Abstract:

Introduction: Cardiovascular diseases (CVD) have emerged as major causes of morbidity and mortality in most African Countries. Heart failure (HF) is one of the most common CVD causing recurrent hospitalization, high morbidity and mortality among admission in our medical wards. Unlike in Western countries, HF in Africa, particularly SSA, occurs at younger age and is attributed to non-ischemic causes such as hypertension, cardiomyopathies, rheumatic heart disease (RHD) and pericarditis. Changes in life style attributable to increased urbanization have resulted in increased prevalence of hypertension, obesity, and diabetes mellitus. On top of that, the increase in the burden of HIV and persistence of rheumatic heart disease (RHD) has added to the burden. Little is known about the magnitude, predictors and outcome of decompensated HF (DHF) in Tanzania.

Objective: To determine the prevalence, etiologies, predictors and outcome of decompensated HF in adults admitted at Bugando Medical Centre medical wards/ICU until three months after discharge.

Methodology: This was a prospective observational cohort study whereby all adult patients (≥18 years) admitted to the Bugando Medical Centre medical wards and ICU were interviewed using a structured questionnaire. Those with signs and symptoms suggestive of heart failure based on Framingham criteria between October and December were enrolled and completed a brief demographic survey and underwent physical examination. Investigations which were done included, blood analysis for serum creatinine, -blood glucose, HIV testing, electrocardiography (ECG), chest x-ray (CXR), and echocardiography. All patients were followed up for 3 months after discharge.

Results: A total of 647 participants were enrolled with 335 (51.8%) males and HIV test was positive in 32 (5%) patients. Among 647 participants, the prevalence of decompensated HF was 22.4% (145 patients) of which 83 (57% were females. The main causes of DHF were hypertension (41.4%), dilated cardiomyopathy (DCM) (17.1%) and RHD (11.7%). The prevalence of ischemic heart disease was 6 (5.4%). Renal dysfunction was the only predictor of three months mortality (p=0.04). The average duration of hospital stay was 8 (5-12) days and in-hospital mortality was 39/145 (26.9%). After one month 66/130 (50.8%) patients had died and the rate of re-admission was 9/63 (14.3%). By three months 78/129 (60.5%) patients were dead.

Conclusion: The magnitude of decompensated heart failure at Bugando Medical Centre (BMC) is very high (22%) with extremely high in-hospital and three month mortality 27% and 61% respectively. Hypertension, DCM and RHD are the main causes of DHF and renal dysfunction in the main predictor of three month mortality.