Types and Outcomes of Arrhythmias in a Cardiac Care Unit in Western Kenya: A Prospective Study
Joan Kiyeng1,2, Constantine Akwanalo1, Wilson Sugut1
1Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret, KE.
Insights
Cardiac arrhythmias, particularly supraventricular tachyarrhythmias like atrial fibrillation, are common in critically ill patients in Kenya. However, having an arrhythmia at admission did not significantly impact 30-day mortality rates.
Area of Science:
- Cardiology
- Critical Care Medicine
- Epidemiology
Background:
- Sustained arrhythmias are common in cardiac care units (CCUs).
- Data on arrhythmia types and outcomes in Africa are limited.
- Previous studies in high-income countries suggest worse outcomes associated with arrhythmias.
Purpose of the Study:
- To determine the types and prevalence of cardiac arrhythmias in CCU patients at Moi Teaching and Referral Hospital (MTRH).
- To compare 30-day outcomes (mortality, readmission, length of stay) between patients with and without arrhythmias upon CCU admission.
Main Methods:
- Prospective cohort study of 160 patients admitted to MTRH-CCU (March-December 2021).
- Patients stratified based on presence or absence of arrhythmia at admission.
- 30-day follow-up for all-cause mortality, readmission, and hospital stay.
Main Results:
- 43.8% of patients had an arrhythmia at admission; supraventricular tachyarrhythmias (SVT) were most common (88.6%), with atrial fibrillation (AF) being the most frequent SVT (82.3%).
- No statistically significant difference in 30-day all-cause mortality between patients with (32.9%) and without (30.0%) arrhythmias at admission (p=0.64).
Conclusions:
- Supraventricular tachyarrhythmias, especially atrial fibrillation, are prevalent in critically ill cardiac patients in Western Kenya.
- Arrhythmia at CCU admission was not associated with significantly different 30-day mortality in this cohort.
Background:
Sustained arrhythmias are frequently encountered in cardiac care units (CCU), but their types and outcomes in Africa are unknown. Studies from high-income countries suggest arrhythmias are associated with worse outcomes.
Objectives:
To determine the types and proportion of cardiac arrhythmias among patients admitted to the CCU at Moi Teaching and Referral Hospital (MTRH), and to compare 30-day outcomes between patients with and without arrhythmias at the time of CCU admission.
Methods:
We conducted a prospective study of a cohort of all patients admitted to MTRH-CCU between March and December 2021. They were stratified on the presence or absence of arrhythmia at the time of CCU admission, irrespective of whether it was the primary indication for CCU care or not. Clinical characteristics were collected using a structured questionnaire. Participants were followed up for 30 days. The primary outcome of interest was 30-day all-cause mortality. Secondary outcomes were 30-day all-cause readmission and length of hospital stay. The 30-day outcomes were compared between the patients with and without arrhythmia, with a p value < 0.05 being considered statistically significant.
Results:
We enrolled 160 participants. The median age was 46 years (IQR 31, 68), and 95 (59.4%) were female. Seventy (43.8%) had a diagnosis of arrhythmia at admission, of whom 62 (88.6%) had supraventricular tachyarrhythmias, five (7.1%) had ventricular tachyarrhythmias, and three (4.3%) had bradyarrhythmia. Atrial fibrillation was the most common supraventricular tachyarrhythmia (82.3%). There was no statistically significant difference in the primary outcome of 30-day mortality between those who had arrhythmia at admission versus those without: 32.9% versus 30.0%, respectively (p = 0.64).
Conclusion:
Supraventricular tachyarrhythmias were common in critically hospitalized cardiac patients in Western Kenya, with atrial fibrillation being the most common. Thirty-day all-cause mortality did not differ significantly between the group admitted with a diagnosis of arrhythmia and those without.
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