Factors associated with poor prognosis among patients admitted with heart failure in a Nigerian tertiary medical centre: a cross-sectional study.

BACKGROUND

Heart failure is a major and growing public health problem worldwide. The prognosis of Heart Failure (HF) is uniformly poor despite advances in treatment. The aims of the present study were to determine the causes of HF among patients admitted to a Nigerian tertiary medical centre, to determine the prevalence of factors known to be associated with poor prognosis among these patients, and to compare the factors and causes between males and females.

METHODS

The study was cross-sectional in design, carried out on eligible patients who were consecutively admitted with HF, in Aminu Kano Teaching Hospital, Kano, Nigeria. The following established factors associated with poor prognosis of HF were assessed: low Left Ventricular Ejection Fraction (LVEF) of < or = 40%, anaemia, renal impairment, cardiac rhythm disturbances on the electrocardiogram, prolonged corrected QT interval (QTc), complete Left Bundle Branch Block (LBBB) and advanced age.

RESULTS

A total of 79 patients were studied over a six-month period. Forty four (55.7%) of these patients were males while the remaining 35 (44.3%) were females. The most prevalent prognostic factor was low LVEF found in a total of 35 patients (44.3%), while the least prevalent was complete LBBB found in two male patients only (2.53%). The commonest cause of heart failure in all patients and males was hypertensive heart disease, found in a total of 45 patients (57.0%), comprising of 33 male (73.3%) and 12 female patients (26.7%) (p = 0.0003). Cardiomyopathies were the commonest causes in females, the predominant type being peripartum cardiomyopathy found in 11 (31.4%) female patients. Acute myocardial infarction has emerged to be an important cause of HF in males (13.6%) with a high in-hospital mortality of 66.7%.

CONCLUSION

The most prevalent factor associated with poor prognosis was low LVEF. Hypertensive heart disease and cardiomyopathies were the most common causes of HF in males and females respectively. The findings of the study should guide decision-making regarding management of HF patients.