Acute heart failure and its outcome Among patients admitted to jimma University medical center, southwest Ethiopia

Abstract

Acute heart failure (AHF) is a life-threatening medical condition that necessitates immediate diagnosis and treatment, which often mandates admission to the hospital. AHF causes more deaths and disability and incurs greater economic costs than any other illnesses in the developed and developing countries. There were no studies reporting the incidence or prevalence of heart failure in the adult population in Ethiopia. In Ethiopia, Institution based studies showed the most common etiology and precipitating factor for acute heart failure were chronic rheumatic heart disease and pneumonia respectively. There is no published prospective study from JUMC on similar topic with key word of „acute heart failure and outcomes‟. So, this study is the first of its kind conducted at JUMC. Objective: To determine etiology, precipitating factors and treatment outcome and predictors of outcome among patients with acute heart failure admitted to medical ward, Jimma university medical center, Southwest Ethiopia from July 12, 2021 to January 10, 2022 Method: A hospital based prospective cohort study was conducted on 184 patients admitted to JUMC from July 12, 2021 to January 10, 2022. Data was collected using a structured questionnaire to determine etiologies, precipitating factors and, predictors of poor treatment outcome of AHF. Data was reported as mean ± SD for continuous variables with normal distributed and median (interquartile range) with non-normal distributed variables; and chi square test was used for categorical variables. Bivariate and multivariate logistic regression analysis was used to evaluate factors that predict poor treatment outcome; p- value ≤ 0.05 was considered statistically significant and reported as 95% CI. Statistical package for social science (SPSS version 26) was used to enter and analyze data Result: Out of 184 patients, the mean age of participants was 48.33 ±18.855, 53.3% were males, 51.1% had ADHF syndrome. The mean (±SD) systolic and diastolic blood pressures were 116.17 ± 24.504 mmHg and 73.34 ± 16.159 mmHg at admission, respectively. The left ventricular ejection fraction was ≤40% in 52.7% of patients. Ischemic heart disease 67 (36.4%) and pneumonia 54 (29.3%) were the most common etiology and precipitating factors for acute heart failure respectively. Hypertension was the leading comorbidity identified. The median length of hospital stay was 9 days (IQR=7 to 13). In hospital mortality was 20.1%. Smoking [AOR= 4.31, (95%CI 1.37, 13.58), P value=0.013), Acute coronary syndrome [AOR= 4.55, (95%CI 1.31, 15.8), P value=0.017], Chronic kidney disease [AOR= 2.69, (95%CI 1.1, 6.54) P value=0.029] and elevated BUN [AOR =2.27 (95%CI 1.05, 4.9) P value=0.036] were independent predictors of mortality. Conclusion & recommendation: Ischemic heart disease and pneumonia were the most common etiology and precipitating factors for acute heart failure, respectively. In hospital mortality was high 37(20.1%) among AHF patients admitted to Jimma University Medical Center. Patients with worsening of heart failure had a relatively higher mortality rate than those with denovo heart failure syndrome. Acute coronary syndrome, chronic kidney disease, smoking and BUN were all independent predictors of mortality. In order to improve patient outcomes, health facilities' diagnostic and treatment capabilities should be upgraded