CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 2, May/June 2023 70 AFRICA (ACEI) in 308 (88%), beta-blockers (BB) in 319 (91%) and mineralocorticoid receptor antagonists (MRA) in 123 patients (35%). IschaemicHFwas treatedwith aspirin and statins. Sintrom was prescribed for atrial fibrillation. Electrolyte disturbance was corrected and anaemia was treated with iron therapy in the case of iron deficiency. In our study, the percentage of patients on all threemedications (ACEI, BB, MRA) was 45% (Fig. 4). The recommended optimal dose was reached in only 11% for ACEI, in 15% for BB and in 12% for MRA. None of the patients was put on ivabradine because it was not available in our hospital during the study period. Among the 157 patients with coronary artery disease, revascularisation was done on 125 ischaemic HF patients (80%). This consisted of coronary artery bypass graft in 18% and percutaneous coronary angioplasty in 82%. Fifty-six patients with valvular HF (70%) underwent valve surgery. We reported a low frequency of resynchronisation therapy (15%) and cardioverter defibrillator implantation (4.5%). Heart transplantation was not performed in our study. In-hospital mortality was 10%. The average length of hospital stay was 12 ± 5 days. In the six-month follow up, we reported death in 16% of patients and a 36% re-admission rate. Predictive factors for six-month mortality identified in univariate analysis are shown in Table 2. Table 3 shows the independent factors of six-month mortality rate, which were age [odds ratio (OR): 8, p = 0.003], ischaemic HF (OR: 1.63, p = 0.01) and diabetes (OR: 2, p = 0.004). Discussion HF is a common pathology. Its fast and widespread development makes it a major public health problem. The number of patients with HF is constantly increasing throughout the world due to aging populations and continuous improvement in the management of cardiovascular diseases.1,2 An estimated worldwide prevalence of HF was > 37.7 million in 2011.3 It is expected that by 2030, the number of HF patients would rise by 25%.4 In developed countries, the prevalence of HF is well known while in Tunisia, data are lacking. In the United States, the number of Americans suffering from HF reached five million in 2005 and more than 550 000 new cases are being diagnosed each year.5 Data for developing countries however are scarce in the literature. The prevalence of HF increases with age.6 The average age of our patients in this study was 59 ± 12 years. These data suggest that the Tunisian population with HF is relatively young compared to data from European and American series.7.8 This can be explained by the better quality of management of ischemic heart disease in these countries and by some aetiological characteristics of HF in emerging countries. The majority of our patients were male, which is confirmed by the literature.1,2,9 Left-sided HF was the most frequently observed clinical presentation in several series and also in our study.10 Table 2. Predictive factors of six-month mortality identified in univariate analysis Predictive factors Deaths (n = 56) Survival (n = 294) p-value Age (years) 62 ± 10 54 ± 11 0.04 Diabetes, n (%) 40 (71) 121 (41) < 0.0001 Atrial fibrillation, n (%) 25 (44.5) 132 (44) NS LBBB, n (%) 20 (36) 97 (32) NS Anaemia, n (%) 28 (50) 42 (14) 0.01 Renal impairement, n (%) 30 (53) 55 (18) 0.001 EF (%) 34 ± 4 36 ± 4 0.04 Ischaemic aetiology, n (%) 33 (59) 124 (42) 0.003 Medication with ACEI, n (%) 50 (89) 272 (92) NS Medication with BB, n (%) 29 (52) 299 (98) 0.01 Cardiover defibrillator, n (%) 2 (3.5) 14 (5) NS Resynchronisation therapy, n (%) 5 (5) 29 (10) NS AF: atrial fibrillation, LBBB: left bundle branch block, EF: ejection fraction, BB: beta-blocker. Table 3. Predictors of six-month mortality identified in multivariate analysis Predictors OR 95% CI p-value Diabetes 5 6.5–32 0.004 Age 10 1.3–1.16 0.003 Ischaemic aetiology 1.63 1.21–22 0.01 Medication with beta-blockers 0.4 0.34–0.09 0.01 ACE-I + BB ACE-I + BB + MRA ACE-I or BB 90% 68% 45% 23% 0% 82% 45% 12% Fig. 4. Therapeutic profile in our study. ACEI: angiotensin converting enzyme inhibitors; BB: beta-blockers; MRA: mineralocorticoid receptor antagonists. Ischaemic event Pulmonary embolism Non compliance with medication and/ or diet Arrhthmia Anemia Pulmonary infection 50% 38% 25% 13% 0% 22% 2% 30% 12% 23% 41% Fig. 3. Factors causing exacerbation of HF.
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