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Agbor VN, Tianyi FL, Aminde LN, Mbanga CM, Petnga SJN, Simo LP, Dzudie A, Chobufo MD, Noubiap JJ. Burden of atrial fibrillation among adults with heart failure in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2022; 12:e061618. [PMID: 36223967 PMCID: PMC9562316 DOI: 10.1136/bmjopen-2022-061618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of atrial fibrillation (AF) in adults with heart failure (HF) and summarise the all-cause mortality ratio among adult patients with coexisting HF and AF in sub-Saharan Africa (SSA). SETTING This was a systematic review and meta-analysis of cross-sectional and cohort studies with primary data on the prevalence and incidence of AF among patients with HF and the all-cause mortality ratio among patients with HF and AF in SSA. We combined text words and MeSH terms to search MEDLINE, PubMed and Global Health Library through Ovid SP, African Journals Online and African Index Medicus from database inception to 10 November 2021. Random-effects meta-analysis was used to estimate pooled prevalence. PRIMARY OUTCOME MEASURES The prevalence and incidence of AF among patients with HF, and the all-cause mortality ratio among patients with HF and AF. RESULTS Twenty-seven of the 1902 records retrieved from database searches were included in the review, totalling 9987 patients with HF. The pooled prevalence of AF among patients with HF was 15.6% (95% CI 12.0% to 19.6%). At six months, the all-cause mortality was 18.4% (95% CI 13.1% to 23.6%) in a multinational registry and 67.7% (95% CI 51.1% to 74.3%) in one study in Tanzania. The one-year mortality was 48.6% (95% CI 32.5% to 64.7%) in a study in the Democratic Republic of Congo. We did not find any study reporting the incidence of AF in HF. CONCLUSION AF is common among patients with HF in SSA, and patients with AF and HF have poor survival. There is an urgent need for large-scale population-based prospective data to reliably estimate the prevalence, incidence and risk of mortality of AF among HF patients in SSA to better understand the burden of AF in patients with HF in the region. PROSPERO REGISTRATION NUMBER CRD42018087564.
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Affiliation(s)
- Valirie Ndip Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Population Health Research, Health Education and Research Organisation, Buea, Southwest, Cameroon
| | | | - Leopold Ndemnge Aminde
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | | | - Saint Just N Petnga
- Kousseri Regional Hospital, Far-North Regional Delegation for Health, Kousseri, Cameroon
| | - Larissa Pone Simo
- General Practice, Dzeng Sub-divisional Hospital, Dzeng, Centre Region, Cameroon
| | - Anastase Dzudie
- Cardiology and Cardiac Pacing Unit, Department of Medicine, Douala General Hospital, Douala, Cameroon
| | - Muchi Ditah Chobufo
- Department of Cardiovascular Diseases Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia, University of Adelaide CHRD, Adelaide, South Australia, Australia
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The Utility of Pentraxin and Modified Prognostic Scales in Predicting Outcomes of Patients with End-Stage Heart Failure. J Clin Med 2022; 11:jcm11092567. [PMID: 35566693 PMCID: PMC9099900 DOI: 10.3390/jcm11092567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/23/2022] [Accepted: 04/29/2022] [Indexed: 12/10/2022] Open
Abstract
Risk stratification is an important element of management in patients with heart failure (HF). We aimed to determine factors associated with predicting outcomes in end-stage HF patients listed for heart transplantation (HT), with particular emphasis placed on pentraxin-3 (PXT-3). In addition, we investigated whether the combination of PTX-3 with the Heart Failure Survival Score (HFSS), the Seattle Heart Failure Model (SHFM), or the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) improved the prognostic strength of these scales in the study population. We conducted a prospective analysis of 343 outpatients with end-stage HF who accepted the HT waiting list between 2015 and 2018. HFSS, SHFM, and MAGGIC scores were calculated for all patients. PTX3 was measured by sandwich enzyme-linked immunosorbent assay with a commercially available kit. The endpoints were death, left ventricular assist device implantation, and HT during the one-year follow-up. The median age was 56 (50−60) years, and 86.6% were male. During the follow-up period, 173 patients reached the endpoint. Independent risk factors associated with outcomes were ischemic etiology of HF [HR 1.731 (1.227−2.441), p = 0.0018], mean arterial pressure (MAP) [1.026 (1.010−1.042), p = 0.0011], body mass index (BMI) [1.055 (1.014−1.098), p = 0.0083], sodium [1.056 [(1.007−1.109), p = 0.0244] PTX-3 [1.187 (1.126−1.251, p < 0.0001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) [HR 1.004 (1.000−1.008), p = 0.0259]. The HFSS-PTX-3, SHFM-PTX-3 and MAGGIC-PTX-3 scores had significantly higher predictive power [AUC = 0.951, AUC = 0.973; AUC = 0.956, respectively] than original scores [AUC for HFSS = 0.8481, AUC for SHFM = 0.7976, AUC for MAGGIC = 0.7491]. Higher PTX-3 and NT-proBNP concentrations, lower sodium concentrations, lower MAP and BMI levels, and ischemic etiology of HF are associated with worse outcomes in patients with end-stage HF. The modified SHFM-PTX-3, HFSS-PTX-3, and MAGGIC-PTX-3 scores provide effective methods of assessing the outcomes in the analyzed group.
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Duran A, Tutor A, Shariati F, Sleem A, Wever-Pinzon J, Desai S, Eiswirth C, Ventura HO, Krim SR. Preimplant hyponatremia does not predict adverse outcomes in patient with left ventricular assist devices. Curr Probl Cardiol 2022:101239. [PMID: 35513184 DOI: 10.1016/j.cpcardiol.2022.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Hyponatremia is a well-established marker of adverse outcomes in chronic heart failure (HF) but not well studied in patients with left ventricular assist device (LVAD). METHODS This is a retrospective study, single center study of HM3 [Abbott, USA] LVAD implants. We divided our population based on their sodium prior to LVAD implantation - hyponatremia if <135 mEq/L and normal sodium if 135 - 145 mEq/L. We compared postoperative and long-term outcomes. RESULTS A total of 195 patients were included, preimplant hyponatremia was present in 40% with a sodium of 132.1±2.1 vs. 137.8±1.9 mEq/L in the normal sodium group. No differences were observed in the postoperative or long-term outcomes. CONCLUSION Preimplant hyponatremia was not associated with mortality or HF admissions, likely due to adequate left ventricular unloading and resolution of the mechanisms that lead to hyponatremia. These results suggest that optimization of mild hyponatremia may not be critical and should not delay LVAD placement.
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Affiliation(s)
- Antonio Duran
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
| | - Austin Tutor
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Farnoosh Shariati
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - Amber Sleem
- Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA
| | - James Wever-Pinzon
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Sapna Desai
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Clement Eiswirth
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA
| | - Hector O Ventura
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Selim R Krim
- Division of Cardiology, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; Section of Cardiomyopathy & Heart Transplantation, John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, LA; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
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Ito H. The possibility of heart failure in patients with "pneumonia". Eur J Intern Med 2021; 91:83. [PMID: 34052078 DOI: 10.1016/j.ejim.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/08/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Hiroshi Ito
- Division of Hospital Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan.
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Zaprudnova RA. Level of natremia as an index of the condition of the organism of animals under stress. REGULATORY MECHANISMS IN BIOSYSTEMS 2021. [DOI: 10.15421/022116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In the diagnosis of stressful conditions in humans and other animals, ionic indicators remain practically unused. In this work, we studied the changes in the concentrations of sodium ions in the blood plasma of freshwater fish under stress caused by stressors of different quality and quantity. Most of the experiments were carried out on adult bream (Abramis brama L) from the Rybinsk Reservoir. Separate experiments were duplicated on adult individuals of roach (Rutilus rutilus L.), pike (Esox lucius L.), and blue bream (Abramis ballerus L.). The concentration of cations in the blood plasma was determined using a Flapho-4 flame photometer. Under the action of mild and short-term stressors of different qualities, the sodium concentration in the internal environment altered toward an increase in concentration gradients on the cell membrane (eustress or physiological stress). Hypernatremia was approximately 10%. Under the action of strong and/or prolonged stressors of different strength, the sodium concentration in the internal environment changed toward a decrease in concentration gradients on the cell membrane (distress or pathological stress). Hyponatremia was 50% in the conditions of acute lethal stress, 20% in subacute lethal stress, 10% or more in chronic lethal stress. During strong acute reversible stress, hyponatremia could reach 30%. Analysis of the material on mammals allowed us to conclude that the adaptation mechanisms in fish and higher vertebrates are similar. In this work, for the first time, the state of the system of electrolyte balance of animals under stress was analyzed from the standpoint of the leading role of ionic concentration gradients on the cell membrane (mainly sodium) in the energetics (level of disequilibrium) of the organism. We propose a concept that in normal and extreme conditions fish use two different defense reactions (or adaptation strategies): active and passive, consisting, respectively, in increasing or decreasing the level of disequilibrium (energy) in the organism. The hyponatremia recorded by numerous authors, which accompanies diseases in humans, is evidently a nonspecific reaction of the organism and serves as an indicator of reduced energy of the organism. It is suggested that the sodium level in the internal environment of the organism be used for diagnosing the stress state of animals.
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Timerga A, Kelta E, Kenenisa C, Zawdie B, Habte A, Haile K. Serum electrolytes disorder and its associated factors among adults admitted with metabolic syndrome in Jimma Medical Center, South West Ethiopia: Facility based crossectional study. PLoS One 2020; 15:e0241486. [PMID: 33152003 PMCID: PMC7644006 DOI: 10.1371/journal.pone.0241486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background Electrolytes play an important role in controlling acid base balance, blood clotting, and body fluid and muscle contractions. Serum electrolytes concentrations are most commonly used tests for assessment of a patient’s clinical conditions, and are associated with morbidity and mortality. Any derangements from the normal range of electrolyte levels in the body is described as electrolyte disorders. The Current study was aimed to determine serum electrolytes disorder and its associated factors among adults admitted with metabolic syndrome at Jimma medical center, South West Ethiopia. Methods A Facility based cross sectional study was conducted on 256 patients admitted medical center with metabolic syndrome during the study period. The World Health Organization stepwise assessment tools and patients’ medical records were used to collect information on factors associated with electrolyte disorders. Bivariable and Multivariable logistic regression analyses were performed to identify factors associated with electrolyte disorder at the level of significance of p value <0.25 with 95% confidence interval of crude odds ratio and <0.05 with 95% confidence interval of adjusted odds ratio respectively. Results The overall prevalence of electrolyte disorders was 44.1% (95%CI:40.99–47.20) with hyponatremia 42.9% (95%CI:39.81–45.99) as the leading electrolyte disorder followed by hypokalemia 20.7% (95%CI:18.17–23.23), hypochloremia 17.6% (95%CI:15.22–19.98) and hypocalcemia 9.4% (95%CI:7.57–11.22). Non-formal education [AOR: 6.81; 95%CI:(3.48,17.01)] alcohol consumption [AOR: 4.28; 95%CI:(1.71,10.70)], diuretics, diuretics [AOR: 4.39; 95%CI:(2.10,9.15)], antidiabetics [AOR: 5.18; 95%CI:(2.44,11.00)], and body mass index [AOR: 11.51; 95%CI:(3.50,18.81)] were identified as independent factors for electrolyte disturbance in multivariable logistic regression. Conclusion The finding of the study revealed that nearly half the study participants with metabolic syndromes had electrolyte disorder. Educational status, habit of alcohol consumption, diuretics, antidiabetics, and having higher body mass index were the independent factors associated with electrolyte disorders. Determination of Serum electrolytes, proper administration of diuretic and health education on behavioral factors were the necessary measures that should be done by concerned bodies to reduce electrolytes disorder.
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Affiliation(s)
- Abebe Timerga
- Department of Biomedical Science, Wolkite University, Biochemistry unit, College of Medicine and Health Sciences, Wolkite, Southern Ethiopia
- * E-mail:
| | - Endryas Kelta
- Department of Biomedical Science, Institute of Health, Jimma University, Biochemistry unit, Faculty of Medical Sciences, Jimma, South West Ethiopia
| | - Chala Kenenisa
- Department of Biomedical Science, Institute of Health, Jimma University, Biochemistry unit, Faculty of Medical Sciences, Jimma, South West Ethiopia
| | - Belay Zawdie
- Department of Biomedical Science, Institute of Health, Jimma University, Biochemistry unit, Faculty of Medical Sciences, Jimma, South West Ethiopia
| | - Aklilu Habte
- Reproductive Health Unit, School of Public Health, College of Medicine and Health Sciences, Wachamo University, Hosanna, Southern Ethiopia
| | - Kassahun Haile
- Department of Medical laboratory Science, College of Medicine and Health Science Wolkite University, Hematology unit, Wolkite, Southern Ethiopia
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Furosemide and spironolactone doses and hyponatremia in patients with heart failure. BMC Pharmacol Toxicol 2020; 21:57. [PMID: 32746925 PMCID: PMC7397681 DOI: 10.1186/s40360-020-00431-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/16/2020] [Indexed: 01/13/2023] Open
Abstract
Background Hyponatremia, a marker of disease severity and prognosis, has been associated with various clinical factors and drug use, especially diuretics. Methods This observational prospective cohort study enrolled patients hospitalized at the University Hospital Center Split because of heart failure (HF). We investigated the association of clinical variables and cardiovascular drugs, including furosemide, hydrochlorothiazide, spironolactone, and their doses, with the presence of hyponatremia at admission. Results Of the 565 included patients, 32.4% were hyponatremic, 62.6% were males, and the mean age was 73.1 ± 10.6 years. In the univariate analysis, hyponatremic patients were more often current smokers (p = 0.01), alcohol consumers (p = 0.01), receiving spironolactone (p = 0.004) or combination of furosemide and spironolactone (p = 0.003). Patients who received 50 and 100 mg of spironolactone, compared to those receiving 25 mg (p < 0.0001), as well as patients who received 250 to 500 mg of furosemide compared to ≤240 mg (p = 0.001), were significantly more often hyponatremic. In the multivariate analysis, when diuretic doses were accounted for, furosemide doses of 250 to 500 mg (p = 0.009), spironolactone doses of 50 to 100 mg (p = 0.0003), increasing age (p = 0.03), diabetes mellitus (p = 0.02) and alcohol consumption (p = 0.04) were independently associated with hyponatremia. Conclusion High doses of furosemide and spironolactone, or concomitant use of these diuretics, seem to be an important cause of hyponatremia in HF patients, particularly in combination with advanced age, diabetes and alcohol consumption. Diuretic dose reduction may help avoid hyponatremia and improve clinical status and prognosis in such patients.
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Mandi DG, Bamouni J, Yaméogo RA, Naïbé DT, Kaboré E, Kambiré Y, Kologo KJ, Millogo GRC, Zabsonré P. Spectrum of heart failure in sub-Saharan Africa: data from a tertiary hospital-based registry in the eastern center of Burkina Faso. Pan Afr Med J 2020; 36:30. [PMID: 32782726 PMCID: PMC7395664 DOI: 10.11604/pamj.2020.36.30.19321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 02/05/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Heart failure (HF) is a strong contributor to non-communicable diseases burden in sub-Saharan Africa (SSA). Few studies have addressed the pattern of HF in Burkina Faso. Methods We conducted a prospective cohort study in patients with acute HF in the Regional Hospital Center of Tenkodogo, eastern region of Burkina Faso. Patients were consecutively enrolled from 1st January 2015 to 31st December 2016 and followed up until June 2017. Primary outcome of interest was mortality. Results Overall 318 of 1805 cardiac cases presented with acute HF (17.62 %). Of the 298 patients included in the analysis process, 239 had de novo HF and 150 were male. The mean age was 58.56 ± 18.54 years. Eighty-eight patients presented with atrial fibrillation. The mean left ventricular ejection fraction (LVEF) was 38.20 ± 12.85 % with reduced ejection fraction (LVEF < 40%) accounting for 59.73% of the cases. Most of the study patients lived in rural areas. Hypertensive heart disease (50.34%) and idiopathic dilated cardiomyopathy (19.80%) were the leading causes of HF. Most patients received renin-angiotensin system blockers contrasting with a lower prescription rate of beta-blockers (99% versus 18.79% respectively). The incidence of all-cause mortality was 31 percent patients-years. Conclusion Heart failure is frequent in SSA, affecting patients at younger age. Predominantly of non-ischemic cause, commonly hypertensive, the disease is associated with high mortality.
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Affiliation(s)
- Dakaboué Germain Mandi
- Cardiology Unit, Department of General Medicine, Regional Hospital Center of Tenkodogo, Tenkodogo, Burkina Faso
| | - Joel Bamouni
- Superior School of Health Sciences, University of Ouahigouya, Ouahigouya, Burkina Faso
| | | | | | - Elisé Kaboré
- Cardiology Unit, Department of General Medicine, Regional Hospital Center of Tenkodogo, Tenkodogo, Burkina Faso
| | - Yibar Kambiré
- Training and Research Unit of Health Sciences, University Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Koudougou Jonas Kologo
- Training and Research Unit of Health Sciences, University Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.,Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Georges Rosario Christian Millogo
- Training and Research Unit of Health Sciences, University Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.,Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | - Patrice Zabsonré
- Training and Research Unit of Health Sciences, University Professor Joseph Ki-Zerbo, Ouagadougou, Burkina Faso.,Department of Cardiology, Teaching Hospital of Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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Ajayi AA, Sofowora GG, Ladipo GO. Explaining Heart Failure Hyper-mortality in Sub Saharan Africa: Global Genomic and Environmental Contribution Review. J Natl Med Assoc 2020; 112:141-157. [PMID: 32165009 DOI: 10.1016/j.jnma.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/05/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
The annual heart failure (HF) mortality rate in Africa is 34% according to the INTERHF study. This is twice the world average of 16.5% and 3.7 times that of South America, 9%. We review evidence-based explanations for the Hyper-mortality of HF, by comparison of North American, Caribbean, Afro-Brazilian with Sub-Saharan African (SSA) nations profiles, and suggest amelioration. 1 year HF mortality rates in SSA ranged from 29% to 58%, and intra-hospital mortality rate from 8 to 26% (n = 8). A clustering of adverse genetic single nucleotide polymorphisms (SNP) predisposing to hypertension and/or left ventricular hypertrophy (LVH) in the black diaspora may contribute. A higher prevalence of HF with reduced Ejection Fraction (HF r EF) phenotype, which is associated with greater mortality is more common in SSA nations. Additionally, a worse co-morbidity burden, especially valvular regurgitations causing LV remodeling (LVR), chronic kidney disease (CKD), anemia, lung disease, infections, late presentation in NYHA III/IV, right ventricular disease (RVD) were also common in SSA. Geographic variation in SSA, HF risk factors and co-morbidity was observed. There was sub-optimal use of guideline directed medical therapy (GDMT) and intracardiac device (ICD) unavailability. Gross Domestic Product -per purchasing power parity (GDP-PPP), which is low in SSA, was inversely correlated both to higher intra-hospital mortality rate % (r = -0.73, r 2 = 0.54 p = 0.038) and higher 1 year HF mortality rate % (r = -0.62, r 2 = 0.38, = 0.098). Localized primary prevention, early detection and prompt treatment of hypertension, diabetes, rheumatic fever, early cardiac valve repair and use of cardiovascular polypill, optimal use of GDMT, national health insurance scheme are advocated to stem the dismal mortality and cost burden of HF.
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Affiliation(s)
- Adesuyi A Ajayi
- Adjunct Professor, Department of Medicine, Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX, 77060, USA.
| | - Gbemiga G Sofowora
- Associate Professor of Cardiology, Cardiovascular Medicine Division, Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Gani O Ladipo
- Retired Professor of Cardiology, Obafemi Awolowo University, Ile -ife, Osun State, Nigeria
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Grattagliano I, Mastronuzzi T, D'Ambrosio G. Hyponatremia associated with long-term medication use in the elderly: an analysis in general practice. J Prim Health Care 2019; 10:167-173. [PMID: 30068472 DOI: 10.1071/hc17084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The aim of this study is to determine the prevalence of hyponatremia, its association with long-term medication use and underlying chronic conditions, the rate of hospitalisation and death within 3 months from its discovery and its management in community-dwelling older people. METHODS One year of data for ~5635 patients aged >65 years was extracted from the databases of 19 general practitioners (GPs); 2569 (45.6%) were checked for hyponatremia. RESULTS Hyponatremia occurred in 205 (8.0%) of 2569 checked individuals: 78.5% (161/205) had hypertension, 31.2% (64/205) diabetes, 23.9% (49/205) chronic renal failure; 38.0% (78/205) received diuretics, 36.6% (75/205) renin-angiotensin system antagonists (ACE-I/ARB) and 9.8% (20/205) serotonin reuptake inhibitors. Drug consumption was higher in hyponatremic patients, although only diuretics, ACE-I/ARB, anti-arrhythmics and opioids were significantly associated with hyponatremia. The likelihood of hyponatremia trebled when four drugs were taken, and it was seven-fold higher with the use of six drugs. Hyponatremia was associated with a higher prevalence of chronic illnesses and higher rate of hospitalisation (13.7% vs 7.7%, P = 0.005) and death (3.9% vs 1.8%, P < 0.035). The use of at least one long-term medication was associated with hospitalisation or death in hyponatremic patients (10% vs 6.3%, P = 0.010). Less than 20% of hyponatremic patients had their sodium level checked again after 1 month. DISCUSSION Hyponatremia is not uncommon among community-living older patients, especially in patients taking medications potentially causing hyponatremia. Hyponatremic patients are likely to encounter more serious events, including hospitalisation and death. Targeted training of GPs is desirable to improve their practice.
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Affiliation(s)
| | - Tecla Mastronuzzi
- Italian College of General Practitioners and Primary Care, Bari, Italy
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Everaert K, Hervé F, Bosch R, Dmochowski R, Drake M, Hashim H, Chapple C, Van Kerrebroeck P, Mourad S, Abrams P, Wein A. International Continence Society consensus on the diagnosis and treatment of nocturia. Neurourol Urodyn 2019; 38:478-498. [PMID: 30779378 DOI: 10.1002/nau.23939] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Patients with nocturia have to face many hurdles before being diagnosed and treated properly. The aim of this paper is to: summarize the nocturia patient pathway, explore how nocturia is diagnosed and treated in the real world and use the Delphi method to develop a practical algorithm with a focus on what steps need to be taken before prescribing desmopressin. METHODS Evidence comes from existing guidelines (Google, PubMed), International Consultation on Incontinence-Research Society (ICI-RS) 2017, prescribing information and a Delphi panel (3 rounds). The International Continence Society initiated this study, the authors represent the ICI-RS, European Association of Urology, and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). RESULTS Diagnostic packages: consensus on, history taking for all causalities, intake diary (fluid, food) and bladder diary, not for its duration. Pelvic (women) or rectal (men) examination, prostate-specific antigen, serum sodium check (SSC), renal function, endocrine screening: when judged necessary. Timing or empty stomach when SSC is not important. Therapeutic packages: the safe candidates for desmopressin can be phenotyped as no polydipsia, heart/kidney failure, severe leg edema or obstructive sleep apnea syndrome. Lifestyle interventions may be useful. Initiating desmopressin: risk management consensus on three clinical pictures. Follow-up of desmopressin therapy: there was consensus on SSC day 3 to 7, and at 1 month. Stop therapy if SSC is <130 mmol/L regardless of symptoms. Stop if SSC is 130 to 135 mmol/L with symptoms of hyponatremia. CONCLUSION A summary of the nocturia patient pathway across different medical specialists is useful in the visualization and phenotyping of patients for diagnosis and therapy. By summarizing basic knowledge of desmopressin, we aim to ease its initiation and shorten the patient journey for nocturia.
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Affiliation(s)
- Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Francois Hervé
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | - Ruud Bosch
- Urology Department, UMC Utrecht, Utrecht, The Netherlands
| | - Roger Dmochowski
- Urology Department, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marcus Drake
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Hashim Hashim
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Christopher Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, United Kingdom
| | | | - Sherif Mourad
- Urology Department, Ain Shams University, Cairo, Egypt
| | - Paul Abrams
- Bristol Urological Institute, University of Bristol, Bristol, United Kingdom
| | - Alan Wein
- Urology Department, University of Philadelphia, Philadelphia, Pennsylvania
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Predictive factors for longer length of hospital stay in patients with heart failure. Anatol J Cardiol 2019; 21:117. [PMID: 30694808 PMCID: PMC6457425 DOI: 10.14744/anatoljcardiol.2018.77270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Naka T, Kohagura K, Kochi M, Ohya Y. Hyponatremia and mortality among very elderly residents in a geriatric health service facility. Clin Exp Nephrol 2018; 22:1404-1410. [PMID: 29951722 DOI: 10.1007/s10157-018-1607-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/17/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hyponatremia is common among elderly patients. This study aimed to examine the prognostic value of hyponatremia among elderly residents in a geriatric facility. METHODS We retrospectively examined the association between serum sodium levels and mortality among 118 residents (82% female, mean age 85.5 years) in a single geriatric health service facility. We defined hyponatremia as Na < 135 mEq/L. On the basis of single measurements of serum sodium at periodic examinations, the patients were divided into hyponatremia and non-hyponatremia groups. Multivariable Cox proportional hazards models were used to evaluate the effect of hyponatremia on mortality from May 2005 to April 2007. RESULTS Thirty-three patients (28%) had hyponatremia. Over a 1-year follow-up period, the cumulative survival rate was significantly lower in patients with hyponatremia than in those without hyponatremia. In a multivariate analysis, including traditional risk factors for death, hyponatremia was associated with an increased mortality risk (adjusted hazard ratio 2.73; 95% confidence interval 1.01-5.16; p = 0.047). CONCLUSIONS Hyponatremia is common and is a predictor of mortality in the near future among very elderly residents of a geriatric facility.
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Affiliation(s)
- Tamayo Naka
- Nishizaki Hospital, Itoman, Okinawa, Japan
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kentaro Kohagura
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
- Dialysis Unit, University Hospital of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, Japan.
| | - Masako Kochi
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Dialysis Unit, University Hospital of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, Japan
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Agbor VN, Essouma M, Ntusi NA, Nyaga UF, Bigna JJ, Noubiap JJ. Heart failure in sub-Saharan Africa: A contemporaneous systematic review and meta-analysis. Int J Cardiol 2018; 257:207-215. [DOI: 10.1016/j.ijcard.2017.12.048] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/04/2017] [Accepted: 12/13/2017] [Indexed: 01/13/2023]
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Nyaga UF, Bigna JJ, Agbor VN, Essouma M, Ntusi NA, Noubiap JJ. Data on the epidemiology of heart failure in Sub-Saharan Africa. Data Brief 2018; 17:1218-1239. [PMID: 29876481 PMCID: PMC5988512 DOI: 10.1016/j.dib.2018.01.100] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 12/04/2022] Open
Abstract
In Sub-Saharan Africa (SSA), chronic non-communicable diseases and cardiovascular diseases in particular, are progressively taking over infectious diseases as the leading cause of morbidity and mortality. Heart failure is a major public health problem in the region. We summarize here available data on the prevalence, aetiologies, treatment, rates and predictors of mortality due to heart failure in SSA.
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Affiliation(s)
- Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jean Joel Bigna
- Faculty of Medicine, University of Paris Sud XI, Le Kremlin Bicêtre, Paris, France
| | | | - Mickael Essouma
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Ntobeko A.B. Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Center, University of Cape Town, Cape Town, South Africa
| | - Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Tsega TA, Demissei BG. A systematic review of epidemiology, treatment and prognosis of heart failure in adults in Ethiopia. J Cardiovasc Med (Hagerstown) 2018; 19:91-97. [PMID: 29324479 DOI: 10.2459/jcm.0000000000000617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Systematic characterization of heart failure in adults in Ethiopia is lacking currently. In this review, we sought to summarize the available scientific evidence on the epidemiology, treatment and prognosis of heart failure in adults in Ethiopia. METHODS A systematic review of PUBMED, EMBASE and SCOPUS was conducted for studies published between January 1990 and July 2017. Studies reporting on incidence, prevalence, treatment or prognosis of heart failure in individuals older than 14 years of age were included. RESULTS The search yielded 66 articles, out of which nine were found to be eligible for inclusion in this review. There are no studies reporting the incidence or prevalence of heart failure in the adult population in Ethiopia. There are, however, indications that heart failure might be a significant burden in the country, and typically affects middle-aged adults. Valvular heart disease, predominantly related to rheumatic heart disease, is the most commonly identified heart failure cause across the included studies. There are very limited data on treatment and prognosis. CONCLUSION There is limited scientific evidence on the epidemiology, treatment and prognosis of heart failure in adults in Ethiopia. Further studies are needed for the better understanding of the burden and treatment of heart failure in the adult population in Ethiopia.
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