ABSTRACT
Heart failure [HF] is a public health problem in both developed countries and emerging ones. The objective of our work is to study its epidemiological, clinical and evolutionary features in a Moroccan hospital. a retrospective study of 200 patients hospitalized between December 2012 and January 2014. HF represents 25% of hospitalizations in departments of cardiology. The average length of stay was 13 +/- 9 days. The mean age was 57.7 +/- 14.3 years. A male predominance is noted with a ratio M / F = 1.2. The main cardiovascular risk factor is hypertension [40%] followed by use of tobacco [30%] and diabetes [28%]. Dyspnea is the main symptom reported in 85% of cases. The clinical presentations were: left HF [64%], right HF [19%], global HF [21%], and cardiogenic shock [7%].The signs found on the EKG were q wave of necrosis [42%], atrial fibrillation [30%], left ventricular hypertrophy [21%] and a left bundle branch block [19%].The chest X-ray objective cardiomegaly [73%], signs of lung overload [60%] and pleural effusion [20%]. Biology shows electrolyte abnormalities in almost a third of cases. Also, renal failure [35%], anemia [25%] and hyperuricemia [12%]. Natriuretic peptides were measured in only 4 patients. Echocardiography showed that 65% of our patients had a systolic HF and a 35% a preserved LVEF [diastolic HF]; the threshold value used to distinguish the two is 45%. 110 patients underwent coronary angiography which objectified coronary artery disease in 81% of cases. The main causes were ischemic heart disease [50%], valvular heart disease [20] diuretics [80%], ACE inhibitors or angiotensin II receptor antagonists [79%], BB [72%] Spironolactone [40%]. Among patients with coronary artery disease, 20% were revascularized by CABG and 28% by coronary angioplasty. 22% of patients underwent valve surgery. The septal alcoholization was performed in 3 patients. Cardiac resynchronization therapy was performed in 9 patients and 3 patients received an implantable cardioverter defibrillator. Heart transplantation was performed in one patient [transferred to France]. In hospital mortality was 10%.The main characteristics of our population is relatively young age, male predominance, ischemic heart disease as leading etiology followed by valvular heart disease and the clear predominance of systolic HF. Despite the epidemiological and clinical characteristics, our series show many similarities with European and American registries. For the therapeutic aspect, and despite the codified recommendations for HF treatment, our care is far from optimal. This study highlights HF characteristics in Morocco and our weaknesses in patients care. It should encourage us firstly to establish a national HF registry, and secondly to treat our patients better, to implement more preventive measures and to emphasize patient education