Outcomes and their associated factors in patients admitted with clinical diagnosis of heart failure at Muhimbili National Hospital

Abstract

ABSTRACT Background: Heart failure is a frequent cause of hospitalization with high morbidity and mortality.3,51 Several factors affect the outcome after hospitalization for heart failure patients.These outcomes include New York Heart Association classification(NYHA)35, morbidity and mortality27,44,50,52 ,Quality of Life(QOL)39,40,43 and duration of stay in ward17,18. Outcomes of patients admitted at MNH appear to be dismal. Studies done elsewhere have shown NYHA classification, medical co-morbidity, patient socio-economic status were associated with poor outcomes.36 The outcome and associated risk factors for patients admitted at MNH with heart failure is unknown. Broad Objective: To determine outcomes and their associated factors in patients admitted with clinical diagnosis of heart failure at Muhimbili National Hospital Study Design and Methodology: This is a descriptive prospective study of consecutive patients newly admitted with diagnosis of heart failure in medical wards between July, 2010 and January, 2011. Only patients who met the Framingham’s criteria for clinical diagnosis were included. Informed consent was obtained. A structured questionnaire was used to collect information on demographics, and co morbidities on admission, outcomes at discharge and at one month follow-up. Outcomes determined included heart failure symptoms and signs, NYHA classification, and QOL score. Duration of stay in ward and mortality was also determined. Ethical clearance was obtained from MUHAS Ethical Review Board. Results: There were a total of 146 patients with a clinical diagnosis of heart failure by Framingham’s criteria out of a total of 180 patients who were admitted during the study period. 41.1% of patients were above 50 years of age and 57.5% were females. Patients in NYHA class III / IV were 88.4%. Other findings indicated that 78.6% had poor to moderate QOL score at discharge, 51.4% could not afford medications, 47.9% had no drug availability, 24.7% had hypertension, 4.1% had diabetes mellitus, 46.7% had an ejection fraction ≤ 45%, and 11.8% patients had atrial fibrillation. It was also found that 32.1% had duration of stay in ward of more than seven days and, 99.3% were in NYHA class I / II at discharge. Common symptoms at discharge were cough (78.6%), bilateral ankle swelling (60.7%) and difficulty in breathing on exertion (41.4%). Out of 111 patients followed up in medical wards and medical clinic, 14.4% were in NYHA class III / IV, 73.9% had poor to moderate QOL score, common symptoms were cough (75.7%), bilateral ankle swelling vii (57.7%) and difficulty in breathing on exertion (46.8%). Proportion of patients who died during study period was 5.4%. Conclusion: 1. There is poor outcome, both at discharge and at one month, for patients admitted with heart failure at MNH. 2. 32.1% of patients admitted with heart failure stay longer than 7 days. 3. Patients in NYHA class III/IV had poor to moderate QOL score at one month. 4. 5.4% of patients admitted with heart failure died by one month. 5. Patients with poor to moderate QOL score at discharge had poor to moderate QOL score at one month. Recommendations: 1. Patient education on drug use, their benefits, and side effects to improve QOL of patients. 2. Emphasis on patients follow-up to improve outcomes and drug availability in hospital. 3. It is recommended that MNH sets appropriate management guidelines for admitted patients.