Clinical and Demographic Characteristics of Patients Presenting with Heart Failure to a Teaching Hospital in Kumasi, Ghana
[1]
Isaac Kofi Owusu, Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
This was a 6-month prospective descriptive study carried out at the Department of Medicine, Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. The main objective of the study was to determine the socio-demographic characteristics and clinical presentation of patients with heart failure seen at KATH, Kumasi, Ghana. Patients aged thirteen years and above admitted to the medical wards with diagnosis of heart failure were recruited. Detailed history, clinical examination, electrocardiography (ECG), Chest X-ray, echocardiography, haematological and biochemistry tests were done. One hundred and sixty seven (167) patients were studied, 86 males and 81 females. They were aged 13 - 90 years with the mean 51.1 ( 21.1) years. Age group 61-70 years had the highest incidence of heart failure. Majority of the patients presented with biventricular failure (71.9 %; n=120) and the New York Heart Association (NYHA) functional class IV (64.2 %; n=107). The commonest presenting complaint was dyspnoea on exertion (95.8 %, n=160), followed by fatigue (94 %, n=157). History of chronic alcohol use was obtained from 43.1 % of the patients. ECG left ventricular hypertrophy (LVH) was seen in 66.5 % of the patients. Hypertension and anaemia were seen in 42.5 % and 47 % of the patients respectively. Conclusions: Heart failure occurred almost equally in males and females with the highest incidence in age group 61-70 years. Majority of the patients presented with NYHA functional class IV. The commonest presenting complaint was dyspnoea on exertion, and ECG LVH, hypertension and anaemia were three major conditions seen in the patients.
Heart failure, orthopnoea, hypertension, electrocardiography, LVH, NYHA functional classification
[1]
Edgar Brice Ngoungou, Victor Aboyans, Philomemne Kouna, et al. Prevalence of cardiovascular disease in Gabon: A population study. Archives of Cardiovascular Disease 2012; 105, 77-83.
[2]
Alberts M, Urdal P, Steyn K, et al. Prevalence of cardiovascular diseases and associated risk factors in a rural black population of South Africa. Eur J Cardiovasc Prev Rehabil 2005; 12:347-54.
[3]
Opie LH, Mayosi BM. Cardiovascular disease in sub-Saharan Africa. Circulation 2005; 112:3536-40.
[4]
Lasater M. The effect of a nurse-managed congestive heart failure clinic on patient readmission and length of stay. Home Healthc Nurse 1996 May: 14 (5): 351 -356.
[5]
Sans S, Kesteloot H, Kromhout D. The burden of cardiovascular diseases mortality in Europe. The task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Eur Heart J. 1997; 18 1231 – 1248.
[6]
Ho KKL, Pinsky JL, Kannel WB, Lery D. The epidemiology of heart failure: The Framingham study. J Am Coll Cardiol 1993; 22 (Supplement A): 6A – 13A.
[7]
Owusu IK, Boakye YA. Prevalence and Aetiology of Heart Failure in Patients Seen at a Teaching Hospital in Ghana. J Cardiovasc Dis Diagn 2013; 1: 131.
[8]
Adams KF, Zannad F. Clinical definition of advanced heart failure. Am Heart J 1998; 135:S204-S215.
[9]
The SOLVD Investigators. The effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med 1991; 325:302.
[10]
The Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med 1997; 336: 525 – 33.
[11]
Cowie MR, Wood DA, Coats AJ. Epidemiology of heart failure; a population-based study. Eur Heart J 1990; 20:421-428.
[12]
Cance WG, Steward AK, Menck HR. The national cancer database reports on treatment patterns for hepatocellular carcinomas: improved survival of surgically resected patients, 1985-1996. Cancer 2000; 88: 912-920.
[13]
King D. Diagnosis and management of heart failure in the elderly. Postgrad Med J. 1996; 72:577 – 580.
[14]
Amoah AG, Kallen C. Aetiology of heart failure as seen from a National Cardiac Referral Centre in Africa. Cardiology 2000; 93 (1-2): 11-18.
[15]
Danbauchi SS, Alhassan MA, David SO, et al. Spectrum or Rheumatic Heart Disease in Zaria, Northern Nigeria. Annals of African Medicine Vol. 3. No 1: 2004: 17-21.
[16]
Edmunds AW. Idiopathic cardiomyopathy in Botswana. J Trop Med Hyg 1979 Jan; 82 (1) 14-17.
[17]
Owusu IK, Adu-Boakye Y, Appiah TL. Hypertensive Heart Failure in Kumasi, Ghana, Open Science Journal of Clinical Medicine. Vol. 2, No. 1, 2014, pp. 39-43.
[18]
Steyn K, Silwa K, Hawkens K, et al. Risk factors associated with myocardial infarction in Africa: the INTERHEART Africa study. Circulation 2005; 112:3554- 61.
[19]
Owusu IK, Y Adu-Boakye, R K Boadi. Cardiovascular Risk Profile Of Patients Seen At A Cardiac Clinic In Kumasi, Ghana. The Internet Journal of Health. 2013 Volume 14 Number 1.
[20]
Kenchaiah S, Narula J, Vasan RS. Risk factors for heart failure. Med Clin North Am. 2004 Sep; 88(5):1145-72.
[21]
Oli K, Tekle-Haimanot R, Forsgren L, Ekstedt J. Rheumatic Heart Disease prevalence among school children of an Ethiopian rural town. Cardiology 1992; 80:152-155.
[22]
Owusu IK, Boakye YA, Appiah LT. Electrocardiographic Abnormalities in Heart Failure Patients at a Teaching Hospital in Kumasi, Ghana. J Cardiovasc Dis Diagn 2014; 2: 142.
[23]
Owusu IK: Electrocardiographic Left Ventricular Hypertrophy In Patients Seen With Hypertensive Heart Failure: The Internet Journal of Third World Medicine. 2007; Volume 6, Number 1.
[24]
Chobanian AV, Bakris GL, Black HR, Cushman WC, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289:2560-2571.
[25]
American Diabetes Association. Screening for type 2 diabetes. Diabetes Care. 1992; 22(supplement 1):S20-S23.
[26]
Nutritional anaemias. Report of a World Health Organization Scientific Group. Geneva, World Health Organization, 1968 (WHO Technical Report Series, No. 405).
[27]
Scott R. C. The electrocardiographic diagnosis of left ventricular hypertrophy.Am Heart J. 1960; 59:155.
[28]
McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural history of heart failure: the Framingham study. N Engl J Med. 1971; 285:1441-1446.
[29]
The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of the heart and great vessels. 6th edition. Boston: Little Brown and Co., 1964.
[30]
Mosterd A, Deckers JW, Hoes AW, Nederpel A. Classification of heart failure in population-based research: an assessment of six heart scores. Eur J Epidemiol. 1997; 13:491-502.
[31]
Task Force for the diagnosis and treatment of acute and chronic heart failure. European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart. Eur Heart J 2012; 33, 1787- 1847.
[32]
Owusu IK: Treatment Of Heart Failure In A Teaching Hospital In Ghana, West Africa. The Internet Journal of Third World Medicine. 2007 Volume 4 Number 2.
[33]
Isezuo AS, Omotoso AB, Araoye MA, Carr J, Corrah T. Determinants of prognosis among black Africans with hypertensive heart failure. Afr J Med Sci. 2003 Jun 32; (2) :143-149.
[34]
Ajayi AA, Sofowora GG, Adigun AQ, Asiyanbola B. Adjunctive sympathoplegic therapy to ACE inhibition in Blacks with congestive heart failure: a comparison of alpha-1 blockade on exercise tolerance and cardiac sympathovagal reflex activity. Ethn Dis. 2003 Winter; 13(1):150.
[35]
Owusu IK: Causes Of Heart Failure As Seen In Kumasi Ghana . The Internet Journal of Third World Medicine. 2007 Volume 5 Number 1.
[36]
Pobee JOM, Biritwum RB, Belcher DW. Congestive cardiac failure in Accra, Ghana – Opportunity and Challenge. Ghana Med J 2002; 36 (1):29-33.
[37]
Spies CD, Sander M, Stangl K, et al. Effects of alcohol on the heart. Curr Opin Crit Care. 2001 Oct;7(5):337-343.
[38]
Oyoo GO, Ogola EN. Clinical and socio-demographic aspects of congestive heart failure patients at Kenyatta National Hospital, Nairobi. East Afr Med J. 1999 Jan; 76 (1): 23-27.
[39]
Francis GS, Goldsmith SR, Levin TB, Olivarez MT, Cohn JN. The neurohormonal axis in congestive heart failure. Ann Intern Med 1984; 101: 370-377.
[40]
Ike SO, Onwubere BJ. The relationship between diastolic dysfunction and the level of blood pressure in Blacks. Ethn Dis. 2003; 13(4): 463 – 469.
[41]
Danbauchi SS. Echocardiographic feature of peripartum cardiac failure: the Zaria syndrome. Trop Doct 2002 Jan; 32(1):24-27.
[42]
Paul S, Paul RV. Anaemia in heart failure: Implications, management and outcomes. Cardiovasc Nurs. 2004 Nov; 19(6s):S57-S66.
[43]
Roth EJ. Heart disease in patients with stroke: incidence, impact, and implications for rehabilitation, I: classification and prevalence. Arch phys Med Rehabil. 1999; 30:1991-1994.
