Abstract:

Background: The global burden of heart failure (HF) is rapidly increasing. Heart failure represents up t0 3% of all hospital admissions and 11% of all deaths in high-income countries with these statistics outpacing those of other chronic diseases. Low and middle-income countries likely bare an even greater burden of HF morbidity, mortality and economic impact. In sub-Saharan Africa, HF prevalence is estimated to be 5% and increasing. At Bugando Medical Centre, HF represents 10% of hospital admissions and 10% of in-hospital deaths. This said, little research exists regarding accuracy of clinical diagnosis in SSA, the incidence of HF at the regional hospital level or the underlying etiologies of HF. Therefore, epidemiologic surveillance and database development is of critical importance for the heart failure population of Mwanza.

Objective: The primary objective was to determine the incidence of HF and HF subtypes at Sekou Toure regional hospital over a two-month period. The secondary objective was to determine the accuracy of clinical HF diagnosis as compared to echocardiographic HF diagnosis.

Methods: A cross-sectional study including patients admitted to Sekou Toure regional hospital medical wards during the 2-month study enrollment period was developed with the primary outcome of incidence of HF admission diagnosis and secondary objective of accuracy of clinical diagnosis as compared to echocardiographic diagnosis. Participants were classified as clinical HF by Framingham HF criteria and echocardiographic HF if bedside echo revealed EF<50% diastolic dysfunction grade II/III.

Results: Overall, 406 patients were enrolled during the study period. Of these, 86 (21%) were admitted with a clinical diagnosis of HF by Framingham criteria. Clinical HF was diagnosed significantly more in female patient’s vs male (74.8% vs 25.6%). The most prevalent preceding risk factor was hypertension (25.3%) followed by diabetes (15%). A HF ward log database for hospital quality was successfully created.