PREDICTORS OF ACUTE HEART FAILURE OUTCOMES AT UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA

O. Adebayo1,2, A. Adebiyi2,3, O.S Ogah1,2,3, M.A. Adeoye1,2,3, A. Aje2 , O.O Oladapo1,2,3

  1. Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan.
  2. Cardiology Unit, Department of Medicine, University College Hospital, Ibadan.
  3. Department of Medicine, Faculty of Clinical Sciences, University of Ibadan, Ibadan.

Abstract

Background: Studies of acute heart failure (AHF) outcomes suggest that there are different predictors of mortality depending on region, ethnicity, and gender.

Objective: The purpose of this study was to identify predictors of six months’ post discharge outcome among AHF patients in a Nigerian tertiary hospital.

Methods and Materials: This study was a prospective observational study conducted at the cardiology unit of the Department of Medicine at the University College Hospital Ibadan. One hundred and sixty AHF participants > 18 years old were recruited.

Results: The mean age of the cohort was 58.0±15.1 years and most were males (59.4%). The independent predictors for death outcome after six months of discharge for AHF and the adjusted hazard ratio) (95% CI) were male gender 2.77 (1.17 -6.56); p = 0.020; systolic blood pressure (mmHg) 0.98 (0.96 – 0.99); p = 0.011; and the presence of hepatomegaly 2.58 (1.02 – 6.51); p = 0.045. Independent predictors for readmission or rehospitalization within 6 months after discharge were presence of right abdominal pain adjusted HR (95% CI): 2.07(1.14 – 3.76), p=0.017; SBP 0.98(0.96 – 0.99), p=0.005. Independent predictors for composite endpoint were male gender: adjusted HR: 2.08 (1.16 – 3.72), p= 0.014 and pericardial effusion and tamponade: 5.31(1.79 – 15.74), p=0.003.

Conclusion: The study provided an insight into the factors contributing to outcomes six-month after admission in a tertiary centre in South-Western Nigeria, and it highlighted the predictive role of systolic blood pressure.

Keywords: Acute heart failure, Ibadan, Outcomes

Correspondence:

Dr. O. Adebayo
Institute of Cardiovascular Diseases,
College of Medicine,
University of Ibadan,
Ibadan

Email: doctorladi@yahoo.com
Submission Date: 15th Sept., 2023
Date of Acceptance: 30th Dec., 2023
Publication Date: 30th Jan., 2024

Introduction

Acute heart failure (AHF) is a clinical syndrome characterised by the sudden or gradual onset of heart failure symptoms and/or signs severe enough to necessitate hospitalization or an emergency department visit.1 Interestingly, the understanding of its complexity and heterogeneity has evolved over the last few decades. Despite the increased understanding of clinical intervention and therapeutics on the condition, survival remains poor in terms of intrahospital mortality, readmission, or post-discharge mortality.2-4

Few literatures available suggest multiple independent factors are associated with AHF outcomes such as mortality, readmission, or all-cause events (mortality combined with readmission). These factors include sociodemographic, past medical history, clinical profile and comorbidities, laboratory parameters, electrocardiographic and echocardiographic features among others.5-7 In IN-HF Outcome Registry, predictors found for AHF outcome included age, low systolic blood pressure, anaemia, and renal dysfunction, signs of cerebral hypo-perfusion, low serum sodium, chronic obstructive pulmonary disease, and pulmonary oedema.8 There is a direct relationship between renal function and AHF outcomes, whether in the short or long term.5, 6

Although most AHF studies were conducted in nonblack African populations, the first multinational study on the subject in Africa identified only few factors as predictors.7 In one study in Northern Nigeria, the identified risk factors included low left ventricular ejection fraction (VEF) (<40%), renal impairment, cardiac rhythm abnormalities such as atrial fibrillation (AF) at six months, prolonged corrected QT interval (QTC) and complete left bundle branch block (LBBB), anaemia and advanced age.9, 10 While lower body mass index, low literacy, low serum sodium level, the presence of atrial fibrillation, renal dysfunction, and valvular dysfunction were predictors of readmission with a six-month follow-up in the Abeokuta HF registry study.11

Overall, there are diverse predictors of outcomes in AHF depending on the location of study.

This study explored a broad range of the variables, notably clinical variables and socio-demographic to identify predictors of 180-day outcomes among AHF patients presenting at the University College Hospital (UCH), Ibadan, Nigeria