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Abstract
Aim: To describe clinical features and management of patients with heart failure at the Yaounde Military Hospital (YMH).
Methods: Retrospective study carried out at cardiology unit of YMH from January 2014 to December 2014. Clinical features and mode of treatment of patients were recorded and analyzed.
Results: 86 patients were studied comprising 63 men (73.2%) and 23 women (26.7%). The mean age was 64.8 ±13. All the patients presented with NYHA functional class III or IV. Alcohol was the most common etiological factor of HF (66.7%), followed by hypertension (37.5%). 20.9 % of the patients in heart failure were smokers. Global heart failure was the common clinical presentation (60.9%). Left bundle branch was present in 23.8% of electrocardiograms while 12.2% of the patients were in atrial fibrillation. Dilated cardiomyopathy was the most common lesion (80%) found at echocardiography. 66.6% of patients presented with severe left ventricular (LV) systolic dysfunction. The mean ejection fraction (EF) of male subjects was 30.1%, while it was 38.7% for women (p=0.044). Current recommended pharmacology therapies were used in only 48% of patients.
Conclusion: Cameroonian patients in heart failure usually present in the sixth decade and the severe heart failure is the rule. Alcohol seems to be the major etiological factor. Less than half the patients take the recommended treatment of HF.
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References
- Karen Sliwa, Albertino D, Bongani M, Mayosi MB, D Phil. Epidemiology and Etiology of Cardiomyopathy in Africa. Circulation 2005;112:3577-3583
- Douglas D. Schocken, Emelia J.B, Gregg C. Fonarow, Harlan M. Krumholz et al. Prevention of heart failure. A scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation. 2008; 117: 2544-2565
- Ntusi NB, Mayosi BM. Epidemiology of heart failure in sub-Saharan Africa. Exp Rev Cardiovasc Ther. 2009;7(2):169-80
- Task force report. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart Journal. 2001; (22): 1527-1560
- Owusu IK, Boakye YA. Prevalence and Aetiology of Heart Failure in Patients Seen at a Teaching Hospital in Ghana. J Cardiovasc Dis Diagn 2013, 1:5
- Stewart S, Wilkinson D, Backer A et al. Mapping the emergence of heart disease in a black, urban population in Africa: The Heart of Soweto Study. Int J Cardiol. 2006 Mar 22;108(1):101-8
- Amoah AG, Kallen C. Aetiology of heart failure as seen from a national cardiac referral centre in Africa. Cardiology. 2000;93(1-2):11-18
- Mosterd A, Cost B, Hoes AW, de Bruijne MC, Deckers JW et al. The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J. 2001 Aug;22(15):1318-27
- Owusu I. Treatment of heart failure in a teaching hospital in Ghana, West Africa. The Internet Journal of Third World Medicine. 2006 Vol 4 N° 2.
- HE J, Ogden LG, Bazzano LA et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med. 2001 Apr 9;161(7):996-1002
- Klatsky AL, Chartier D, Udaltsova N, Gronningen N et al. Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease. Am J Cardiol. 2005 Aug 1;96(3):346-51
- Lloyd –Jones DM, Larson MG, Leip EP, Beiser A et al. Lifetime Risk for Developing Congestive Heart Failure. The Framingham Heart Study. Circulation. 2002;106:3068-3072.
- Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996 May 22-29;275(20):1557-62
- Isezouo SA. Seasonal variation in hospitalisation for hypertension-related morbidities in Sokoto, north-western Nigeria. Int J Circumpolar Health. 2003 Dec;62(4):397-409
- Kingue S, Dzudie A, Menanga A et al. A new look at adult chronic heart failure in Africa in the age of the Doppler echocardiography: experience of the medicine department at Yaounde General Hospital. Ann Cardiol Angeiol (Paris). 2005 Sep;54(5):276-83
- Thiam M. Cardiac insufficiency in the african cardiology milieu. Bull Soc pathol Exot. 2003 Aug;96(3):217-8
- Ola BA, Adewuya AO, Ajayi OE, Akintomide AO et al. Relationship between depression and quality of life in Nigerian outpatients with heart failure. J Psychosom Res. 2006 Dec;61(6):797-800
- Khan NK, Goode KM, Cleland JG, Rigby AS, Freemantle N et al. Prevalence of ECG abnormalities in an international survey of patients with suspected of confirmed heart failure at death or discharge. Eur J Heart Fail. 2007 May;9(5):491-501
- Ojji DB, Alfa J, Ajayi SO et al. Pattern of heart failure in Abuja, Nigeria: an echocardiographic study. Cardiovasc J Afr. 2009 Nov-Dec;20(6):349-52
- Neubauer S, Schilling T, Zeidler J et al. Impact of guideline adherence on mortlity in treatment of left heart failure. Herz. 2016 Feb 16.
- Kim JY, Kim HJ, Jung SY, Kim KI, Song HJ et al. Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database. BMC Cardiovasc Disord. 2012 Jul 31;12:60
- McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012 Aug;14(8):803-69
References
Karen Sliwa, Albertino D, Bongani M, Mayosi MB, D Phil. Epidemiology and Etiology of Cardiomyopathy in Africa. Circulation 2005;112:3577-3583
Douglas D. Schocken, Emelia J.B, Gregg C. Fonarow, Harlan M. Krumholz et al. Prevention of heart failure. A scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation. 2008; 117: 2544-2565
Ntusi NB, Mayosi BM. Epidemiology of heart failure in sub-Saharan Africa. Exp Rev Cardiovasc Ther. 2009;7(2):169-80
Task force report. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart Journal. 2001; (22): 1527-1560
Owusu IK, Boakye YA. Prevalence and Aetiology of Heart Failure in Patients Seen at a Teaching Hospital in Ghana. J Cardiovasc Dis Diagn 2013, 1:5
Stewart S, Wilkinson D, Backer A et al. Mapping the emergence of heart disease in a black, urban population in Africa: The Heart of Soweto Study. Int J Cardiol. 2006 Mar 22;108(1):101-8
Amoah AG, Kallen C. Aetiology of heart failure as seen from a national cardiac referral centre in Africa. Cardiology. 2000;93(1-2):11-18
Mosterd A, Cost B, Hoes AW, de Bruijne MC, Deckers JW et al. The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J. 2001 Aug;22(15):1318-27
Owusu I. Treatment of heart failure in a teaching hospital in Ghana, West Africa. The Internet Journal of Third World Medicine. 2006 Vol 4 N° 2.
HE J, Ogden LG, Bazzano LA et al. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med. 2001 Apr 9;161(7):996-1002
Klatsky AL, Chartier D, Udaltsova N, Gronningen N et al. Alcohol drinking and risk of hospitalization for heart failure with and without associated coronary artery disease. Am J Cardiol. 2005 Aug 1;96(3):346-51
Lloyd –Jones DM, Larson MG, Leip EP, Beiser A et al. Lifetime Risk for Developing Congestive Heart Failure. The Framingham Heart Study. Circulation. 2002;106:3068-3072.
Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996 May 22-29;275(20):1557-62
Isezouo SA. Seasonal variation in hospitalisation for hypertension-related morbidities in Sokoto, north-western Nigeria. Int J Circumpolar Health. 2003 Dec;62(4):397-409
Kingue S, Dzudie A, Menanga A et al. A new look at adult chronic heart failure in Africa in the age of the Doppler echocardiography: experience of the medicine department at Yaounde General Hospital. Ann Cardiol Angeiol (Paris). 2005 Sep;54(5):276-83
Thiam M. Cardiac insufficiency in the african cardiology milieu. Bull Soc pathol Exot. 2003 Aug;96(3):217-8
Ola BA, Adewuya AO, Ajayi OE, Akintomide AO et al. Relationship between depression and quality of life in Nigerian outpatients with heart failure. J Psychosom Res. 2006 Dec;61(6):797-800
Khan NK, Goode KM, Cleland JG, Rigby AS, Freemantle N et al. Prevalence of ECG abnormalities in an international survey of patients with suspected of confirmed heart failure at death or discharge. Eur J Heart Fail. 2007 May;9(5):491-501
Ojji DB, Alfa J, Ajayi SO et al. Pattern of heart failure in Abuja, Nigeria: an echocardiographic study. Cardiovasc J Afr. 2009 Nov-Dec;20(6):349-52
Neubauer S, Schilling T, Zeidler J et al. Impact of guideline adherence on mortlity in treatment of left heart failure. Herz. 2016 Feb 16.
Kim JY, Kim HJ, Jung SY, Kim KI, Song HJ et al. Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database. BMC Cardiovasc Disord. 2012 Jul 31;12:60
McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012 Aug;14(8):803-69