ABSTRACT
BACKGROUND: To determine and compare the demographic characteristics, clinical profile and management of patients with heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) in a Turkish cohort. METHODS: The APOLLON trial (A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON) is an observational and multicenter study conducted in Turkey. Consecutive patients admitted to the cardiology clinics who were at least 18â¯years of age and had HFmrEF or HFpEF were included (NCT03026114). RESULTS: The study population included 1065 (mean age of 67.1⯱â¯10.6â¯years, 54% women) patients from 12 sites in Turkey. Among participants, 246 (23.1%) had HFmrEF and 819 (76.9%) had HFpEF. Compared to patients with HFpEF, those with HFmrEF were more likely to be male (57.7 vs 42.2%; pâ¯<â¯0.001), had higher N-terminal pro-B-type natriuretic peptide levels (853 vs 528â¯pg/ml, pâ¯<â¯0.001), were more likely to have ECG abnormalities (72.4 vs 53.5%, pâ¯<â¯0.001) and hospitalization history for heart failure (28 vs 18.6%; pâ¯=â¯0.002). HFmrEF patients were more likely to use ß-blockers (69.9 vs 55.2%, pâ¯<â¯0.001), aldosterone receptor antagonists (24 vs 14.7%, pâ¯=â¯0.001), statins (37 vs 23%, pâ¯<â¯.001), and loop diuretics (39.8 vs 30.5%, pâ¯=â¯0.006) compared to patients with HFpEF. CONCLUSIONS: The results of APOLLON study support that the basic characteristics and etiology of HFmrEF are significantly different from HFpEF. This registry also showed that the patients with HFmrEF and HFpEF were younger but undertreated in Turkey compared to patients in western countries.
Subject(s)
Heart Failure/epidemiology , Heart Failure/physiopathology , Stroke Volume , Ventricular Function, Left , Adrenergic beta-Antagonists/therapeutic use , Aged , Comorbidity , Cross-Sectional Studies , Echocardiography , Female , Heart Failure/drug therapy , Humans , Logistic Models , Male , Middle Aged , Multivariate Analysis , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Registries , Risk Factors , Sodium Potassium Chloride Symporter Inhibitors/therapeutic use , Turkey/epidemiologyABSTRACT
BACKGROUND: The presence of psychiatric morbidity in the child and adolescent age group is demonstrable in various studies conducted in various settings in Kenya. This study set out to determine the psychiatric morbidity and socio-demographic profile of patients who eventually present for care at a tertiary specialist child and adolescent mental health clinic in Kenya. Knowledge of the patterns of presentation of disorders is crucial for planning of service scale up as well as serving as a useful training guide. METHODS: This was a cross sectional descriptive study of 166 patients and their guardians presenting to the child and adolescent mental health clinics at a tertiary referral hospital in Nairobi, Kenya. Data was collected using a researcher designed socio-demographic questionnaire and the Kiddie-schedule for affective disorders and schizophrenia-present and lifetime (KSADS-PL 2009 Working Draft) and analysed using Statistical Package for Social Scientists. RESULTS: There were more males (56%) than females in this study and the participant's mean age was 13.6 years. Substance abuse disorders were the most prevalent presentation (30.1%) followed by depressive disorders (13.9%), with most referrals to the clinic coming from medical practitioners and teachers. The mean time to accessing care at the clinic after the onset of symptoms was 16.6 months, with the longest time taken to specialist care being 183 months. CONCLUSIONS: The findings from this study will go a long way to support the establishment of programs that improve timely child and adolescent mental health service delivery. The involvement of various stakeholders such as the education sector and the community is key in the development of these programs.