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VOLUME 13 NUMBER 1 • JULY 2016
RESEARCH ARTICLE
SA JOURNAL OF DIABETES & VASCULAR DISEASE
We examined (1) length of hospital stay (LoS), (2) Survival
status on discharge (dead or alive), (3) short-term case fatality/
re-admission (30 days), (4) medium-term case fatality (within 180
days), (5) rehospitalisation status (within 180 days), and (6) event-
free survival from re-admission or death.
The study was reviewed and approved by the institution’s ethics
review board. All the subjects gave informed consent and the study
was carried out in accordance with the Declaration of Helsinki.
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Statistical analysis
Data were entered into EpiData software. The EpiData association
(att. Jens Lauritsen, Enghavevej 34, DK5230 Odense M, Denmark)
was used for data entry, while SPSS version 15 and Stata version
11.1 were used for data cleaning and analysis. Continuous variables
are presented as means and standard deviations (SDs), or medians
with their 25th and 75th percentiles when the distribution of the
data did not follow Gaussian distribution.
Categorical variables are displayed as frequencies and
proportions. Group comparison was done with the Student’s
t
-test,
and chi-square statistics was used for comparison of categorical
variables. Survival function estimates were performed using the
Kaplan–Meier method and the difference was tested using the
log-rank test. The follow up was censored at six months post
admission.
Predictors of survival were determined using univariate
regression analyses. Thereafter multiple logistic regression analysis
was performed to identify independent predictors of survivals (
p
<
0.1 used for selection of variables).
Results are expressed as odds ratio (OR) with their 95%
confidence intervals (95% CI). Odds ratios that were significantly
greater than 1.00 implied that subject with that attribute had
higher risks of death compared to subjects who did not. A
p
-value
of < 0.05 was taken as significant.
Results
Overall, there were 150 men (52.6%) and 135 (47.4%) women
(Table 1). The mean age was 56.3 ± 15.6 years (57.0 ± 13.6 and
55.4 ± 17.6 years for men and women, respectively) with 46%
aged ≥ 60 years. Around one-third had no formal education, two-
thirds were married and most (75.8%) were urban residents. The
majority of the subjects were in NHYA class III (75.4%).
The women were more likely not to have had formal education
(43.7 vs 26.0%,
p
= 0.029), more likely not to be a smoker (96.3
vs 68.7%,
p
< 0.001), and less likely to be a current alcohol user
(2.2 vs 9.3%,
p
< 0.001). Alternatively, men had higher rates of
hypertension (85.3 vs 77.0%) and chronic obstructive pulmonary
disease (COPD) (7.3 vs 6.7%).
Table 2 shows the laboratory profile, aetiological risk factors and
discharge medications. Serum urea and creatinine concentrations
were significantly higher in men than women.
Except for peripartum cardiomyopathy (PPCM), the aetiological
risk factors were similar in men and women. Hypertensive heart
disease was found in 75.8% of patients, dilated cardiomyopathy
in 8.4%, cor-pulmonale in 5.6%, pericardial diseases in 3.2% and
rheumatic heart disease in 2.5%. PPCM, thyroid heart disease,
coronary artery disease and endomyocardial fibrosis were found in
2.1, 1.1, 0.4, 0.4 and 0.7% of patients, respectively.
The discharge medications were similar in men and women
except for beta-blockers, which were prescribed more in men.
Table 3 depicts the 12-lead ECG and echocardiographic
Table 2.
Aetiology of HF and discharge medications in the 285 subjects.
Variable
All (
n
= 285) Men (
n
= 150) Women (
n
= 135)
Aetiology of HF,
n
(%)
Hypertension
216 (75.8)
119 (79.3)
97 (71.9)
Dilated cardiomyopathy 24 (8.4)
16 (10.7)
8 (5.9)
Cor pulmonale
16 (5.6)
9 (6.0)
7 (5.2)
Pericardial diseases
9 (3.2)
1 (0.7)
8 (5.9)
Rheumatic heart disease 7 (2.5)
4 (2.7)
3 (2.2)
Peripartum
cardiomyopathy
6 (2.1)
0 (0.0)
6 (4.4)
Thyroid heart disease
3 (1.1)
0 (0.6)
3 (2.2)
Ischaemic heart disease 1 (0.4)
1 (0.7)
0 (0.0)
Adult congenital
heart disease
1 (0.4)
0 (0.0)
1 (0.7)
Endomyocardial fibrosis
2 (6.7)
0 (0.0)
2 (0.7)
Type of heart failure
Systolic heart failure (%)
66.4
71.4
60.9
Heart failure with
normal EF (%)
33.6
28.6
39.1
Medications, n (%)
Loop diuretics
249 (87.4)
132 (88.0)
117 (86.7)
Digoxin
219 (76.8)
114 (76.0)
105 (77.8)
ACE inhibitors/ARBs
281 (98.6)
148 (98.7)
133 (98.5)
Beta-blockers
56 (19.6)
35 (23.3)
21 (15.6)
Spironolactone
247 (86.7)
133 (87.3)
116 (85.9)
Hydrallazine–isosorbide 33 (11.7)
19 (12.9)
14 (10.4)
Amiodarone
5 (1.8)
4 (2.7)
1 (0.7)
Table 3.
Twelve-lead ECG and echocardiographic profile according to
gender.
All
Men
Women
Variable (
n
= 285)
(
n
= 150) (
n
= 135)
p
-value
Ventricular rate (bpm) 96.3 ± 22.5 94.3 ± 17.3 101.3 ± 21.8 0.110
QRS duration (ms)
116.0 ± 26.2 117.1 ± 24.5 107.8 ± 41.1 0.213
QT interval (ms)
350.7 ± 30.6 374.3 ± 35.0 348.8 ± 45.5 0.006
Corrected QT (ms)
442.0 ± 20.9 462.2 ± 38.2 447.6 ± 36.2 0.085
Atrial fibrillation (%)
13.3
16.7
9.6
0.337
Aortic root
diameter (cm)
3.2 ± 0.6 3.26 ± 0.58 2.84 ± 0.38 < 0.001
Left atrial
diameter (cm)
5.9 ± 0.8 4.75 ± 0.89 4.50 ± 0.85 0.176
Left atrial area (cm
2
)
30.15 ± 9.91 28.8 ± 9.0 24.7 ± 6.3 0.010
IVSD (cm)
1.18 ± 0.28 1.33 ± 0.39 1.23 ± 0.32 0.393
LVPWd (cm)
1.38 ± 0.35 1.19 ± 0.39 1.10 ± 0.35 0.116
LVIDd (cm)
5.52 ± 0.97 5.81 ± 1.61 5.16 ± 1.45 0.353
LVIDs (cm)
4.51 ± 1.57 4.80 ± 1.63 4.16 ± 1.43 0.001
Fractional
shortening (%)
14.5 ± 2.97 17.77 ± 13.10 19.80 ± 12.21 0.060
Ejection fraction (%)
36.8 ± 6.53 40.57 ± 23.61 45.12 ± 20.11 0.007
E/A ratio
2.11 ± 1.55 2.14 ± 1.47 1.90 ± 1.25 0.199
DT (ms)
145.8 ± 59.2 144.2 ± 58.3 147.9 ± 60.5 0.480
IVRT (ms)
111.0 ± 34.3 114.9 ± 35.8 106.1 ± 32.1 0.127
LV mass (absolute)
449.0 ± 217.5 561.7 ± 106.6 233.0 ± 54.24 0.026
LV mass (indexed)
274.1 ± 117.5 336.4 ± 46.6 160.9 ± 16.1 0.016
Mitral
regurgitation (%)
19.6
18.7
20.7 0.894
Tricuspid
regurgitation (%)
15.1
12.7
17.8 0.459
IVSD = interventricular septal wall thickness in diastole, LVPWd = left
ventricular posterior wall thickness in diastole, LVIDd = left ventricular
internal diameter in diastole, LVIDs = left ventricular internal diameter in
systole, DT = deceleration time, IVRT = isovolumic relaxation time.