A systematic review of epidemiology, treatment and prognosis of heart failure in adults in Ethiopia

Patterns of beta-blocker use and dose optimization among ambulatory heart failure patients with reduced ejection fraction (HFrEF) attending public hospitals in Northeast Ethiopia: a multi-center cross-sectional study

BACKGROUND

Evidence-based beta-blockers are essential in managing heart failure with reduced ejection fraction (HFrEF) and are known to improve cardiovascular outcomes. Despite robust nascent guideline recommendations, studies indicate that beta-blockers are often underutilized or administered below target doses. This shivery issue is particularly relevant in Ethiopia, where comprehensive evaluations of beta-blocker utilization and dosing practices are limited. The Northeast region, specifically Dessie, remains underexplored in this context.

OBJECTIVE

This study aimed to evaluate the appropriate usage trend and dose optimization of beta-blockers among HFrEF patients attending ambulatory clinics of Dessie Comprehensive Specialized Hospital (DCSH) and Boru Meda General Hospital (BMH), Dessie, Ethiopia, 2024 G.C.

METHODS

A cross-sectional, multi-center study was conducted from February 1 to July 30, 2024, involving 200 randomly selected adult patients with confirmed HFrEF (120 from DCSH and 80 from BMH), who had at least 6-month regular follow-up visits at their respective ambulatory clinics. The study rigorously followed the latest (2022) American Heart Association (AHA) guideline recommendation. Patient's medical records was reviewed to gather the necessary data. A logistic regression analysis was performed to identify factors associated with beta-blocker use. Statistical significance was declared at p-value < 0.05.

RESULTS

Among the 200 patients, 88% were prescribed beta-blockers. About 15% of the patients were not receiving beta-blockers whereas they are indicated. Out of the total, 96.5% received guideline-recommended beta-blockers, with bisoprolol being the most common (65%), followed by metoprolol (29%) and carvedilol (3%). Only 13% of beta-blocker users were on optimal doses, with average daily doses of 27.9 mg for metoprolol succinate, 10.0 mg for carvedilol, and 4.8 mg for bisoprolol. Factors positively associated with beta-blocker use included Angiotensin Converting Enzyme Inhibitor use (AOR: 15.48, 95% CI: 2.11-113.54, p = 0.007), and taking multiple medications (AOR: 7.12, 95% CI: 1.54-33.02, p = 0.012), while ingestion of secondary prevention agents (AOR: 0.05, 95% CI: 0.01-0.98, p = 0.048) and male gender (AOR: 0.08, 95% CI: 0.01-0.47, p = 0.005) were negatively associated. Baseline ejection fraction of 25-40% (AOR: 5.44, 95% CI: 1.09-27.12, P = 0.039) was a sole predictor for sub-optimal beta-blocker use.

CONCLUSION

Although most patients with HFrEF were prescribed evidence-based beta-blockers, only a limited number reached the optimal dosing levels. It is crucial to align clinical practice with the latest guidelines, prioritize ongoing research, and enhance educational efforts for both healthcare providers and patients. By doing so, it is possible to significantly improve the effective utilization of beta-blockers, ultimately leading to better patient outcomes in this region.

Acute kidney injury and its associated factors among patients with acute decompensated heart failure admitted to the university of Gondar Hospital, Northwest Ethiopia: a hospital-based cross-sectional study

BACKGROUND

Heart failure often leads to hospitalization and can directly impact other organs, such as the kidneys. Acute kidney injury (AKI) is a common complication in patients hospitalized for acute decompensated heart failure (ADHF) and is associated with worse outcomes. However, there are limited data on the magnitude of AKI among hospitalized ADHF patients in resource-limited settings such as Ethiopia. This study sought to determine the prevalence of AKI and the factors associated with AKI in ADHF patients in Northwest Ethiopia.

METHOD

A hospital-based cross-sectional study was conducted at the University of Gondar Hospital in Northwest Ethiopia from June 1 to September 30, 2022. A total of 239 participants were included using consecutive sampling. Demographic information was collected through patient interviews, and relevant clinical and laboratory data were obtained from the patients' medical records. The data were analyzed using STATA version 15.0. Bivariate and multivariate logistic regression analyses were carried out to identify independently associated factors of AKI among patients with ADHF. A P value < 0.05 was considered to indicate statistical significance.

RESULTS

The overall prevalence of AKI in ADHF patients was 25.1% (CI = 19.98-31.03). Older age ≥ 60 years(AOR = 2.95, 95%CI:1.34-6.21), diabetes mellitus (AOR = 9.55,95%CI:2.68-33.99),Hypertension (AOR = 2.34,95% CI:1.08-5.07), sepsis (AOR = 2.13,95%CI:1.09-4.8), use of loop diuretics (AOR = 4.03,95%CI:1.86-8.69) and previous history of AKI (AOR = 11.56,95%CI:4.02-33.26) were independently associated with the occurrence of AKI among ADHF patients.

CONCLUSION

A quarter of the patients admitted with ADHF developed AKI. Older age; comorbid diabetes mellitus, hypertension, or sepsis; a previous history of AKI; and the use of loop diuretics were associated with the occurrence of AKI. Such clinical characteristics available at hospital admission can be used to identify patients at increased risk for developing AKI.

The experience of people living with heart failure in Ethiopia: A qualitative descriptive study

BACKGROUND

Heart failure is a serious chronic medical condition that negatively impacts daily living. Living with heart failure can be challenging due to the physical symptoms, unpredictable nature of the disease, and lifestyle changes required. The objective of this study was to explore and describe the experiences of people living with heart failure and how it affects their health-related quality of life in Ethiopia.

METHODS

A qualitative descriptive design was employed to explore the experience of people living with heart failure, guided by the Theory of Symptom Management. A purposive sample of 14 participants was recruited from the cardiac outpatient clinics at two tertiary-level public hospitals in Ethiopia. Data were collected using a semi-structured interview. The recorded interviews were transcribed verbatim in Amharic, translated into English, and entered NVivo statistical software for analysis. An inductive-deductive hybrid thematic analysis method was used to analyse the data.

RESULTS

Three themes were identified deductively, while an additional three themes emerged inductively:-"Journey from diagnosis to daily life with heart failure"; "Symptom experience"; "Impact of heart failure on health-related quality of life"; "Perception of health-related quality of life and influencing factors"; "Symptom management and coping strategies"; and "Challenges faced in the journey of living with heart failure". Fatigue, and depression were the most frequently reported symptoms. Participants described how their condition affected their overall physical functioning. Participants utilized consistent follow up-care, adhered to their medications, ensured adequate rest, made dietary modifications, sought social support and engaged in spiritual activities to manage their symptoms and cope with their condition. Challenges they faced included financial difficulties, unavailability of medications, and a lack of continuity of care.

CONCLUSION

People living with heart failure in Ethiopia experience various symptoms. The impact of heart failure on various aspects of their lives, combined with the challenges they face while living with heart failure, significantly affect their health-related quality of life. Health care providers caring for these people need to understand their experiences and the impact on their daily life. Effective multimodal interventions are needed to reduce the impact of heart failure and improve health-related quality of life in this population.

Bridging the gap between recommendation and reality: Improving dietary adherence of heart failure populations a cross-sectional study in Ethiopia

BACKGROUND

Heart failure (HF), a complex condition arising from impaired ventricular function, necessitates strict adherence to dietary recommendations for optimal patient management. However, information regarding adherence and its influencing factors remains limited.

AIM

This study aimed to assess dietary recommendation adherence and its associated factors among HF patients at Southern Ethiopia public hospitals.

METHODS AND RESULTS

A cross-sectional study involving 521 participants employed systematic random sampling. Data collection utilized pre-tested, interviewer-administered questionnaires and medical chart reviews. Data were entered and analyzed using Epi Data 3.1 and SPSS 20.0 software. Descriptive statistics were performed. Variables with p-values < 0.25 in binary logistic regression were included in multivariable logistic regression analyses. Statistical significance was set at p < 0.05 with a 95% confidence interval. Results are presented in text, tables, and figures. With a 97.4% response rate, adherence ranged from 20.3% (vegetables and fruits) to 60.3% (fat-free diet). Only 8.1% achieved good adherence across all parameters, with overall adherence at 33.4% (95% CI: 29-37). Multivariable analysis revealed that patients aged 41-60 years (AOR: 1.7), with a history of admission (AOR: 2.5), free from comorbidities (AOR: 0.58), and possessing a favorable attitude (AOR: 0.45) had statistically significant associations with good adherence.

CONCLUSION

Dietary adherence among HF patients remains a challenge. Healthcare providers, particularly those in chronic follow-up settings, should prioritize improving patient attitudes towards proper dietary practices. Tailored education programs targeting younger patients and those free from comorbidities should be implemented. Continuous monitoring, evaluation, and staff recognition for effective client counseling are crucial.

Self-care behaviour and associated factors among heart failure patients in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

This study aimed to estimate the pooled level of self-care behaviour among heart failure patients in Ethiopia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

PubMed/MEDLINE, HINARI, Web of Sciences, Scopus, Google Scholar, Science Direct, African journals online and University repositories were searched from 1 January 2000 to 1 November 2023.

ELIGIBILITY CRITERIA

We include studies that examined self-care behaviour among heart failure patients, studies that report factors associated with self-care behaviour and observational studies (cross-sectional, case-control and cohort) with full text available.

DATA EXTRACTION AND SYNTHESIS

The data were extracted with Microsoft Excel and analysed by using STATA V.11 software. The weighted inverse variance random-effects model at 95% CI was used to estimate the pooled level of self-care behaviour and its associated factors among heart failure patients. Tests of heterogeneity, test of publication bias and subgroup analyses were also employed.

RESULTS

Thirteen cross-sectional studies with 4321 study participants were included; and the pooled level of good self-care behaviour among heart failure patients in Ethiopia was found to be 38.3% (95% CI 31.46 to 45.13). Only 68.8% of heart failure patients were knowledgeable about heart failure. Knowledge about heart failure (Adjusted Odds Ratio (AOR)=3.39; 95% CI 2.42 to 4.74) and absence of comorbidity (AOR=2.69; 95% CI 1.35 to 5.37) were significantly associated with good self-care behaviour among heart failure patients in Ethiopia.

CONCLUSION

The majority of heart failure patients in Ethiopia did not adhere to the recommended self-care behaviours. Nearly one-third of heart failure patients were not knowledgeable about heart failure. Knowledge about heart failure and the absence of comorbidities were significantly associated with good self-care behaviour. Therefore, efforts should be devoted to increasing knowledge and preventing comorbidities among heart failure patients.

PROSPERO REGISTRATION NUMBER

CRD42023394373.

Patients' knowledge on cardiovascular risk factors and associated lifestyle behaviour in Ethiopia in 2018: A cross-sectional study

BACKGROUND

Cardiovascular disease (CVD) is posing a major public health challenge globally. Evidence reports significant gaps in knowledge of cardiovascular risk factors among patients with CVD. Despite the growing burden of cardiovascular disease in developing countries, there is limited data available to improve the awareness of this area, which is crucial for the implementation of prevention programs.

METHODS

A cross-sectional survey was conducted in two referral hospitals in Eastern Ethiopia from June-September 2018. Outpatients with a confirmed diagnosis cardiovascular conditions were eligible for participation in the study. A convenience sampling technique was used. The primary outcome of the study was knowledge of cardiovascular risk factors among patients with cardiovascular disease. The knowledge of cardiovascular disease risk factors was measured using a validated instrument (heart disease fact questionnaire). A score less than 70% was defined as suboptimal knowledge. Multivariable linear regression was used to examine the relationship between knowledge of cardiovascular risk factors and explanatory variables.

RESULTS

A total of 287 patients were enrolled in the study. Mean age was 47±11yrs and 56.4% of patients were females. More than half of patients (54%) had good knowledge on cardiovascular risk factors (scored>70%), whilst 46% demonstrated suboptimal knowledge levels in this area. Urban residency was associated with higher cardiovascular risk factors knowledge scores, whereas, never married and no formal education or lower education were identified as predictors of lower knowledge scores. There was no statistically significant association between knowledge of cardiovascular risk factors and actual cumulative risk behaviour.

CONCLUSION

Almost half of CVD patients in Ethiopia have suboptimal knowledge regarding cardiovascular risk factors. Residence, education level and marital status were associated with knowledge of cardiovascular risk factors. Implementation of innovative interventions and structured, nurse-led lifestyle counselling would be required to effectively guide patients in developing lifestyle modification and achieve sustainable behaviour change.