Résumé
Background: Hospitalized heart failure [HHF] is a challenging clinical entity in cardiology. Data on HHF patients from the Middle East is scarce. Observational studies may provide an initial insight that could improve disease management and guide the design of future clinical trials
Objective: To evaluate the management, in-hospital mortality, and one-year readmission predictors of HHF patients admitted to the coronary care unit
Setting: Coronary Care Unit, Salmaniya Medical Complex, Bahrain
Design: A Prospective Study
Method: Two hundred forty-five HHF patients were included in the study. Clinical data during hospitalization and upon discharge were recorded from 1 January 2012 to 31 March 2012. Followup was extended for 12-months for readmissions with heart failure [HF]
Result: One hundred seventy [69%] were males, and the mean age was 64 years. The main causes of HF decompensation were non-compliance 59 [24%], myocardial ischemia 51 [21%] and hypertensive crisis 39 [16%]. Comorbidities included were systemic hypertension, 179 [73%], hyperlipidemia, 166 [68%], and diabetes mellitus, 161 [64%]. The mean left ventricular ejection fraction [EF] was 34%. In-hospital mortality rate was 9.4%. Patients who were taking angiotensin receptor blockers [ARB] before admission had reduced in-hospital mortality. Upon discharge, 213 [87%] patients were taking renin-angiotensin system blockers, 170 [69%] were taking beta-blockers, and 66 [27%] were taking mineralocorticoid receptor antagonist [MRA]. The rate of readmission with HF was 47% at one year
Conclusion: HHF patients in this study have multiple comorbidities and an increased in-hospital mortality. In-hospital mortality-related variables and predictors of HF readmission should be verified in a larger population and employed in clinical practice, as these factors might help to improve patient outcome
Résumé
Background: Peripartum cardiomyopathy [PPCM] is a myocardial disease of pregnancy in which heart failure develops during the last month of pregnancy or up to five months postdelivery with no identified cause. Recovery of the myocardium is anticipated and variable factors are implicated
Objective: To evaluate the time of diagnosis in PPCM and how it could affect myocardial recovery. Design: A Prospective Clinical Study. Setting: Salmaniya Medical Complex, Bahrain
Method: Patients who fulfilled the criteria for PPCM were prospectively recruited from 1 January 2014 to 31 December 2014. Follow-up was extended until June 2016. Personal characteristics, clinical, biochemical and echocardiographic data were documented. All patients had clinical assessment and echocardiogram at six months post-delivery
Result: Four females suffering from PPCM were included in the study. Two [50%] had complete recovery of their left ventricular [LV] function after six months. The time of presentation and diagnosis was at early postpartum period. The recovered myocardium was assessed further with dobutamine stress echocardiography [DSE] that confirmed normal contractile reserve. The two recovered patients reconceived with no relapse. On the other hand, the other two [50%] nonrecovered females had their diagnosis made either at antepartum or late postpartum period
Conclusion: Recovery of PPCM might be related to the early postpartum diagnosis. Having high clinical suspicion for diagnosis might help to improve the outcome. Timely instituted therapy might aid in LV recovery
Résumé
Improving blood pressure control requires the identification of covariates associated with uncontrolled hypertension. To evaluate blood pressure control and predictors for uncontrolled hypertension. A Cross-Sectional Study. Cardiology Out-patient Department, Salmaniya Medical Complex. We documented personal factors, comorbidities, blood pressure measurements and the use of anti-hypertensive medications in 371 hypertensive patients from 1 January 2012 to 30 April 2012. Ordinal logistic regression was used to identify factors associated with poor blood pressure control. The mean age of the patients was 54.6 +/- 11.8 years. Two hundred forty-six [66.3%] patients had a mean blood pressure of <140/90; the rest had a mean blood pressure of >140/90. Age group 45-65 years, multidrug regimen, and poorly controlled diabetes were independent predictors of poor blood pressure control. Three hundred thirty-eight [91.1%] patients were on polytherapy receiving an average of three medications. The poorest blood pressure control was among diabetics, 207 [55.8%] and renal impairment patients 67 [18.1%]. The rate of BP control could be improved in the Cardiology Secondary Care Ambulatory Department. Most of the patients were on triple combination therapy. Diabetes and renal impairment are the main risk factors for poor blood pressure control
Résumé
To evaluate the association between glycemic control and hypertensive crisis. A Cross Sectional Study. Cardiology Unit, Salmaniya Medical Complex. One hundred forty-five patients with diabetes mellitus, above 18 years admitted from 1 June 2010 to 31 December 2010 for a hypertensive crisis were reviewed. A control group consisted of 145 diabetic patients, age and sex matched, without hypertensive crisis were recruited for the study. A hypertensive crisis is classified into urgency or emergency, based on the absence or presence of acute target organ involvement. Glycated hemoglobin [HbAlc] level of <53 mmol/mol is the threshold for good glycemic control. The relationship between various clinical presentation and HbAlc was assessed. One hundred forty-five were reviewed, 87 [60%] were males and 58 [40%] were females. Twenty-six [18%] of the crisis group had HbAlc of < 53 mmol/mol; 75 [52%] of the control subjects had HBAlc <53 mmol/mol, [P value<0.0001]. Among the hypertensive crisis group, the rate of hypertensive emergencies, 84 [58%], was greater than those of hypertensive urgencies, 61 [42%]. Left ventricular failure [LVF] was the most common clinical presentation. Poor glycemic control was closely related to hypertensive emergency [P value=0.042]. Patients with HBAlc <53 mmol/mol had lower rates of hypertensive emergencies than those with HBAlc >53mmol/mol, 11 [42%] and 75 [63%], respectively. It was found that hypertensive patients with good glycemic control are at a lesser risk of getting emergency hypertensive crisis. Controlling diabetes may confer protection against hypertensive crisis and in particular, emergencies and the related cardiovascular complications