Prevalence, sociodemographic and clinical pattern of acute decompensated heart failure at Muranga District Hospital
Heart failure is a complex clinical syndrome associated with very significant morbidity and mortality. Due to its increasing prevalence. it is gaining increased attention, particularly because of the current and future burden on health care systems. It is therefore important to recognize the different clinical presentations of heart failure and choose the most appropriate treatment. Heart failure is a major public health problem worldwide. The last two decades have witnessed a progressive and remarkable increase in the morbidity and mortality of heart failure, in association with a reduction in age-adjusted mortality due to cardiovascular events. Regretfully, most of the published data on heart failure is based on work in Caucasian populations within the developed world. and data on its incidence, prevalence, aetiology, treatment, and outcome in Africa are lacking. This study aims to shed some light on the prevalence of ADHF. and outline the socio- demographic features and clinical patterns associated with the condition, at a peripheral hospital in rural Kenya. OBJECTIVE OF THE STUDY To describe the prevalence, clinical and sociodemographic characteristics of patients admitted with heart failure to the medical wards of Muranga district hospital. METHODOLOGY STUDY DESIGN AND SETTING Prospective observational study in the adult medical wards at the Muranga district hospital STUDY SUBJECTS Patients admitted to the medical ward with symptoms of dyspnea or a presumptive diagnosis of acute decompensated congestive heart failure over a 6 month period SAMPLE SIZE Approximately 19 patients are admitted with a diagnosis of heart failure monthly, therefore approximately 114 patients will be expected to be enrolled during the 6 month study period. SAMPLING, DATA COLLECTION AND ANALYSIS Consecutive sampling was done, on all patients admitted with dyspnea as the main complaint or those with an admitting diagnosis of heart failure. The Modified Frammingham Criteria for Heart Failure was administered to each and those who fulfilled the criteria were defined as a case of heart failure and were enrolled into the study. Data was entered into a study proforma and questionnaire. Data analysis was done using statistical package for social scientists (SPSS) version 17. RESULTS The study was conducted at between May and October 2011. A total of 2104 patients were admitted into the medical wards. Of these, 274 presented with dyspnea as the main complaint or an adrriitting diagnosis of heart failure and were screened. One hundred and one patients were recruited into the study after meeting the inclusion criteria. This translated to a prevalence of 4.9%. There was a slight male preponderance with a male to female ratio of 1.4: 1. The mean age was 60.2 years. Majority of the patients were born and had been living in Muranga for the last five years and were of a low social economic status, with most being peasant farmers. High alcohol consumption was reported, with 23% having history of alcohol use in the last one year. Thirty two percent of the patients in the study population had history of past or current smoking. Over ninety per cent of patients presented with severe disease with 56% being in New York Heart Association class IV. Hypertension and diabetes were the most common co morbidities in the sample population: Hypertensive heart disease was the most common aetiological factor accounting for 36% of the cases followed by dilated cardiomyopathy at 25%. Poor drug compliance was the most common precipitating factor, contributing to 53% of the cases. The in- hospital case fatality rate was 5.9% CONCLUSION In conclusion we report a high HF disease burden in a rural Kenyan community and identify Hypertensive Heart Disease and Dilated Cardiomyopathy as 8ccounting for two thirds of cases. This we find to be commensurate with the high frequency of the recognized HF antecedent of hypertension, diabetes mellitus, cigarette and heavy alcohol consumption, that are amenable to recognized primordial and primary prevention strategies.