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Heart Failure Etiologies and Challenges to Care in the Developing World: An Observational Study in the Democratic

Didier Malamba-Lez¹, Dophra Ngoy-Nkulu², Paul Steels³

¹Department of Internal Medicine, Faculty of Medicine, University of Lubumbashi, Democratic Republic of Congo; Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.

Journal of Cardiac Failure

|October 26, 2018

Insights

Heart failure patients in the Democratic Republic of Congo face high mortality and loss to follow-up due to late presentation and limited resources. Non-ischemic causes are prevalent, highlighting critical care gaps.

Area of Science:

Cardiology
Global Health
Public Health

Background:

Limited data exists on heart failure (HF) causes, outcomes, and care organization in developing nations.
Understanding HF in resource-limited settings is crucial for improving patient management.

Purpose of the Study:

To investigate the causes, risk factors, and outcomes of heart failure in Lubumbashi, Democratic Republic of Congo (DRC).
To determine factors associated with mortality and challenges in HF patient follow-up.

Main Methods:

A consecutive series of 231 heart failure patients were analyzed from November 2014 to September 2016.
Echocardiography, clinical data, and hospitalization costs were assessed to identify mortality predictors and care challenges.

Main Results:

Hypertension, chronic kidney disease, alcohol abuse, and obesity were common HF risk factors.
Dilated cardiomyopathy was the primary etiology (48%); in-hospital mortality was 19%, linked to low estimated glomerular filtration rate and atrial fibrillation.
High loss to follow-up (46%) was attributed to poverty, poor health literacy, and disorganized care, contributing to a 35% mortality rate within one year.

Conclusions:

Heart failure patients in DRC present late with predominantly non-ischemic cardiomyopathy.
Limited resources and high mortality underscore the urgent need for improved HF care strategies in the region.

Read full analysis

Abstract

Background:

Limited data are available regarding causes and outcomes of heart failure as well as organization of care in the developing world.

Methods And Results:

We included consecutive patients diagnosed with heart failure from November 2014 to September 2016 in a university and private hospital of Lubumbashi, Democratic Republic Congo. Baseline data, including echocardiography, were analyzed to determine factors associated with mortality. Cost of hospitalization as well as challenges for care regarding follow-up were determined. A total of 231 patients (56 ± 17 years, 47% men, left ventricular ejection fraction 29 ± 15%, 20% atrial fibrillation) were diagnosed, more during heart failure hospitalizations (69%) than as outpatients (31%). Main risk factors for heart failure included hypertension (59%), chronic kidney disease (51%), alcohol abuse (38%), and obesity (32%). Dilated cardiomyopathy was the most prevalent etiology (48%), with ischemic cardiomyopathy being present in only 4%. In-hospital mortality rate was 19% and associated with an estimated glomerular filtration rate of <60 mL·min^-1·1.73 m^-2 (P < .01) and atrial fibrillation (P = .02). One hundred six patients (46%) were lost to follow-up, which was mainly related to lack of organization of care, poverty, and poor health literacy. Of the remaining 95 subjects, another 33 (35%) died within 1 year after presentation. The average cost of care for a 10-day hospitalization was higher in a private than in a university hospital (885 vs 409 USD).

Conclusions:

Patients admitted for heart failure in DRC have a high incidence of nonischemic cardiomyopathy and present late during their disease, with limited resources being available accounting for a high mortality rate and very high loss to follow-up.

Keywords:

Heart failure challenges to care developing world

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