Mwita Julius Chacha, Dewhurst Matthew J, Magafu Mgaywa G, Goepamang Monkgogi, Omech Bernard, Majuta Koketso Lister, Gaenamong Marea, Palai Tommy Baboloki, Mosepele Mosepele, Mashalla Yohana
Department of Internal Medicine, University of Botswana, Gaborone, Botswana; Department of Internal medicine, Princess Marina Hospital, Gaborone,Botswana. Email:
Department of Cardiology, North Tees and Hartlepool NHS Foundation Trust, UK.
Cardiovasc J Afr. 2017;28(2):112-117. doi: 10.5830/CVJA-2016-067. Epub 2016 Aug 24.
Heart failure is a common cause of hospitalisation and therefore contributes to in-hospital outcomes such as mortality. In this study we describe patient characteristics and outcomes of acute heart failure (AHF) in Botswana.
Socio-demographic, clinical and laboratory data were collected from 193 consecutive patients admitted with AHF at Princess Marina Hospital in Gaborone between February 2014 and February 2015. The length of hospital stay and 30-, 90- and 180-day in-hospital mortality rates were assessed.
The mean age was 54 ± 17.1 years, and 53.9% of the patients were male. All patients were symptomatic (77.5% in NYHA functional class III or IV) and the majority (64.8%) presented with significant left ventricular dysfunction. The most common concomitant medical conditions were hypertension (54.9%), human immuno-deficiency virus (HIV) (33.9%), anaemia (23.3%) and prior diabetes mellitus (15.5%). Moderate to severe renal dysfunction was detected in 60 (31.1%) patients. Peripartum cardiomyopathy was one of the important causes of heart failure in female patients. The most commonly used treatment included furosemide (86%), beta-blockers (72.1%), angiotensin converting enzyme inhibitors (67.4%), spironolactone (59.9%), digoxin (22.1%), angiotensin receptor blockers (5.8%), nitrates (4.7%) and hydralazine (1.7%). The median length of stay was nine days, and the in-hospital mortality rate was 10.9%. Thirty-, 90- and 180-day case fatality rates were 14.7, 25.8 and 30.8%, respectively. Mortality at 180 days was significantly associated with increasing age, lower haemoglobin level, lower glomerular filtration rate, hyponatraemia, higher N-terminal pro-brain natriuretic peptide levels, and prolonged hospital stay.
AHF is a major public health problem in Botswana, with high in-hospital and post-discharge mortality rates and prolonged hospital stays. Late and symptomatic presentation is common, and the most common aetiologies are preventable and/or treatable co-morbidities, including hypertension, diabetes mellitus, renal failure and HIV.
心力衰竭是住院的常见原因，因此会影响诸如死亡率等住院结局。在本研究中，我们描述了博茨瓦纳急性心力衰竭（AHF）患者的特征和结局。
收集了2014年2月至2015年2月期间在哈博罗内公主玛丽娜医院连续收治的193例AHF患者的社会人口统计学、临床和实验室数据。评估了住院时间以及30天、90天和180天的住院死亡率。
平均年龄为54±17.1岁，53.9%的患者为男性。所有患者均有症状（77.5%为纽约心脏协会功能分级III或IV级），大多数（64.8%）表现为严重左心室功能障碍。最常见的合并症为高血压（54.9%）、人类免疫缺陷病毒（HIV）（33.9%）、贫血（23.3%）和既往糖尿病（15.5%）。60例（31.1%）患者检测到中度至重度肾功能不全。围产期心肌病是女性患者心力衰竭的重要原因之一。最常用的治疗方法包括呋塞米（86%）、β受体阻滞剂（72.1%）、血管紧张素转换酶抑制剂（67.4%）、螺内酯（59.9%）、地高辛（22.1%）、血管紧张素受体阻滞剂（5.8%）、硝酸盐（4.7%）和肼屈嗪（1.7%）。中位住院时间为9天，住院死亡率为10.9%。30天、90天和180天的病死率分别为14.7%、25.8%和30.8%。180天时的死亡率与年龄增加、血红蛋白水平降低、肾小球滤过率降低、低钠血症、N末端脑钠肽前体水平升高以及住院时间延长显著相关。
AHF是博茨瓦纳的一个主要公共卫生问题，住院和出院后死亡率高，住院时间延长。晚期和有症状的表现很常见，最常见的病因是可预防和/或可治疗的合并症，包括高血压、糖尿病、肾衰竭和HIV。
