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VOLUME 13 NUMBER 1 • JULY 2016
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Short-term outcomes after hospital discharge in patients
admitted with heart failure in Abeokuta, Nigeria: data from
the Abeokuta Heart Failure Registry
OKECHUKWU S OGAH, SIMON STEWART, AYODELE O FALASE, JOSHUA O AKINYEMI, GAIL D
ADEGBITE, ALBERT A ALABI, AMINA DURODOLA, AKINLOLU A AJANI, KAREN SLIWA
Correspondence to: Okechukwu S Ogah
Ayodele O Falase
Division of Cardiology, Department of Medicine, University College Hospital,
Ibadan, Nigeria
e-mail:
osogah56156@yahoo.comOkechukwu S Ogah
Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University
of the Witwatersrand, Johannesburg, South Africa
Simon Stewart
NHMRC Centre of Research Excellence to Reduce, Inequality in Heart
Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia
Joshua O Akinyemi
Department of Epidemiology and Medical Statistics, College of Medicine,
University of Ibadan, Nigeria
Gail D Adegbite, Albert A Alabi
Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
Amina Durodola, Akinlolu A Ajani
Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
Karen Sliwa
Hatter Institute for Cardiovascular Research in Africa and IIDMM,
Department of Medicine, Faculty of Health Sciences, University of Cape
Town, South Africa
Previously published in
Cardiovasc J Afr
2014;
25
(5): 217–223
S Afr J Diabetes Vasc Dis
2016;
13
: 20–26
Abstract
Background:
Compared to other regions of the world, there
is a paucity of data on the short-term outcome of acute heart
failure (AHF) in Africa’s most populous country, Nigeria. We
examined the six-month outcomes (including case fatality)
in 285 of 309 AHF subjects admitted with HF to a tertiary
hospital in Abeokuta, Nigeria.
Methods:
The study cohort of 285 subjects comprised 150
men (52.6%) and 135 women (47.4%) with a mean age of
56.3 ± 15.6 years and the majority in NYHA class III (75%).
Results:
There were a number of differences according to the
subject’s gender; men being older and more likely to present
with hypertensive heart disease (with greater left ventricular
mass) while also have greater systolic dysfunction. Mean
length of stay was 10.5 ± 5.9 days. Mean follow up was 205
days, with 23 deaths and 20 lost to follow up. At 30 days,
4.2% (95% CI: 2.4–7.3%) had died and by 180 days this had
increased to 7.5% (95% CI: 4.7–11.2%); with those subjects
with pericardial disease demonstrating the highest initial
mortality rate. Over the same period, 13.9% of the cohort
was re-admitted at least once.
Conclusions:
The characteristics of this AHF cohort in
Nigeria were different from those reported in high-income
countries. Cases were relatively younger and presented
with non-ischaemic aetiological risk factors for HF, especially
hypertensive heart disease. Moreover, mortality and
re-admission rates were relatively lower, suggesting region-
specific strategies are required to improve health outcomes.
Keywords:
heart failure, mortality, outcome, Abeokuta, Nigeria
Introduction
Heart failure (HF) has emerged as a global epidemic in at-risk
populations, including those living in high-income countries and, as
recently described, in low- to middle-income regions of the world,
such as sub-Saharan Africa.
1-4
While there are well-established HF
registries to capture both the characteristics and health outcomes
among those hospitalised with AHF in Europe,
5,6
North America,
7,8
and the Asia–Pacific region,
3,9,10
there are few reports from sub-
Saharan Africa.
11
This includes Nigeria (the most populous country
in the region), where HF has emerged as a potentially large public
health problem.
1
Although there have been many therapeutic gains in the
management of chronic HF,
12
leading to improved overall survival
rates,
13
there has been very little parallel success (pending further
evaluation of the recently reported RELAX trial
14
with regard to
AHF). This is particularly important when one considers the high
proportion of patients who still require hospitalisation for acute HF,
and associated high levels of in-patient case fatality and poor short-
to medium-term health outcomes.
Given the paucity of data describing health outcomes in
unselected patients hospitalised with AHF in Nigeria (and indeed
the wider sub-Saharan Africa), we examined short- (30 days) to
medium-term outcomes (180 days) in consecutive subjects with
AHF recruited into the Abeokuta HF registry over a period of six
months. Standardised data collected via the registry were used to
both describe the baseline characteristics of the cohort and identify
correlates of mortality during the six-month follow up.
Methods
The Abeokuta HF registry was a hospital-based, single-centre,
prospective, observational study that consecutively recruited 285
subjects with de novo AHF and 24 cases of decompensated HF
(acute-on-chronic HF), all admitted during the period 1 January
2009 to 31 December 2010. The 24 cases of decompensated HF
were excluded from the final analysis.