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20

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.com

Okechukwu 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.