Cargando…

Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

BACKGROUND: The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. METHODS: In a prospective observational study, adult patients presenting wi...

Descripción completa

Detalles Bibliográficos
Autores principales: Prattipati, Sainikitha, Sakita, Francis M., Kweka, Godfrey L., Tarimo, Tumsifu G., Peterson, Timothy, Mmbaga, Blandina T., Thielman, Nathan M., Limkakeng, Alexander T., Bloomfield, Gerald S., Hertz, Julian T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277059/
https://www.ncbi.nlm.nih.gov/pubmed/34255782
http://dx.doi.org/10.1371/journal.pone.0254609
_version_ 1783722008437063680
author Prattipati, Sainikitha
Sakita, Francis M.
Kweka, Godfrey L.
Tarimo, Tumsifu G.
Peterson, Timothy
Mmbaga, Blandina T.
Thielman, Nathan M.
Limkakeng, Alexander T.
Bloomfield, Gerald S.
Hertz, Julian T.
author_facet Prattipati, Sainikitha
Sakita, Francis M.
Kweka, Godfrey L.
Tarimo, Tumsifu G.
Peterson, Timothy
Mmbaga, Blandina T.
Thielman, Nathan M.
Limkakeng, Alexander T.
Bloomfield, Gerald S.
Hertz, Julian T.
author_sort Prattipati, Sainikitha
collection PubMed
description BACKGROUND: The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. METHODS: In a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality. RESULTS: Of 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21–0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35–5.56, p = 0.006). CONCLUSION: In a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting.
format Online
Article
Text
id pubmed-8277059
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-82770592021-07-20 Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study Prattipati, Sainikitha Sakita, Francis M. Kweka, Godfrey L. Tarimo, Tumsifu G. Peterson, Timothy Mmbaga, Blandina T. Thielman, Nathan M. Limkakeng, Alexander T. Bloomfield, Gerald S. Hertz, Julian T. PLoS One Research Article BACKGROUND: The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings. METHODS: In a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality. RESULTS: Of 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21–0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35–5.56, p = 0.006). CONCLUSION: In a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting. Public Library of Science 2021-07-13 /pmc/articles/PMC8277059/ /pubmed/34255782 http://dx.doi.org/10.1371/journal.pone.0254609 Text en © 2021 Prattipati et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Prattipati, Sainikitha
Sakita, Francis M.
Kweka, Godfrey L.
Tarimo, Tumsifu G.
Peterson, Timothy
Mmbaga, Blandina T.
Thielman, Nathan M.
Limkakeng, Alexander T.
Bloomfield, Gerald S.
Hertz, Julian T.
Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study
title Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study
title_full Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study
title_fullStr Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study
title_full_unstemmed Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study
title_short Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study
title_sort heart failure care and outcomes in a tanzanian emergency department: a prospective observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277059/
https://www.ncbi.nlm.nih.gov/pubmed/34255782
http://dx.doi.org/10.1371/journal.pone.0254609
work_keys_str_mv AT prattipatisainikitha heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT sakitafrancism heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT kwekagodfreyl heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT tarimotumsifug heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT petersontimothy heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT mmbagablandinat heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT thielmannathanm heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT limkakengalexandert heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT bloomfieldgeralds heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy
AT hertzjuliant heartfailurecareandoutcomesinatanzanianemergencydepartmentaprospectiveobservationalstudy