Causes de réhospitalisation pour insuffisance cardiaque dans le service de cardiologie du CHU de Brazzaville (République du Congo) / The causes of rehospitalization for heart failure in the department of cardiology at the university hospital of Brazzaville (Republic of the Congo)

But: Identifier les causes de réhospitalisation pour insuffisance cardiaque (IC) Patients et méthode: cette étude transversale a été menée entre avril 2014 et mars 2015 dans le service de cardiologie du centre hospitalier universitaire de Brazzaville (République du Congo). Ont été inclus, les patients ayant des antécédents d'hospitalisation pour IC. Résultats: Quatre-vingt-onze patients, 54 femmes (59,3%) ont été inclus. Le sexe-ratio était de 0,7. La fréquence de réhospitalisation pour IC était de 19%. L'âge moyen était de 62 ± 16 ans (extrêmes: 24-89 ans). Le nombre moyen de réadmissions était de 2 ± 0,8 (extrêmes: 1 à 5), les réhospitalisation fréquentes (supérieur à 3) étaient de 33 (36,2%). Les patients présentaient un statut socioéconomique faible dans 59 cas (64,8%), et une hypertension artérielle dans 40 cas (43,9%). L'examen physique a retrouvé : une insuffisance cardiaque globale 77 cas (84,6%), une insuffisance cardiaque droite exclusive 5 cas (5,5%). Les causes de l'insuffisance cardiaque étaient: la cardiopathie hypertensive 40 cas (43,9%), la cardiomyopathie dilatée 28 cas (30,8%) et les valvulopathies 9 cas (10%). Les principales causes de réhospitalisation étaient: les écarts du régime hyposodé 64 cas (70,3%), la mauvaise observance du traitement 56 cas (61,5%), la grippe 15 cas (16,5%), la fibrillation atriale 12 cas (13,2%), débit de filtration glomérulaire réduite 12 cas (13,2%). La durée moyenne d'hospitalisation était de 11 ± 6,4 jours (extrêmes: 2-29). Le décès a été enregistré dans 5 cas (5,5%). Conclusion: L'absence de respect pour un régime pauvre en sodium et une mauvaise adhésion au médicament ont été les principales causes de réhospitalisation pour IC à Brazzaville. À cet égard, il est nécessaire de promouvoir l'éducation thérapeutique et d'améliorer l'accès au traitement.

Background: to identify the causes of readmission for heart failure (HF) Methods: this cross-sectional study was conducted in April 2014 to march 2015 in the department of cardiology, University Hospital of Brazzaville (Republic of the Congo). We had included, the patients who had a history of hospitalization for HF. Results: Ninety-one patients, 54 women (59.3%) were included. Sex-ratio was 0.7. The frequency of readmission for HF was 19%. The mean age was 62±16 years (range: 24-89). The average number of readmission was 2±0.8 (range: 1-5), the history of readmission ≥ 3, were 33 (36.2%). The patients were low socio-economic status in 59 cases (64.8%). In examination, patients were in congestive HF (n=77, 84.6%), right-sided HF (n=5). The causes of HF were: hypertensive heart disease (n=40, 43.9%), dilated cardiomyopathy (n=28, 30.8%), and valvular heart disease (n=9). The main causes of readmission were: excessive salt intake (n=64, 70.3%), poor drug-adherence (n=56, 61.5%), influenza (n=15, 16.5%), atrial fibrillation (n=12, 13.2%), reduced estimate glomerular filtration rate (n=12, 13.2%). The average length of hospitalization was 11±6.4 days (range: 2-29). The death was recorded in 5 cases (5.5%). Conclusion: No respect of low sodium diet and poor drug adherence, were the most causes of readmission for HF at Brazzaville. In regard of this facts, promoting therapeutic education is needed, and increasing access to treatment

Predictors of incident heart failure in a cohort of patients with ischemic heart disease

Introduction: heart failure (HF) is a major complication following ischemic heart disease (IHD) and it adversely affects the outcome. The objective of this study was to identify predictors of HF in patients with IHD. Methods: this is a 24-month longitudinal retrospective study of all consecutive patients diagnosed with IHD. Endpoints were incident HF and time to incident HF. Patients with a previous history of HF were excluded. Results: a total of 306 patients with IHD were included in the analysis. The 6-month, 12-month and 18-month cumulative risk of developing incident HF were 18.8%, 28.4%, and 53.5% respectively. Increasing age, female gender, diabetes mellitus (DM), lower hemoglobin, and dilated left atrium were strong predictors of incident HF. Predictors of shorter time to incident HF were coexisting DM and hypertension, and the presence of dilated left atrium in patients with left ventricular ejection fraction < 40%. The strongest predictor of incident HF in patients with DM was a higher level of LDL cholesterol.Conclusion: patients with IHD have a higher risk of incident HF. Strong predictors of incident HF in these patients were increasing age, female gender, DM, lower hemoglobin and dilated left atrium. Such patients need close follow-up and more intensive treatment

Heart failure in Ethiopian children: mirroring the unmet cardiac services

BACKGROUND: HeartFailure (HF) is a progressive clinical and pathophysiological syndrome caused by cardiovascular and noncardiovascular abnormalities. Childhood HF has not been well studied in Sub-Sharan Africa, particularly in Ethiopia. Hence, this study aimed at describing the pattern and outcome of pediatrics HF at a referral-teaching hospital. METHODS: Medical records of 216 HFchildren aged 2months to 14 years, and admitted between January 2014 and January 2016 were reviewed. Clinical information was collected, analyzed and presented in tables and pie charts. RESULTS: A total of 2000 children were admitted to Hawassa University Hospital during the study period. HF accounted for 10.8% (216) of pediatrics admissions, 51.9% males. The median age of the study subjects was 6years. Functionally, NYHA/Ross class III and IV consisted 65(30.1%) and 139(64.4%) of HF. Structural heart diseasewas the commonest cause of HF, 144(66.7%): Rheumatic heart disease (RHD),75(52%), and congenital heart disease (CHD),64(44.5%). Anemia and renal cases contributed to 50(23.1) and 12(5.6%) of HF.CHD was predominantly documented in <5years. Pneumonia 66(42.9%), and infective endocarditis 29(18.8%) were the common precipitating/comorbid conditions with HF.Thecase fatality rate of HF was 13.9 %( 30). CONCLUSION: In this study, HF accounted for a tenth of pediatrics admissions. Structural heart disease was the commonest cause of heart failure. CHD and RHD affected predominantly children of <5years of age and >5 years of age. Echocardiographic screening of HF cases for structural heart disease and optimal care for patients with underlying structural heart disease are recommended

Burning issues in the prevention of heart failure

Chronic heart failure is common, debilitating, and often the culmination of pervasive cardiovascular insults that systematically undermine the heart's circulatory capacity and invoke counterproductive neuro-hormonal compensatory changes. Prevention of chronic heart failure therefore requires minimising the impact of traditional cardiovascular risk factors with incisive treatment of hypertension and type II Diabetes Mellitus (T2DM) and prompt lifestyle interventions for smoking, lack of exercise, obesity and hypercholesterolemia. This review is narrative, with selected emphasis on major studies, rather than structured on a specific clinical question, and should be read as such

Association between common etiologies and precipitants of acute decompensated heart failure

Background: Acute decompensated heart failure (ADHF) comprises the etiology of heart failure and the precipitant of acute decompensation. Early identification of the precipitant of ADHF is important in management, but an association between the precipitant and etiology of ADHF has not been established. Objective: The objective of this study is to determine whether the precipitant of acute decompensation is associated with the etiology of heart failure. Methods: This was a prospective observational study conducted over 2 years. Patients with ADHF secondary to common etiologies such as hypertension and rheumatic heart diseases (RHD) were enrolled in the study. The demographics, precipitants, and relevant variables on echocardiography and electrocardiography were documented. The frequencies of the etiology and precipitants of heart failure were derived. The Chi-square test was used to determine an association between categorical variables, and independent t-test was used to compare the means of continuous variables. A value of P < 0.05 was considered statistically significant. Results: There were a total of 190 participants. Hypertensive and RHD were 96 (50.5%) and 94 (49.5%), respectively. One hundred and three (54.2%) were females and males were 87 (45.8%). The precipitants were pneumonia 104 (54.7%), arrhythmias 47 (24.7%), urinary tract infection 36 (19.5%), and infective endocarditis 3 (1.6%). The association between these etiologies and precipitants of ADHF yielded a value ofP = 0.597. Conclusion: There is no association between the precipitant and etiology of ADHF. Therefore, the precipitant of ADHF should be actively sought for in every case for optimal management and better outcomes

The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study

Introduction The prevalence of cardiovascular disease in sub-Saharan Africa is substantial and growing. Much remains to be learned about the relative burden of acute coronary syndrome (ACS), heart failure, and stroke on emergency departments and hospital admissions.Methods A retrospective chart review of admissions from September 2017 through March 2018 was conducted at the emergency department of a tertiary care center in northern Tanzania. Stroke admission volume was compared to previously published data from the same hospital and adjusted for population growth. Results Of 2418 adult admissions, heart failure and stroke were the two most common admission diagnoses, accounting for 294 (12.2%) and 204 (8.4%) admissions, respectively.ACS was uncommon, accounting for 9 (0.3%) admissions. Of patients admitted for heart failure, uncontrolled hypertension was the most commonly identified etiology of heart failure, cited in 124 (42.2%) cases. Ischemic heart disease was cited as the etiology in only 1 (0.3%) case. Adjusting for population growth, the annual volume of stroke admissions increased 70-fold in 43 years, from 2.9 admissions per 100,000 population in 1974 to 202.2 admissions per 100,000 in 2017.Conclusions :The burden of heart failure and stroke on hospital admissions in Tanzania is substantial, and the volume of stroke admissions is rising precipitously. ACS is a rare diagnosis, and the distribution of cardiovascular disease phenotypes in Tanzania differs from what has been observed outside of Africa. Further research is needed to ascertain the reasons for these differences

Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana

Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients.Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF.Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality.Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality.Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub-Saharan Africa, and call for more studies to be done in this region

Prognosis in heart failure with preserved ejection fraction

Heart Failure with preserved Ejection Fraction (HFpEF), like other heart failure syndromes, is heterogeneous in etiology and pathophysiology, rather than a single disease. HFpEF may account for about half of all patients with heart failure. Patients have symptoms and signs of HF with normal or near normal left ventricular EF (LV EF>50 %). The classical risk factors for developing HFpEF include advanced age and co-morbidities, notably hypertension, atrial fibrillation, and the metabolic syndrome. When complicated by increasing congestion requiring hospital admission, the prognosis is poor; 30% or more of such patients will die within 1 year (nearly two-thirds die from cardiovascular causes). Patients with chronic stable symptoms have a better prognosis. Patients with HFpEF represent an important group of patients presenting in clinical practice with HF. Overall, it appears that patients with HFpEF are at lower risk of death than patients with HFrEF, although mortality remains high in both groups. Application of the same therapeutic hypotheses that have been successfully utilized among patients with HFrEF have not been demonstrated to result in improved survival

Insuffisance cardiaque de l'adulte : Une étude sur 130 cas à l'hôpital au Service de cardiologie de l'hôpital national de Niamey au Niger

Nous rapportons dans cette étude les aspects épidémiologiques, diagnostiques, évolutifs et pronostiques de l'insuffisance cardiaque du sujet âgé de plus de 15 ans en milieu hospitalier nigérien. C'est une étude prospective menée en quatre (4) mois. Elle a concerné des sujets des deux sexes âgés de plus de 15 ans, admis dans un tableau d'insuffisance cardiaque. Nous avons inclus 103 cas soit 35,15% des 293 patients: 59 hommes (57,30%), 44 femmes (42,70%) (p =1,34) âgés en moyenne de 55,05 ans (extrêmes : 17 et 96 ans), la tranche d'âge la plus touchée était celle de plus de 65 ans (n= 36, soit 34,96%). Les facteurs de risque les plus fréquents étaient l'HTA (n=59, soit 49,50%), le tabac (n=13, soit 12,62%), le diabète (n=9, soit 8,73%).L'insuffisance cardiaque était globale (n = 79, soit 76,70%), gauche (n=21, soit 20,38%), et droite exclusive (n=3, soit 2,91%). Les cardiopathies en cause étaient, ischémiques (n=37, soit 35,92%), hypertensives (n = 32, soit 31,06%), les valvulopathies (n=12, soit 11,65%), CMPP (n=8, soit 7,76%), un cœur pulmonaire chronique a été objectivé dans 4 cas (3,88%) de même qu'une péricardite dans 4 cas (3,88%), les cardiomyopathies hypertrophiques (n=3, soit 2,77%). Une endocardite dans 1 cas et une cardiothyréose chez un seul patient. Le traitement a été exclusivement médical avec les diurétiques dans 94,17%, les inhibiteurs de l'enzyme de conversion (IEC) dans 94,20%, les bétabloquants (BB) dans 52,42% et les dérivés nitrés dans 18,44%. La létalité a été de 5,82% (n=6). La prévention consiste à lutter contre l'ensemble des facteurs de risque notamment l'HTA dont la prévention primaire s'avère ainsi nécessaire

Insuffisance cardiaque au Centre Hospitalier Universitaire de Libreville : aspects épidémiologiques, cliniques et apport du bilan complémentaire

Introduction et objectif : L'Insuffisance Cardiaque (IC) est une pathologie fréquente à l'échelle mondiale. L'objectif de ce travail était de décrire le profil épidémiologique et clinique de l'IC et de relever l'apport des examens paracliniques disponibles au Gabon dans la prise en charge.Patients et méthodes : Il s'est agi d'une étude rétrospective, descriptive, allant de janvier 2015 à décembre 2016. Elle a porté sur l'analyse de 464 dossiers de patients admis pour IC en cardiologie au Centre Hospitalier Universitaire de Libreville (CHUL).Résultats : La prévalence de l'IC était de 51,7%, l'âge moyen des patients était de 54,6 ± 18,3 ans. Le sex-ratio était de 1,26. L'hypertension artérielle (HTA) (55,5%) et l'obésité (19,2%) constituaient les principaux facteurs de risque cardiovasculaire. La présentation clinique prédominante était l'IC globale (62,5%) et le mode d'installation était progressif dans 92% des cas. L'échocardiographie-Doppler et le dosage des peptides natriurétiques étaient réalisés respectivement chez 57,5% et 44,4% des patients. Les cardiopathies retrouvées étaient essentiellement hypertensives (45,3%) et valvulaires (15%). Une altération sévère de la fonction systolique du VG était notée chez 40,4% des patients. L'IC à fraction d'éjection ventriculaire gauche préservée représentait 8,3% des causes d'IC identifiées. Le taux moyen NT pro-BNP était de 7430,3 ± 7152,5 pg/ml.Conclusion : L'IC est le principal motif d'hospitalisation en cardiologie au CHUL. Elle affecte des sujets relativement jeunes. L'étiologie la plus fréquente est l'HTA. L'échocardiographie-Doppler et le NT-proBNP ont permis d'estimer la sévérité des lésions initiales

Endomyocardial Fibrosis: is it a Systemic Disease?

Background: Patients with endomyocardial fibrosis (EMF) characteristically present with gross ascites and absent or minimal pedal oedema. This has long puzzled clinicians; especially since this clinical picture remains the same regardless of whether there is left; right or biventricular ventricular heart failure. The development of ascites; therefore; may not be directly and solely related to changes in the heart; but to local changes in the peritoneum. In order to investigate this possibility we performed peritoneal biopsies on 28 EMF patients.Methods: Successful peritoneal biopsies were performed on 28 EMF patients and 11 age-matched healthy controls who had died in road accidents.Results: All 28 patients (100%) showed complete or partial peritoneal fibrosis. Twenty Six (93%) had additional signs of chronic peritonitis characterised mainly by lymphocytes (92%) eosinophils (27%) and plasma cells (23%). Neutrophils were not seen. Vascularisation was common (87%) with an increase in capillaries and granulation tissue. Other components were Russel bodies (50%); deposits of fibrin (50%) and haemosiderin pigment (32%). Only two samples showed fibrosis without signs of inflammation. None of the controls showed any of these changes.Conclusion: Peritoneal fibrosis was found in all and peritonitis in most of our EMF patients. This suggests that pathology of EMF is not confined to the heart but also involves the peritoneum. This local peritoneal inflammation may explain why marked ascites is often present with little or no peripheral oedema; and why conventional heart failure treatment is of limited value

Prise en charge de l'insuffisance cardiaque au Centre Hospitalier Universitaire de Brazzaville : aspects socio-économiques

Introduction : Le but de l'étude était d'évaluer le coût de la prise en charge de l'insuffisance cardiaque et l'impact du niveau socio-économique sur l'attitude des patients.Patients et méthodes : Il s'agit d'une étude prospective et analytique réalisée dans le service de cardiologie et de médecine interne du Centre Hospitalier et Universitaire de Brazzaville, du 1er janvier au 31 décembre 2014. Ont été inclus, les patients hospitalisés pour une insuffisance cardiaque. Le coût financier était exprimé en franc de la coopération financière pour l'Afrique (FCFA). Résultats : La série comportait 279 patients répartis en 117 hommes (41,9%) et 162 femmes (58,1%), âgés en moyenne de 57,7 &plus 16,6 ans. Le revenu mensuel était inférieur à 90.000 FCFA dans 65,9% des cas, entre 90.000 et 180.000 FCFA dans 23,3% des cas et supérieur à 180.000 FCFA dans 10,8% des cas. Les patients sans aucun niveau d'instruction représentaient 27,6%. Ceux ayant les niveaux du primaire, du secondaire et du supérieur respectivement 24%, 36,6% et 11,8%. Le délai moyen de consultation était de 22 ± 23,3 jours. Il s'agissait d'un premier épisode d'insuffisance cardiaque chez 170 patients (60,9%), d'une récidive chez les 109 autres (39,1%). Pour ce dernier groupe de patients, l'observance médicamenteuse était bonne (18,3%), présentait des problèmes minimes (21,1%), n'était pas effective (60,6%). L'insuffisance cardiaque était droite chez 16 patients (5,7%), gauche chez 70 patients (25,1%) et globale chez 193 patients (69,2%). Le bilan paraclinique était réalisé chez 276 patients (98,9%) dans un délai moyen de 3,8 ± 4,2 jours. La durée moyenne d'hospitalisation était de 15,7 ± 8,5 jours, et le coût global moyen de 181.821,8 ± 79.026,3 FCFA. La prise en charge médicamenteuse ainsi que des frais d'hospitalisation relevaient du patient dans 108 cas (38,7%), d'un proche parent dans 171 cas (61,3%)

Treatment of Diastolic Heart Failure in Hypertensive Diabetic Patients : between Illusion and Achievements : Review

Hypertension is the most prevalent cardiovascular disease in the world. Because of associated morbidity and mortality; it is in one of the most important public health problems. Hypertension is the most important cause of heart failure with low or preserved ejection fraction. If hypertension develops concomitantly with diabetes mellitus; treatment of the two diseases becomes more complex. It is known that beta-blockers may induce type 2 diabetes; but new generation drugs such as nebivolol do not have this effect.There are many drugs with proven efficacy in lowering blood pressure; but the optimal treatment to prevent progression to heart failure is uncertain. Beta-blockers are a class of drugs with benefits for both hypertension and heart failure. Drugs in this class have different pharmacological properties in terms haemodynamic and cardiovascular effects. Nebivolol is a beta-blocker that causes vasodilatation mediated by nitric oxide release. This medicine lowers blood pressure; prevents endothelial dysfunction and improves coronary flow reserve and diastolic function independent of ventricular geometry changes. The action of nebivolol is superior to classic beta-blockers due to reversibility of subclinical changes in the left ventricle before the onset of heart failure.In the early stages of heart failure with preserved ejection fraction management is not yet established. Therefore it is important to know that in these situations nebivolol has beneficial effects

The Use of Angiotensin-Converting Enzyme Inhibitors in General Medicine

Angiotensin-converting enzyme (ACE) inhibitors are a class of drugs commonly used in the management of hypertension; congestive heart failure; cerebrovascular disease; stable coronary heart disease and diabetes-associated nephropathy. ACE inhibitors are divided into three classes; namely sulphydryl-containing ACE inhibitors structurally related to captopril; carboxyl-containing ACE inhibitors structurally related to enalapril; and phosphorus-containing ACE inhibitors structurally related to fosinopril. Though these classes of drugs are important in the treatment of the above conditions; they are not without side-effects. It is very important for clinicians to be aware of these side-effects so that patients can be warned; and compliance can be improved

Beta Blockers and their Combinations in the Management of Hypertension

Beta blockers have been prescribed for the treatment of primary hypertension for a very long time. Currently; it is doubtful whether this is still a good idea. In fact; many are of the opinion that beta blockers should be relegated to a fourth-line drug; if used at all; for the treatment of hypertension. So what happened? Why the change of heart? Basically; two issues are driving this new view of beta blockers.Firstly; beta blockers are cardioprotective when given to patients with a recent myocardial infarction and reduce subsequent mortality significantly. Certain types of beta blockers reduce mortality in patients with heart failure. This efficacy in secondary protection was translated to primary prevention without a critical assessment; and this is particularly the case in hypertension.Secondly; reducing blood pressure by any means may not automatically translate into reduced cardiovascular morbidity and mortality. This happened with beta blockers in the primary treatment of hypertension

Prediction of functional capacity during six-minute walk among patients with chronic heart failure

Formulae for predicting functional capacity during 6-minue walk are lacking and the accuracy of the existing formulae has been challenged in deferent populations. The purpose of this study was to develop an equation that would be useful in predicting functional capacity in form of maximum oxygen consumption) (V0 ) in Chronic Heart Failure Patients (CHF) during exercise. Sixty-five subjects were recruited for the study. The procedure required the subjects to walk on a self paced speed on a 20 meter marked level ground for 6 minutes. The distance covered in 6 minutes was measured and the speed calculated. The result showed that the distance covered was highly correlated with the VO2 (0.65; p 0.01). The regression analysis revealed that a linear equation model developed was a good predictor ofV0 for the group. The study concluded that in situation where sophisticated equipments are lacking; this equation might be useful during exercise supervision for patients withCHF. [VO2 (ml kg-1 min-1)