performed using a Cox proportional hazard analysis in order to obtain a time-to-event risk ratio after adjustment for confounders. In all the statistical tests, the significance level was fixed at p < 0.05. Results The baseline characteristics of patients are reported in Table 1. The average age was 59 ± 12 years (range: 35–85). A male predominance was noted with a ratio of male:female of 1.2. The main cardiovascular risk factor in 164 patients was the use of tobacco (47%), followed by diabetes in 161 (46%) and hypertension in 150 patients (43%). The clinical presentation was dominated by signs of left HF in 192 patients (55%), global HF in 140 (40%) and cardiogenic shock in 18 patients (5%). The main electrocardiographic abnormalities were atrial fibrillation in 148 patients (41%), ventricular extrasystoles in 28%, non-sustained ventricular tachycardia in 8% and left bundle branch block in 126 patients (36%). Laboratory results showed hyponatraemia in almost 30% of cases (n = 105), renal impairment in 87 patients (25%), anaemia in 70 (20%) and a thyroid disorder was observed in 35 patients (10%). Echocardiography showed that the EF was reduced, with an average of 34 ± 6% (range: 20–40). The distribution of patients according to EF value is shown in Fig. 2. The global longitudinal strain calculated for 277 patients (79%) was altered in all cases, with an average value of –11 (range: –7.3 to –14.2) (26 ± 1.8%). Left ventricular filling pressures were high in 154 patients (44%), functional mitral regurgitation was noted in 214 patients (61%) and the right ventricle was dilated in 84 patients (24%), with impaired function in 11% of cases. Major factors were associated with exacerbation of HF, dominated by bronchopulmonary infection in 143 patients (41%) and non-compliance with medication and/or diet in 105 subjects (30%) (Fig. 3). The main aetiologies of HF were ischaemic heart disease in 157 patients (45%), valvular heart disease in 81 (23%), hypertension in 59 (17%) and cardiomyopathies in 35 patients (10%). The most commonly used medications were diuretics in 315 patients (90%), angiotensin converting enzyme inhibitors Table 1. General characteristics of our population Demographics Patients (n) Age 59 ± 12 Diabetes 161 Gender ratio 1.2 Tobacco use 164 Hypertension 150 Anaemia 70 Atrial fibrillation 148 LBB 126 Ejection fraction (%) 34 ± 6 Aetiology Ischaemic 157 Hypertensive 59 Valvular 81 Cardiomyopathies 35 ACEI use 308 BB use 319 Resynchronisation 30 DAI 16 LBBB: left bundle branch block, ACEI: angiotensin converting enzyme inhibitors, BB: beta-blockers, DAI: defibrillator automatic implantation. Population hospitalised for chronic HF n = 380 Included patients: first episode of HF with EF ≤ 40 % n = 350 Excluded patients Isolated right heart failure n = 10 Excluded patients: mid-range HF 40% < EF < 50% n = 15 Excluded patients: preserved HF EF ≥ 50% n = 5 Fig. 1. Flow chart of the study. HF: heart failure; EF: ejection fraction. EF [20–30%] EF [31–35%] EF [36–40%] 50% 38% 25% 13% 0% 28% 24% 48% Fig. 2. Population distribution according to ejection fraction. EF: ejection fraction.
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