Incidence, clinical outcomes and associated factors among valvular heart disease patients admitted to medical ward of Jimma Medical Center

Abstract

Background: In Ethiopia, it was reported that valvular heart disease is the most prevalent diagnosis among cardiac cases admitted to hospitals. However, the existing studies did not assessed the risk factors and outcomes of this disease. Objective: The aim of this study was to assess the incidence, clinical outcomes and associated factors of valvular heart disease patients admitted to the medical ward of Jimma Medical Center. Methods: Hospital based prospective cohort study was used. A total of 156 moderate to severe valvular heart disease patients were followed for consecutive 90 days. Descriptive statistics was presented in frequency tables and figures. Chi-square (χ2) test was used to assess the associations between categorical variables. Independent student t-test and Mann whitney U test was used to compare the mean/median difference of continuous variables. Kaplan Meier with logrank test was used to describe and compare the survival status of the patients. Multivariate cox regression with hazard ratio (HR) was used to identify predictors of mortality. Finally, variables with a P value <0.05 was considered statistically significant. Result: Female accounted for 79 (50.64%) of the study participants. The mean (SD) age of the paricipants was 45.62±19.126 years. Hypertension 36(23.1%) was the most common co-morbid disease. Cardiomyopathy 56 (35.90%) and rheumatic heart disease 48 (30.77%) was the two most common etiologies. Mitral regurgitation (84.0%) was the most frequent valvular disease. Majority 130 (83.33%) of the patients were presented with congestive heart failure and prescribed diuretics 145 (92.9%). The incidence of death was 2.38 cases per 1000 person days. The overall mean (SD) survival time was 80.80±1.84 (SE) days. Presence of chronic kidney disease (AHR=2.56, 95% confidence interval (CI) [1.62-4.06]), urban residence (AHR=1.598, 95%CI [1.11-2.305]), severe pulmonary stenosis (AHR=3.34, 95%CI [1.19-9.34]), and atrial fibrilation (AHR=1.52, 95%CI [1.05-2.19]) increased the risk of death. While admission with congestive heart failure (AHR=0.61, 95% CI [0.41-0.912]) and use of angiotensin converting enzyme inhibitors (AHR=0.36, 95%CI [0.135-0.96]) reduced the risk of death. Conclusion: The all-cause mortality of valvualr heart disease patients was high. Etiologies of valvular heart disease patients were diverse, with high burden of mitral regurgitation. Presence of chronic kidney disease, urban residence, severe pulmonary stenosis and atrial fibrilation increased the risk of death. However, presence of admission congestive heart failure and use of angiotensin converting enzyme inhibitors decreased the risk of death. Thus, attention should be given to the care of valvular heart disease patients.