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Jan RK, Alsheikh-Ali A, Mulla AA, Sulaiman K, Panduranga P, Al-Mahmeed W, Bazargani N, Al-Suwaidi J, Al-Jarallah M, Al-Motarreb A, Salam A, Al-Zakwani I. Outcomes of guideline-based medical therapy in patients with acute heart failure and reduced left ventricular ejection fraction: Observations from the Gulf acute heart failure registry (Gulf CARE). Medicine (Baltimore) 2022; 101:e29452. [PMID: 35687781 PMCID: PMC9276384 DOI: 10.1097/md.0000000000029452] [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: 10/04/2021] [Accepted: 04/22/2022] [Indexed: 01/04/2023] Open
Abstract
This study aimed to report on the use, predictors and outcomes of guideline-based medical therapy (GBMT) in patients with acute heart failure (HF) with reduced ejection fraction of <40% (HFrEF), from seven countries in the Arabian Gulf.Patients with acute HFrEF (N = 2680), aged 18 years or older, and hospitalized February-November 2012 were recruited and data were collected post discharge at 3 months (n = 2477) and 1 year (n = 2418). The use and doses of GBMT were evaluated as per European, American and Canadian HF guidelines. Analyses were performed using multivariate logistic regression. This study was registered at clinicaltrials.gov (NCT01467973).The majority of patients were on dual (39%) and triple (39%) GBMT modalities, 14% received one GBMT medication, while 7.2% were not on any GBMT medications. On admission, 80% of patients were on renin-angiotensin system (RAS) blockers, 75% on b-blockers and 56% on mineralocorticoid receptor antagonists (MRAs), with a small proportion of these patients were taking target doses (RAS blockers 13%, b-blockers 7.3%, MRAs 14%). Patients taking triple GBMT were younger (P < .001), less likely to have comorbidities such as diabetes mellitus (P < .001) and CKD/dialysis (P < .001), less likely to receive in-hospital invasive treatments (P < .001), and more likely to be treated by a cardiologist (P < .001), than patients on a single medication. Patients taking triple GBMT showed significantly reduced all-cause mortality both at 3-months (P = .048), and at 12-months (P = .003), compared to patients taking no GBMT.Triple GBMT prescribing and dosing in patients with HFrEF were suboptimal in the Arabian Gulf. Further studies are required to investigate GBMT utilization and dosing in the outpatient setting.
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Affiliation(s)
- Reem K. Jan
- College of Medicine, Mohammed Bin Rashid University of Medicine & Health Sciences, Dubai, UAE
| | - Alawi Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine & Health Sciences, Dubai, UAE
| | - Arif Al Mulla
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Kadhim Sulaiman
- Department of Cardiology, Royal Hospital, Muscat, Oman
- Director General of Specialized Medical Care, Ministry of Health, Muscat, Oman
| | | | - Wael Al-Mahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | | | - Jassim Al-Suwaidi
- Department of Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
- Qatar Cardiovascular Research Centre, Doha, Qatar
| | - Mohammed Al-Jarallah
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al-Amiri Hospital, Kuwait City, Kuwait
| | - Ahmed Al-Motarreb
- Department of Internal Medicine, Faculty of Medicine, Sana’a University, Sana’a, Yemen
| | - Amar Salam
- Department of Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Deek H, Newton PJ, Kabbani S, Hassouna B, Macdonald PS, Davidson PM. The Lebanese Heart Failure Snapshot: A National Presentation of Acute Heart Failure Admissions. J Nurs Scholarsh 2020; 52:506-514. [DOI: 10.1111/jnu.12583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Hiba Deek
- Chi Iota Assistant Professor Faculty of Health Sciences Beirut Arab University Beirut Lebanon
| | - Phillip J. Newton
- Professor and Director Western Sydney Nursing & Midwifery Research Centre Western Sydney University and Western Sydney Local District New South Wales Australia
| | - Samer Kabbani
- Clinical Associate Professor of Medicine Lebanese American University; Director, Cardiology Division; Director, Clinical Research Unit Rafik Hariri University Hospital Byblos Lebanon
| | - Bassel Hassouna
- Interventional cardiologist Head, Cardiology Department Makassed Medical Director Beirut Lebanon
| | - Peter S. Macdonald
- St Vincent Hospital Professor of Medicine University of New South Wales, and St Vincent's Heart Transplant Unit HeadTransplantation Research LaboratoryVictor Chang Institute Syndey New South Wales Australia
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Al-Zendani A, Al-Emad A, Al-Motarreb A, Amen M, Al-Sagheer N, Hadi HA, Al-Wather N, Al-Fakeh H, Cimino S, Agati L. Acute heart failure in Yemen. J Cardiovasc Med (Hagerstown) 2018; 20:156-158. [PMID: 30550524 DOI: 10.2459/jcm.0000000000000748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Aziz Al-Zendani
- Medicine Department, Faculty of Medicine and Health Sciences, Thamar University
| | - Adel Al-Emad
- Department of Community Medicine, Faculty of Medicine and Health Science
| | | | - Mervat Amen
- Cardiac Centre, AL-Thawrah Teaching Hospital, Sana'a, Yemen
| | - Nora Al-Sagheer
- Department of Medicine, Faculty of Medicine, Sana'a University
| | - Hana Abu Hadi
- Cardiac Centre, AL-Thawrah Teaching Hospital, Sana'a, Yemen
| | | | | | - Sara Cimino
- Department of Cardiology, 'Sapienza' University of Rome, Rome, Italy
| | - Luciano Agati
- Department of Cardiology, 'Sapienza' University of Rome, Rome, Italy
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Aljundi AHS, Mohammed SFK, Patel A, Singh R, Arabi A, AlBinali HA, Al Suwaidi J. Inotropic agents use in patients hospitalized with acute decompensated heart failure: a retrospective analysis from a 22-year registry in a Middle-Eastern Country (1991-2013). BMC Cardiovasc Disord 2016; 16:47. [PMID: 26892533 PMCID: PMC4759856 DOI: 10.1186/s12872-016-0223-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/11/2016] [Indexed: 01/11/2023] Open
Abstract
Background Data about the use of positive inotropic agents in patients hospitalized with acute decompensated heart failure (ADHF) is limited. Methods The records of 8066 patients with ADHF who were hospitalized at Hamad Medical Corporation, Qatar from 1991 to 2013 were analyzed to explore demographics and clinical characteristics of the patients according to inotropic agents use. Results Eight hundred fifty eight patients [10.6 %, 95 % CI (10 to 11.3 %)] received intravenous inotropic support. Patients receiving inotropes were more likely to be female and have preserved ejection fraction when compared to those not receiving inotropic agents. Comorbidities associated with higher likelihood of receiving inotropic treatment included acute myocardial infarction, chronic renal impairment, dyslipidemia, hypertension, obesity and hyperglycemia. Patient on inotropes were more likely to undergone percutaneous coronary intervention (PCI), intra-aortic balloon pump support and intubation. There were no differences in the mean plasma BNP and CK-MB levels between the 2 groups. Heart failure patients receiving inotropes also were more likely to have complications including ventricular tachycardia (2.0 % vs. 0.9 %, p = 0.003), prolonged hospital stay (8.0 vs. 5.0 days, p = 0.001), cardiac arrest (14.6 % vs. 3.2 %, p = 0.001) and in-hospital mortality (30.8 % vs. 9.1 %, p = 0.001). Over the study period there was an increase use of inotropic agents and decreased mortality rates. Conclusion Inotropic use increased over the period whereas; female gender and conventional cardiac risk factors were predictors of inotropic agents use in the study.
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Affiliation(s)
- Amer H S Aljundi
- Department of Clinical Pharmacology, Heart Hospital, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
| | - Shaban F K Mohammed
- Department of Clinical Pharmacology, Heart Hospital, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar
| | - Ashfaq Patel
- Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdulrahman Arabi
- Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hajar A AlBinali
- Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Al Suwaidi
- Department of Clinical Pharmacology, Heart Hospital, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar.
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Panduranga P, Al-Zakwani I, Sulaiman K, Al-Habib K, Alsheikh-Ali A, Al-Suwaidi J, Al-Mahmeed W, Al-Faleh H, Elasfar A, Ridha M, Bulbanat B, Al-Jarallah M, Asaad N, Bazargani N, Al-Motarreb A, Amin H. Comparison of Indian subcontinent and Middle East acute heart failure patients: Results from the Gulf Acute Heart Failure Registry. Indian Heart J 2015; 68 Suppl 1:S36-44. [PMID: 27056651 PMCID: PMC4824330 DOI: 10.1016/j.ihj.2015.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/05/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare Middle East Arabs and Indian subcontinent acute heart failure (AHF) patients. METHODS AHF patients admitted from February 14, 2012 to November 14, 2012 in 47 hospitals among 7 Middle East countries. RESULTS The Middle Eastern Arab group (4157) was older (60 vs. 54 years), with high prevalence of coronary artery disease (48% vs. 37%), valvular heart disease (14% vs. 7%), atrial fibrillation (12% vs. 7%), and khat chewing (21% vs. 1%). Indian subcontinent patients (382) were more likely to be smokers (36% vs. 21%), alcohol consumers (11% vs. 2%), diabetic (56% vs. 49%) with high prevalence of AHF with reduced ejection fraction (76% vs. 65%), and with acute coronary syndrome (46% vs. 26%). In-hospital mortality was 6.5% with no difference, but 3-month and 12-month mortalities were significantly high among Middle East Arabs, (13.7% vs. 7.6%) and (22.8% vs. 17.1%), respectively. CONCLUSIONS AHF patients from this region are a decade younger than Western patients with high prevalence of ischemic heart disease, diabetes mellitus, and AHF with reduced ejection fraction. There is an urgent need to control risk factors among both groups, as well as the need for setting up heart failure clinics for better postdischarge management.
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Affiliation(s)
| | - Ibrahim Al-Zakwani
- Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Oman
| | | | - Khalid Al-Habib
- Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Alawi Alsheikh-Ali
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Jassim Al-Suwaidi
- Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Center, Doha, Qatar
| | - Wael Al-Mahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates
| | - Hussam Al-Faleh
- Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Abdelfatah Elasfar
- Adult Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia; Tanta University, Egypt
| | | | | | | | - Nidal Asaad
- Adult Cardiology, Hamad Medical Corporation and Qatar Cardiovascular Research Center, Doha, Qatar
| | | | - Ahmed Al-Motarreb
- Internal Medicine, Faculty of Medicine, Sana'a University, Sana'a, Yemen
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Sabbag A, Suleiman M, Glick A, Medina A, Golovchiner G, Steiner H, Arad M, Goldenberg I, Glikson M, Beinart R. Ethnic differences among implantable cardioverter defibrillators recipients in Israel. Am J Cardiol 2015; 115:1102-6. [PMID: 25743210 DOI: 10.1016/j.amjcard.2015.01.538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/23/2015] [Accepted: 01/23/2015] [Indexed: 12/01/2022]
Abstract
Heart failure is an increasingly common condition arising from a variety of different pathophysiological processes. Little is known about the unique features of Israeli Arabs who present with heart failure and who undergo cardiac device implantation. The study population comprised of 4,671 patients who were enrolled in the national Israeli Implantable Cardioverter Defibrillator registry. We compared demographic, clinical, and echocardiographic characteristics; device-related indications; and outcomes between Israeli Arabs (n = 733) and Jews (n = 3,938), who were enrolled in the registry from July 2010 through December 2013. Israeli Arabs constituted 15.7% of the study population. They were younger at presentation compared with Jews (57 ± 15 vs 66 ± 12 years, respectively; p <0.001), with a greater burden of co-morbidities, including diabetes mellitus and chronic obstructive lung disease and smoking. In addition, Arab patients had a greater frequency of non-ischemic cardiomyopathy (40.2% vs 24.6%, respectively; p <0.001), which was associated with a greater frequency of familial history of sudden cardiac death. During 15 ± 9 month follow-up, the mortality rates and appropriate device therapy were similar in both ethnic groups. In conclusion, Israeli Arab patients implanted with implantable cardioverter defibrillators display unique clinical features with greater prevalence of non-ischemic cardiomyopathy characterized by an early-onset and rapid deterioration.
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Affiliation(s)
- Avi Sabbag
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Aharon Glick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Aharon Medina
- Department of Cardiology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Gregory Golovchiner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petah Tiqva, Israel
| | - Hillel Steiner
- Department of Cardiology, Baruch Padeh Poria Medical Center, Israel
| | - Michael Arad
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Goldenberg
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Glikson
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sulaiman K, Panduranga P, Al-Zakwani I, Alsheikh-Ali AA, AlHabib KF, Al-Suwaidi J, Al-Mahmeed W, AlFaleh H, Elasfar A, Al-Motarreb A, Ridha M, Bulbanat B, Al-Jarallah M, Bazargani N, Asaad N, Amin H. Clinical characteristics, management, and outcomes of acute heart failure patients: observations from the Gulf acute heart failure registry (Gulf CARE). Eur J Heart Fail 2015; 17:374-84. [PMID: 25739882 DOI: 10.1002/ejhf.245] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 01/11/2023] Open
Abstract
AIMS The purpose of this study was to describe the clinical characteristics, management, and outcomes of acute heart failure (HF) patients from the Gulf acute heart failure registry (Gulf CARE). METHODS AND RESULTS Data from 5005 HF patients admitted to 47 hospitals in seven Gulf countries during February to November 2012 were analysed. Fifty-five per cent of patients presented with acute decompensated chronic HF, while 45% had new-onset HF. Mean age was 59 ± 15 years, 63% were males, and 83% were Gulf citizens. Co-morbid conditions were hypertension (61%), diabetes mellitus (50%), CAD (47%), and atrial fibrillation or flutter (14%). The median LVEF was 35% (25-45%) with 69% presenting as HF with reduced EF (HFrEF). CAD was the most prevalent aetiology (53%) followed by idiopathic cardiomyopathy (18%), hypertensive heart disease (16%), and valvular heart disease (9%). At discharge, 71% and 78% of patients received beta-blockers and ACE inhibitors/ARBs, respectively. Use of coronary intervention and device therapy was <10%. In-hospital mortality was 6.3%. Re-hospitalization and cumulative mortality at 3 and 12 months were 18%/13% and 40%/20%, respectively. CONCLUSIONS Gulf CARE results show that patients from this region are a decade younger than their Western counterparts, with a high prevalence of diabetes and HFrEF, and a lower prevalence of AF. Use of coronary intervention and device therapy was low, with high re-hospitalization rates. Short- and long-term mortality rates were similar to those of Western registries, but should be interpreted in the light of the younger age of Gulf CARE patients.
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Al Suwaidi J. The Dallas Heart Study using the probability sample technique for ethnicity and cardiovascular health differences. Glob Cardiol Sci Pract 2015; 2015:1. [PMID: 25830146 PMCID: PMC4374096 DOI: 10.5339/gcsp.2015.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 01/25/2015] [Indexed: 11/03/2022] Open
Abstract
The decrease in cardiovascular death rates in the United States has been slower in blacks than whites, especially in patients < 65 years of age. The Dallas Heart Study was designed as a single-site, multiethnic, population-based probability sample to produce unbiased comparison of cardiovascular health among multiple ethnicities.
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Affiliation(s)
- Jassim Al Suwaidi
- Qatar Cardiovascular Research Center and Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Alkindi F, El-Menyar A, Al-Suwaidi J, Patel A, Gehani AA, Singh R, Albinali H, Arabi A. Left Bundle Branch Block in Acute Cardiac Events: Insights From a 23-Year Registry. Angiology 2014; 66:811-7. [PMID: 25477500 DOI: 10.1177/0003319714560223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Between 1991 and 2013, we evaluated the demographics, presentations, and final diagnosis of patients hospitalized with acute cardiac events and left bundle branch block (LBBB). Of 50 992 patients, 768 (1.5%) had LBBB. Compared with non-LBBB patients, patients with LBBB were mostly older, female, diabetic, and had hypertension and chronic kidney failure (CKF; P < .001 for all). Dyspnea (P < .001) and dizziness (P = .037) were more frequent in patients with LBBB. The most frequent cause of admission with LBBB was congestive heart failure (CHF; 54.2%), followed by ST-elevation myocardial infarction (STEMI; 13.3%), valvular heart disease (9.4%), unstable angina (8.3%) and Non-STEMI (7.7%). On multivariate analysis, CKF (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.09-3.70) and LBBB (OR: 2.96, 95% CI: 2.01-4.42) were predictors of in-hospital mortality in the entire study population. Further analysis of patients with LBBB showed that CKF (OR: 2.93, 95% CI: 1.40-6.12) was the only predictor of in-hospital mortality. Regardless the presenting symptoms, CHF was the final diagnosis in most cases with LBBB.
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Affiliation(s)
- Fahad Alkindi
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical School, Ar-Rayyan, Qatar Clinical Research, Trauma Section, Hamad Medical Corporation, Doha, Qatar Internal Medicine, Cardiology Section, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Jassim Al-Suwaidi
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Ashfaq Patel
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Abdurrazzak A Gehani
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hajar Albinali
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Abdulrahman Arabi
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
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Ogah OS, Stewart S, Falase AO, Akinyemi JO, Adegbite GD, Alabi AA, Durodola A, Ajani AA, Sliwa K. Short-term outcomes after hospital discharge in patients admitted with heart failure in Abeokuta, Nigeria: data from the Abeokuta Heart Failure Registry. Cardiovasc J Afr 2014; 25:217-23. [PMID: 25210973 PMCID: PMC4241595 DOI: 10.5830/cvja-2014-040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 07/01/2014] [Indexed: 01/20/2023] Open
Abstract
Background Compared to other regions of the world, there is a paucity of data on the short-term outcome of acute heart failure (AHF) in Africa’s most populous country, Nigeria. We examined the six-month outcomes (including case fatalities) in 285 of 309 AHF subjects admitted with HF to a tertiary hospital in Abeokuta, Nigeria. Methods The study cohort of 285 subjects comprised 150 men (52.6%) and 135 women (47.4%) with a mean age of 56.3 ± 15.6 years and the majority in NYHA class III (75%). Results There were a number of differences according to the subject’s gender; men being older and more likely to present with hypertensive heart disease (with greater left ventricular mass) while also having greater systolic dysfunction. Mean length of stay was 10.5 ± 5.9 days. Mean follow up was 205 days, with 23 deaths and 20 lost to follow up. At 30 days, 4.2% (95% CI: 2.4–7.3%) had died and by 180 days this had increased to 7.5% (95% CI: 4.7–11.2%); with those subjects with pericardial disease demonstrating the highest initial mortality rate. Over the same period, 13.9% of the cohort was re-admitted at least once. Conclusions The characteristics of this AHF cohort in Nigeria were different from those reported in high-income countries. Cases were relatively younger and presented with non-ischaemic aetiological risk factors for HF, especially hypertensive heart disease. Moreover, mortality and re-admission rates were relatively lower, suggesting region-specific strategies are required to improve health outcomes.
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Affiliation(s)
- Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria; Soweto Cardiovascular Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Simon Stewart
- NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Ayodele O Falase
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Joshua O Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Gali D Adegbite
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Albert A Alabi
- Department of Medicine, Sacred Heart Hospital, Lantoro, Abeokuta, Nigeria
| | - Amina Durodola
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Akinlolu A Ajani
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and IIDMM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; NHMRC Centre of Research Excellence to Reduce, Inequality in Heart Disease Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
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Sulaiman KJ, Panduranga P, Al-Zakwani I, Alsheikh-Ali A, Al-Habib K, Al-Suwaidi J, Al-Mahmeed W, Al-Faleh H, El-Asfar A, Al-Motarreb A, Ridha M, Bulbanat B, Al-Jarallah M, Bazargani N, Asaad N, Amin H. Rationale, Design, Methodology and Hospital Characteristics of the First Gulf Acute Heart Failure Registry (Gulf CARE). Heart Views 2014; 15:6-12. [PMID: 24949181 PMCID: PMC4062990 DOI: 10.4103/1995-705x.132137] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is paucity of data on heart failure (HF) in the Gulf Middle East. The present paper describes the rationale, design, methodology and hospital characteristics of the first Gulf acute heart failure registry (Gulf CARE). MATERIALS AND METHODS Gulf CARE is a prospective, multicenter, multinational registry of patients >18 year of age admitted with diagnosis of acute HF (AHF). The data collected included demographics, clinical characteristics, etiology, precipitating factors, management and outcomes of patients admitted with AHF. In addition, data about hospital readmission rates, procedures and mortality at 3 months and 1-year follow-up were recorded. Hospital characteristics and care provider details were collected. Data were entered in a dedicated website using an electronic case record form. RESULTS A total of 5005 consecutive patients were enrolled from February 14, 2012 to November 13, 2012. Forty-seven hospitals in 7 Gulf States (Oman, Saudi Arabia, Yemen, Kuwait, United Gulf Emirates, Qatar and Bahrain) participated in the project. The majority of hospitals were community hospitals (46%; 22/47) followed by non-University teaching (32%; 15/47 and University hospitals (17%). Most of the hospitals had intensive or coronary care unit facilities (93%; 44/47) with 59% (28/47) having catheterization laboratory facilities. However, only 29% (14/47) had a dedicated HF clinic facility. Most patients (71%) were cared for by a cardiologist. CONCLUSIONS Gulf CARE is the first prospective registry of AHF in the Middle East, intending to provide a unique insight into the demographics, etiology, management and outcomes of AHF in the Middle East. HF management in the Middle East is predominantly provided by cardiologists. The data obtained from this registry will help the local clinicians to identify the deficiencies in HF management as well as provide a platform to implement evidence based preventive and treatment strategies to reduce the burden of HF in this region.
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Affiliation(s)
| | | | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, Sultan Qaboos University and Gulf Health Research, Muscat, Oman
| | - Alawi Alsheikh-Ali
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Khalid Al-Habib
- Department of Cardiology, King Fahad Cardiac Centre, King Khalid University Hospital, College of Medicine, Riyadh, Saudi Arabia
| | | | - Wael Al-Mahmeed
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Husam Al-Faleh
- Department of Cardiology and Cardiovascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Nidal Asaad
- Department of Cardiology, Hamad General Hospital, Doha, Qatar
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Bahrain
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Women hospitalized with atrial fibrillation: Gender differences, trends and outcome from a 20-year registry in a middle eastern country (1991–2010). Int J Cardiol 2013; 168:975-80. [DOI: 10.1016/j.ijcard.2012.10.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 10/02/2012] [Accepted: 10/28/2012] [Indexed: 11/22/2022]
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El-Menyar A, Ahmed E, Albinali H, Al-Thani H, Gehani A, Singh R, Suwaidi JA. Mortality trends in women and men presenting with acute coronary syndrome: insights from a 20-year registry. PLoS One 2013; 8:e70066. [PMID: 23936143 PMCID: PMC3729461 DOI: 10.1371/journal.pone.0070066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 06/14/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is the leading cause of mortality worldwide. The present study evaluated the impact of gender in patients hospitalized with acute coronary syndromes (ACS) over a 20-year period in Qatar. METHODS Data were collected retrospectively from the registry of the department of cardiology for all patients admitted with ACS during the study period (1991-2010) and were analyzed according to gender. RESULTS Among 16,736 patients who were admitted with ACS, 14262 (85%) were men and 2474 (15%) were women. Cardiovascular risk factors were more prevalent among women in comparison to men. On admission, women presented mainly with non-ST-elevation ACS and were more likely to be undertreated with β-blockers (BB), antiplatelet agents and reperfusion therapy in comparison to men. However, from 1999 through 2010, the use of aspirin, angiotensin-converting enzyme inhibitors and BB increased from 66% to 79%, 27% to 41% and 17% to 49%, respectively in women. In the same period, relative risk reduction for mortality was 64% in women and 51% in men. Across the 20-year period, the mortality rate decreased from 27% to 7% among the Middle Eastern Arab women. Multivariate logistic regression analysis showed that female gender was independent predictor of in-hospital mortality (odd ratio 1.51, 95% CI 1.27-1.79). CONCLUSIONS Women presenting with ACS are high-risk population and their in-hospital mortality remains higher for all age groups in comparison to men. Although, substantial improvement in the hospital outcome has been observed, guidelines adherence and improvement in the hospital care have not yet been optimized.
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Affiliation(s)
- Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- Department of Trauma Surgery, Clinical Research, Hamad Medical Corporation, Doha, Qatar
- Cardiology Unit, Department of Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Emad Ahmed
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hajar Albinali
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Al-Thani
- Department of Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdurrazak Gehani
- Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Al Suwaidi
- Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- * E-mail:
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Salam AM, AlBinali HA, Al-Mulla AW, Singh R, Suwaidi JA. Secular Trends, Treatments, and Outcomes of Middle Eastern Arab and South Asian Patients Hospitalized With Atrial Fibrillation. Angiology 2012; 64:498-504. [DOI: 10.1177/0003319712460332] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A prospective registry was made of all patients hospitalized with atrial fibrillation (AF) in the State of Qatar from 1991 to 2010. Clinical characteristics, management, and outcomes were compared according to ethnicity (Middle Eastern Arab vs South Asian). During this 20-year period, 2857 Arabs and 548 Asians were hospitalized for AF. Arabs were 9 years older and more likely to have hypertension, diabetes mellitus (DM), chronic renal impairment, and dyslipidemia than the Asians. Valvular heart disease and acute coronary syndromes were more common among Asians, while congestive heart failure was more common in Arabs. The overall inhospital mortality was lower in Asians than that of Arabs, while stroke rates were comparable. There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period, but there was no change in mortality trends. Our findings underscore the need to study AF according to ethnicity.
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Affiliation(s)
- Amar M. Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hajar A. AlBinali
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Wahid Al-Mulla
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Al Suwaidi
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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Ahmed E, El-Menyar A, Singh R, Al Binali1 HA, Al Suwaidi J. Effect of age on clinical presentation and outcome of patients hospitalized with acute coronary syndrome: a 20-year registry in a middle eastern country. Open Cardiovasc Med J 2012; 6:60-7. [PMID: 22670161 PMCID: PMC3367301 DOI: 10.2174/1874192401206010060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 04/26/2012] [Indexed: 12/22/2022] Open
Abstract
Introduction: Despite the fact that the elderly constitute an increasingly important group of patients with acute coronary syndrome (ACS), they are often excluded from clinical trials and are underrepresented in clinical registries. Aims: To evaluate the impact of age in patients hospitalized with ACS. Methods: Data collected for all patients presenting with ACS (n=16,744) who were admitted in Qatar during the period (1991-2010) and were analyzed according to age into 3 groups (≤50 years [41.4%], 51-70 years [48.7%] and >70 years [9.8%]). Results: Older patients were more likely to be women and have hypertension, diabetes mellitus, and renal failure, while younger patients were more likely to be smokers. Non-ST-elevation myocardial infarction and heart failure were more prevalent in older patients. Older age was associated with undertreatment with evidence-based therapies and had higher mortality rate. Age was independent predictor for mortality. Over the study period, the relative reduction in mortality rates was higher in the younger compared with the older patients (61, 45.9 and 35.5%). Conclusions: Despite being a higher-risk group, older patients were undertreated with evidence based therapy and had worse short-term outcome. Guidelines adherence and improvement in hospital care for elderly patients with ACS may potentially reduce morbidity and mortality.
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Affiliation(s)
- Emad Ahmed
- Department of Cardiology and cardiovascular surgery, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
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