[Burden of comorbidities in heart failure patients hospitalized at the Abidjan Heart Institute]. / Poids des comorbidités chez les insuffisants cardiaques hospitalisés à l'Institut de cardiologie d'Abidjan.

OBJECTIVE: The aim of our work was to appreciate the importance of comorbidities of heart failure individually and globally in patients hospitalized at the Cardiology Institute of Abidjan. PATIENTS AND METHODS: This was a prospective cohort study of adult heart failure patients hospitalized from January to December 2015, and followed up over 12 months. Co-morbidities were analysed through their prevalence, their relationship with the etiologies, and their impact on the prognosis. RESULTS: Three hundred and two patients (mean age: 55.5±16.9 years, 61.6 % male) were recruited. High blood pressure, anaemia and kidney dysfunction were the most common co-morbidities (48 %, 43.7 % and 41.3 % respectively). There was an average of 3.4±1.8 comorbidities per patient with an increase in the number of comorbidities with age (P<0.05) and a more frequent association with hypertensive and ischemic heart disease (P<0.001). During the one-year follow-up, 96 patients died. Apart from hepatic dysfunction (RR=1.97, 95 % CI [1,19-3.25], P=0.008, a high score of Charlson index appeared as a risk factor of death as much in univariate analysis (RR=4.15 95 % CI [2.32-7.41], P<0.001), as in multivariate analysis according to the Cox model (RR=2.48. 95 % CI [1.08-5.09], P=0.03) confirmed by Kaplan Meier curves (P<0.001). CONCLUSION: Comorbidities are common in our heart failure patients and significantly affect their prognosis.

[Prevalence and characteristics of acute coronary syndromes in a sub-Saharan Africa population]. / Prévalence et caractéristiques des syndromes coronariens aigus dans une population d'Afrique subsaharienne.

AIM: To assess prevalence, characteristics and management of acute coronary syndromes in sub-Saharan Africa population. PATIENTS AND METHODS: Prospective survey from January, 2010 to December, 2013, carried out among patients aged 18 years old, admitted to intensive care unit of Abidjan Heart Institute for acute coronary syndrome (ACS). RESULTS: Four hundred and twenty-five (425) patients were enrolled in this study. Prevalence of ACS was 13.5%. Mean age was 55.4±11 years. Clinical presentation was predominantly ST-segment elevation myocardial infarction (STEMI) in 71.5% of subjects, non-ST-segment elevation acute coronary syndrome (NSTE-ACS) accounted for 28.5%. Two hundred and eighty patients (65.9%) were transferred by unsafe transportation. Among the 89 patients admitted within 12hours of the onset of symptoms, primary percutaneous coronary intervention was performed in 20 patients (22.5%), or 6.6% of STEMI as a whole. Twenty-five patients (8.2%) received fibrinolytic therapy with alteplase. In-hospital death rate was 10%. CONCLUSION: The prevalence of acute coronary syndromes is increasing in sub-Saharan Africa. Excessive delays of admission and limited technical facilities are the major difficulties of their management in our regions.

[Assessment of treatment adherence among black Africans with heart failure]. / Évaluation de la compliance chez l'insuffisant cardiaque noir africain.

STUDY AIM: to analyze patient-related factors that may influence adherence in patients with heart failure in an African cardiology department. METHODOLOGY: This prospective observational study took place in the in-patient department of the Abidjan cardiology institute and enrolled consecutive patients hospitalized for decompensated heart failure from January to November 2014. The inclusion criteria were chronic heart failure in patients older than 18 years, developing for at least 6 months and treated by medication. The revised heart failure compliance questionnaire was used. RESULTS: The study included 121 patients. Overall adherence was poor in 88.4% of patients. Multiple linear regression analyses showed that use of traditional medicine was associated with poor adherence for the following 3 components: keeping follow-up appointments, medication intake, and sodium limitations. Overall adherence increased with the number of hospitalizations (OR = 1.69, 95% CI 1.13-2.53; p = 0.01). This increase persisted after adjustment for age, sex, educational level, marital status, medical insurance coverage and the use of alternative medicines (traditional and Chinese) (OR = 1.70; CI 1.12-2.28; p = 0.01). CONCLUSION: Adherence among black Africans with heart failure remains poor, influenced too much by traditional medicine. Therapeutic education is essential to improve patients' knowledge about their disease and its treatment.

[Compliance to treatment in heart failure patients in Lomé]. / Observance thérapeutique de l'insuffisant cardiaque à Lomé

BACKGROUND: The incidence and prevalence rates of the heart failure in the world approach epidemic proportions. The evaluation of the follow-up of the treatment of heart failure can allow the setting up of strategies to reduce the frequency of decompensations and improve the quality of life of these patients. OBJECTIVES: To estimate the compliance to treatment and factors liable to influence it in Togolese patients suffering from heart failure. PATIENTS AND METHODS: This study was carried out from January 1st, 2008 to June 30th, 2009 in the department of cardiology of the university teaching hospital Campus in Lomé and included prospectively, patients with chronic heart failure hospitalized for acute decompensation and of which the heart failure was diagnosed and treated for at least 3 months. Questionnaires were filled to estimate the compliance to medication, to diet, as well as knowledge of the patients on their disease and their relationship with their doctor and their family. RESULTS: In the 103 patients included, we noticed no good compliance to medication; there were 74.7% of bad compliance to medication, 47.3% of good compliance to diet; 62.1% of patients had enough knowledge on their disease, 29.1% considered that their doctor did not grant them enough time; 57.3% estimated to have no necessary support of their family. Bad compliance to treatment was correlated to the existence or not of a health care insurance (OR=115.5; 95% CI=21.51-620.08; P<0.0001); this difference persisted after adjusting for age, sex and monthly income (OR=99.65; 95% CI=18.87-587.21; P=0.001). Bad compliance was not associated with monthly income (OR=0.93; 95% CI=0.37-2.28; P=0.944); it was neither influenced by traditional therapy (OR=1.58 95% CI=0.64-3.91; P=0.43), nor recovery prayers (OR=1.6; 95% CI=0.62-4.13; P=0.45), nor frequency of tablets intake (≥3 intake day), OR=0.169; 95% CI=0.05-0.49; P=0.43. CONCLUSION: The compliance to medication in Togolese heart failure patients was very low and essentially correlated to the absence of health care insurance.

[Management of high-grade atrioventricular block in Lomé, Togo]. / Prise en charge des blocs auriculoventriculaires de haut degré à Lomé (Togo).

The purpose of this cross-sectional study was to describe epidemiological, clinical and therapeutic aspects of high-grade atrioventricular block in Lomé. Out of 2245 patients hospitalized between June 2004 and May 2009, a total of 22 cases of high-grade atrioventricular block were detected thus a prevalence of 1%. The main symptoms were syncope and presyncope (73%) and dyspnea (50%). There was 77.2% of chronic grade III atrioventricular block and 22.8% of grade II atrioventricular block. A pacemaker has been established in 8 patients (40% of the patients presenting a class I indication) in VVI (R) mode. We noted 59% of deaths among patients who did not benefited from any cardiac pacing.