Characteristics and outcomes of patients hospitalised with acute heart failure at a tertiary academic hospital in South Africa
A Mazaza, H Weich, A DoubellAbstract
Background
Data on AHF (acute heart failure) in Sub-Saharan Africa are limited, particularly regarding its characteristics and use of modern guideline-directed medical therapy (GDMT)1 . This study aimed to evaluate the epidemiology, clinical presentation, treatment patterns, and outcomes of patients with AHF in South Africa.
Methods
A retrospective, single-centre study including all patients admitted with AHF in 2022
Results
A total of 339 patients with equal gender distribution (51.9% male) were admitted with AHF. The majority (91%) had heart failure with reduced ejection fraction (HFrEF), with a mean age of 53 ± 15.4 years. Idiopathic dilated cardiomyopathy (DCMO) was the predominant cause of HFrEF (72%). The in-hospital mortality for HFrEF was 3.9%, with a mean hospital stay of 6 ± 5 days. At two years, the case fatality rate was 27.7%. Non-invasive ventilation or inotropes were required in 16.4% of HFrEF patients. Among newly diagnosed HFrEF patients, 19.9% experienced at least one all-cause readmission within 2022, with 44.3% of readmissions occurring within one month of discharge. At discharge, 87.5% of HFrEF patients were on an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 88.7% on a beta blocker, and 56.3% on a mineralocorticoid receptor antagonist. However, uptake of newer guideline-directed medical therapies was low, with only 3.9% on SGLT2 inhibitors and 1.3% on ARNIs. Thirty-six (11.6%) HFrEF patients were eligible for cardiac resynchronisation therapy (CRT) and 42.9% of those with a Class 1 indication received a CRT implant.
Conclusion
This is the first study to characterise a South African AHF population in the era of modern HF therapy. This study illustrates a predominance of idiopathic DCMO in a relatively young AHF population with a high rate of readmission after first HF diagnosis despite an improvement in prescription of accessible GDMT. These findings underscore the need for strategies to improve availability of modern HF therapy in resource-limited settings and thereby reduce HF hospitalisations.For image description, please refer to the figure legend and surrounding text.