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The Ibadan Chronic Heart Failure Project: Baseline Clinical Profile, Management, and Six-Month Outcomes of the First
O S Ogah1,2,3, O A Orimolade1,2,3, A S Oguntade2
1Cardiology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. Tel. +234 806 77 47 121
Insights
Chronic heart failure (HF) in Nigeria is primarily caused by hypertensive heart disease. While outcomes are similar for men and women, the underuse of modern HF therapies highlights a critical need for improved care in sub-Saharan Africa.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Chronic heart failure (HF) poses a significant and growing health burden in sub-Saharan Africa, with limited contemporary data from large African populations.
- Understanding the specific characteristics and outcomes of HF patients in this region is crucial for effective public health strategies.
Purpose of the Study:
- To investigate the clinical profile, current management practices, and short-term outcomes of patients diagnosed with chronic heart failure (HF).
- To characterize the cohort within the Ibadan Heart Failure Project in Nigeria.
Main Methods:
- A prospective, hospital-based cohort study involving adult patients with chronic heart failure at University College Hospital, Ibadan, Nigeria.
- Data collection included baseline sociodemographic, clinical, and echocardiographic information, with a six-month follow-up period to assess all-cause mortality and hospital readmission.
Main Results:
- Hypertensive heart disease was the leading etiology of HF in 1,290 participants (mean age 56.7 years; 55.8% male), followed by dilated and rheumatic heart disease.
- Six-month cumulative incidence of readmission, death, and composite events were 4.9%, 12.9%, and 17.8%, respectively. Beta-blocker use correlated with reduced readmission risk, while renin-angiotensin-aldosterone axis inhibitors showed significant risk reduction for death and composite events.
- Elevated serum creatinine increased readmission and mortality risk, whereas increased tricuspid annular plane systolic excursion was associated with lower risks of death and composite events.
Conclusions:
- Hypertensive heart disease is the primary driver of chronic heart failure in the Nigerian cohort studied.
- Despite comparable short-term outcomes between sexes, the low utilization of contemporary evidence-based therapies indicates a need for systemic interventions to enhance HF management across sub-Saharan Africa.
Background:
Chronic heart failure is an increasing cause of morbidity and mortality across sub-Saharan Africa, yet contemporary data from large African cohorts remain limited.
Objectives:
To characterise the clinical profile, management, and short-term outcomes of patients with chronic HF enrolled in the Ibadan Heart Failure Project.
Methods:
The Ibadan Heart Failure Project is a real-life, pragmatic, prospective, hospital-based cohort of adults with chronic heart failure being conducted at University College Hospital, Ibadan, Nigeria. The present report is based on participants recruited between September 1, 2016, and December 31, 2022. Baseline sociodemographic, clinical, and echocardiographic data were obtained, and participants were followed for six months. The primary outcomes were all-cause mortality and hospital readmission.
Results:
Among 1,290 patients (mean age 56.7 ± 15.4 years; 55.8% men), hypertensive heart disease was the leading cause, followed by dilated cardiomyopathy and rheumatic heart disease. Women were younger and more likely to have preserved or mildly reduced ejection fraction. The use of sodium-glucose cotransporter-2 inhibitors (3.3%) was low. The cumulative incidence of readmission, death, and a composite of these events at six months was 4.9%, 12.9%, and 17.8%, respectively. The use of beta blockers was associated with 43% reduction in the risk of readmission (HR-0.57, 95%CI-0.33-0.97), while the use of renin -angiotensin-aldosterone axis inhibitors was associated with 62% and 46% reduction in the risk of death and composite of readmission and death, respectively. A unit increase in serum creatinine is associated with 11% and 32% increase in readmission and death, respectively (HR-1.11, 95%CI-1.00-1.23 and HR-1.32, 95% CI-1.21-1.45, respectively) In addition, a unit increase in tricuspid annular plane systolic excursion is associated 64% and 53% lower risk of death and composite of readmission and death, respectively. (HR-0.36, 95%CI-0.22-0.60, HR-0.47, 95%CI-0.30-0.73 respectively). No significant sex or age-related differences were observed in adjusted risks of hospitalization or death.
Conclusions:
Hypertensive heart disease remains the predominant cause of chronic heart failure in Nigeria. Despite similar short-term outcomes across sexes, suboptimal use of newer evidence-based therapies underscores the need for system-level interventions to improve HF care in sub-Saharan Africa.
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