Socio-demographics, clinical profile and disposition of in-patients with acute decompensated heart failure at Kenyatta National Hospital

Abstract

Background Heart failure is a major clinical and public health problem worldwide due its high morbidity and mortality. It is a disease of the elderly in the developed countries. Valuable information concerning its epidemiology, clinical and laboratory characteristics is scanty in Africa in general and Kenya in particular. We conducted a study to determine the prevalence and evaluate the socio-demographics, clinical characteristics and disposition of in-patients with acute decompensated heart failure at Kenyatta National Hospital - a tertiary medical centre in Nairobi, Kenya. Objective To determine epidemiologic features, clinical profile and non- pharmacological level of care in heart failure patients admitted at Kenyatta National Hospital. Design Prospective Clinical observational register of patients admitted with acute decompensated heart failure over a period of six months. Setting Medical wards at Kenyatta National Hospital, Nairobi, Kenya. Subjects Two hundred and eighty six patients aged thirteen years and above admitted with acute decompensated heart failure. Diagnosis was based on the Modified Framingham Clinical Criteria for the Diagnosis of Heart Failure. Results A total of 5,043 patients were admitted into the medical wards over the six months period (December 2007- may 2008). Of these, 458 patients were screened and 286 recruited giving a prevalence of 5.7%. Female comprised 53.8% and males while 46.2%. The mean age was 44 years. Their districts of birth and residence over the past 5 years were mainly Nairobi and Central Kenya (province) districts. Two hundred and five (71.6%) had attained none or only primary education. One hundred and four (54%) were married (54%) and 111 (39.9%) were employed. Eighty five of the (29.7%) had history of alcohol consumption while 66 (23.2%) had history of tobacco smoking. Two hundred and sixty nine patients (94.2%) were admitted in NYHA functional classes III and IV. The mean haemoglobin level was 12.92g/dl while their median creatinine was 97micromoll1. The mean serum sodium concentration was 137 mmolll, with 102 (35.8%) having Hyponatriema. The mean serum potassium concentration was 4.8mmo1l1. The commonest radiological findings were cardiomegally (97.3%) and alveolar oedema (81.4%). Non pharmacological treatment was poorly offered. In-hospital mortality was 10.8%. Conclusion The six month period prevalence of acute decompensated heart failure in medical inpatients at KNH was high at 5.7%. Both sexes were affected equally. It is a disease of all age groups with a peak in the 20-40 year age bracket. Majority of patients were admitted with NYHA class III and IV symptoms and were fluid overloaded. Non pharmacological modes of therapy offered at discharge were significantly sub-optimal.