Abstract:

Introduction: The burden of cardiovascular disease is growing at an alarming pace in low- and middle-income countries, especially in Sub-Saharan Africa (SSA). Heart failure (HF) in SSA is associated with higher rates of rehospitalization, poor quality of life and high mortality. In SSA, it is estimated that 3-7% of all admissions to hospitals are due to HF. For inpatient HF patients in Tanzania, studies have found greater than 50% mortality rate at 12 months post discharge. In developed countries, outpatient HF clinics have been associated with reduction of 30-day readmission and mortality rates. However, there is limited published data on HF outcomes for HF patients seen at outpatient clinics in SSA. The purpose of this study was to determine frequency of hospitalization, occurrence of stroke, and mortality at two HF outpatient clinics in Mwanza city, Tanzania.

Methods: From February 2017 to September 2018 HF patients at Bugando Medical Center and Sekou Toure Regional Hospital outpatient clinics were recruited and followed for 12 months. HF was confirmed by Framingham criteria and the severity was determined by New York Heart Association (NYHA) classification. Participant’s data were collected in four waves over the course of 12 months. Demographic data were collected at baseline and data on hospitalization, occurrence of stroke, and mortality were collected during the follow up period.

Results: Four hundred and eighteen patients were enrolled and 369 were included in the final analysis. Most were female (n=264, 63%), small scale farmers (n=278, 66.5%) and from Mwanza City (n=299, 71.5%). More than two-thirds did not have health insurance (n=295, 70.6%) and the majority were in the NYHA I and II classification (n=267, 64.7%) during the study period. Twenty-one, 25, 11 and 13 HF patients were hospitalized at least once in the 1st, 2nd, 3rd, and 4th data collection periods respectively. Fifty patients died (14%) and 7 sustained stroke (2%) over the 12 months period.

Conclusion: Moderate levels of hospitalization, mortality, occurrence of stroke was reported in this study compared published inpatient studies in Tanzania. Interventions are needed to improve the long-term health and survival of HF patients attending HF outpatient clinics in Mwanza City.