Moyehodie Yikeber Abebaw, Muluneh Mitiku Wale, Belay Alebachew Taye, Fenta Setegn Muche
Department of Statistics, Debre Tabor University, Debre Tabor, Ethiopia.
Front Cardiovasc Med. 2022 May 6;9:817074. doi: 10.3389/fcvm.2022.817074. eCollection 2022.
Heart failure (HF) is a major health problem that affects patients and healthcare systems worldwide. It is the leading cause of morbidity and death and negatively impacts the quality of life, healthcare costs, and longevity. However, the causes of death were not well defined. This study aimed to identify the determinants of death among patients with HF in the Amhara Region, Northwest Ethiopia.
A multicenter retrospective cohort study was conducted on 285 patients in the age group 15 years or older under follow-up from 1 January 2015 to 31 December 2019. Descriptive analyses were summarized using the Kaplan-Meier survival curve and the log-rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to 5 years after they were admitted to the HF department to follow up on their treatment.
Out of 285 patients with HF, 93(32.6%) of the respondents were dying within 5 years of follow-up. Anemia was the common comorbid disease (30.5%), and valvular heart disease was the most common etiology (33.7%) of chronic heart failure in this study. This study showed a significant mortality difference between hospitals. HF patients with hypertension [adjusted hazard ratio (AHR): 3.5076, 95% confidence interval (CI): 1.43, 8.60], anemia (AHR: 2.85, 95% 1.61, 5.03), pneumonia (AHR: 2.02, 95% 1.20, 3.39), chronic kidney disease (2.23, CI: 1.31, 3.77), and diabetes mellitus (AHR: 2.42, 95% CI: 1.43, 4.09) were at a higher risk of death. Moreover, patients with symptoms listed in the New York Heart Association Class (III and IV), Ischemic Heart Disease and unknown etiologies, men (AHR: 2.76, 95%:1.59, 4.78), and those with a high pulse rate (AHR: 1.02, 95%:1.00, 1.04) were at a higher risk of death.
There was a mortality difference between hospitals. This study has revealed that HF patients with anemia, diabetes mellitus, pneumonia, hypertension, chronic kidney disease, HF etiologies, severe New York Heart Association Class (III and IV), men, and high pulse rate were the main factors associated with death. Health professionals could give more attention to patients whose pulse rate is high, men, and a patient who had comorbidities in the ward.
心力衰竭（HF）是一个重大的健康问题，影响着全球的患者和医疗保健系统。它是发病和死亡的主要原因，对生活质量、医疗成本和寿命产生负面影响。然而，死亡原因尚未明确界定。本研究旨在确定埃塞俄比亚西北部阿姆哈拉地区心力衰竭患者的死亡决定因素。
对2015年1月1日至2019年12月31日期间接受随访的285名15岁及以上年龄组的患者进行了一项多中心回顾性队列研究。使用Kaplan-Meier生存曲线和对数秩检验进行描述性分析总结。然后，采用Cox比例风险回归模型来估计患者入住心力衰竭科室接受治疗后5年内的死亡风险。
在285例心力衰竭患者中，93例（32.6%）受访者在随访的5年内死亡。贫血是常见的合并症（30.5%），瓣膜性心脏病是本研究中慢性心力衰竭最常见的病因（33.7%）。本研究显示不同医院之间存在显著的死亡率差异。患有高血压的心力衰竭患者[调整后风险比（AHR）：3.5076，95%置信区间（CI）：1.43，8.60]、贫血（AHR：2.85，95%：1.61，5.03）、肺炎（AHR：2.02，95%：1.20，3.39）、慢性肾脏病（2.23，CI：1.31，3.77）和糖尿病（AHR：2.42，95%CI：1.43，4.09）的死亡风险更高。此外，纽约心脏协会心功能分级（III级和IV级）、缺血性心脏病和病因不明、男性（AHR：2.76，95%：1.59，4.78）以及心率高的患者（AHR：1.02，95%：1.00，1.04）死亡风险更高。
不同医院之间存在死亡率差异。本研究表明，贫血、糖尿病、肺炎、高血压、慢性肾脏病、心力衰竭病因、纽约心脏协会心功能分级严重（III级和IV级）、男性以及心率高的心力衰竭患者是与死亡相关的主要因素。医护人员应更加关注病房中心率高的患者、男性患者以及患有合并症的患者。
