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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...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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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 |
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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 |
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