Assessing and Improving the Care of Patients With Heart Failure in Ghana: Protocol for a Prospective Observational Study and the Ghana Heart Initiative-Heart Failure Registry

BACKGROUND

Heart failure (HF) is a leading cause of morbidity and mortality globally, with a high disease burden. The prevalence of HF in Ghana is increasing rapidly, but epidemiological profiles, treatment patterns, and survival data are scarce. The national capacity to diagnose and manage HF appropriately is also limited. To address the growing epidemic of HF, it is crucial to recognize the epidemiological characteristics and medium-term outcomes of HF in Ghana and improve the capability to identify and manage HF promptly and effectively at all levels of care.

OBJECTIVE

This study aims to determine the epidemiological characteristics and medium-term HF outcomes in Ghana.

METHODS

We conducted a prospective, multicenter, multilevel cross-sectional observational study of patients with HF from January to December 2023. Approximately 5000 patients presenting with HF to 9 hospitals, including teaching, regional, and municipal hospitals, will be recruited and evaluated according to a standardized protocol, including the use of an echocardiogram and an N-terminal pro-brain natriuretic peptide (NT-proBNP) test. Guideline-directed medical treatment of HF will be initiated for 6 months, and the medium-term outcomes of interventions, including rehospitalization and mortality, will be assessed. Patient data will be collated into a HF registry for continuous assessment and monitoring.

RESULTS

This intervention will generate the necessary information on the etiology of HF, clinical presentations, the diagnostic yield of various tools, and management outcomes. In addition, it will build the necessary capacity and support for HF management in Ghana. As of July 30, 2023, the training and onboarding of all 9 centers had been completed. Preliminary analyses will be conducted by the end of the second quarter of 2024, and results are expected to be publicly available by the middle of 2024.

CONCLUSIONS

This study will provide the necessary data on HF, which will inform decisions on the prevention and management of HF and form the basis for future research.

TRIAL REGISTRATION

ISRCTN Registry (United Kingdom) ISRCTN18216214; https:www.isrctn.com/ISRCTN18216214.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52616.

Indications for echocardiography and confirmation rates of cardiovascular diseases: experience of a specialist cardiac outpatient clinic in Kumasi, Ghana

Background

Transthoracic echocardiography is a very helpful noninvasive cardiovascular imaging technique for the diagnosis and risk stratification in the management of patients with cardiovascular diseases. We aimed to review the clinical indications for transthoracic echocardiography and the confirmation rate of cardiovascular diseases by echocardiography at a specialist cardiac clinic in Ghana.

Methods

Using a cross-sectional study design, the echocardiography reports of all patients above the age of 15 who were assessed at the clinic were analyzed. Data on patient demographics, clinical history, clinical indication for echocardiography, and the echocardiographic findings were analyzed using version 25.0 of the Statistical Package for Social Sciences (SPSS).

Results

A total of 594 participants were studied. The age range of participants was 15-96 years, with a mean (± standard deviation) age of 53.72 (± 17.25) years. There were more females (50.17%) than males (49.83%). Most (54.21%) of the participants had echocardiography for cardiac evaluation. Other indications included hypertension/hypertensive heart disease (HHD) (n = 131; 22.06%), heart failure (n = 69; 11.62%), chest pains (n = 12; 2.02%), and valvular heart disease (VHD) (n = 11; 1.85%). Three hundred and eight-nine (70.30%) of the participants had their clinical diagnoses confirmed by echocardiography; echocardiographic confirmation rates for heart failure, VHD, and HHD were 92.75%, 90.91%, and 88.54%, respectively.

Conclusion

Echocardiography showed high confirmation rates for our patients with heart failure, VHD, and HHD. Prompt usage of this noninvasive cardiovascular imaging for the initial evaluation of patients with cardiovascular diseases is highly recommended.

The correlation between obesity and other cardiovascular disease risk factors among adult patients attending a specialist clinic in Kumasi. Ghana

<abstract><sec> <title>Background</title> <p>Obesity is a complex and multifactorial disease marker, which has become a major threat to cardiovascular health. We sought to assess the correlation of obesity and other cardio-metabolic risk factors in patients seen at the outpatient specialist clinic in Ghana.</p> </sec><sec> <title>Method</title> <p>A prospective cross-sectional study was conducted on 395 patients at Precise Specialist Clinic in Kumasi, Ghana. A standardized questionnaire was used to obtain demographic, anthropometric and clinical data of patients. Fischer's exact test for statistical significance at a 95% confidence interval was used to evaluate associations between categorical variables. The associations between obesity indices and cardiovascular disease risk factors were analyzed by Pearson's correlation.</p> </sec><sec> <title>Results</title> <p>Of the 395 participants, 187 were males and 208 were females. The mean (± standard deviation) age of study participants was 59.29 (± 13.93); more than half of the participants were between 50 and 69 years. The mean BMI of male participants was significantly lower than the mean BMI of female participants (28.18 kg/m² vs 31.16 kg/m², <italic>P-value</italic> &lt; 0.0001). Gender was significantly associated with the weight categories (<italic>P</italic> = 0.0144). Obesity was seen more in females (49.0%) than in males (35.8%). The Pearson correlation analysis also showed a significant positive correlation between obesity, increasing systolic blood pressure (<italic>r</italic> = 0.1568, <italic>P-value</italic> = 0.0018) and increasing diastolic blood pressure (<italic>r</italic> = 0.2570, <italic>P-value</italic> &lt; 0.0001).</p> </sec><sec> <title>Conclusions</title> <p>Obesity was found to be significantly associated with female gender, increasing age, increasing systolic blood pressure, and increasing diastolic blood pressure. Efforts to step-up preventive measures to reduce the increasing prevalence of obesity in Ghana are highly recommended.</p> </sec></abstract>

Cardiac Abnormalities of People Living with HIV: A Comparative Study Between HAART Experience and Treatment Naïve Groups in Ghana

Purpose

This study determined electrocardiographic and echocardiographic abnormalities of people living with HIV (PLWHIV); comparing the findings of PLWHIV on HAART versus treatment naïve groups.

Patients and Methods

In a prospective cross-sectional study, we recruited 157 PLWHIV on Highly Active Antiretroviral Therapy (HAART) and 28 HAART naïve PLWHIV. Clinical examination, electrocardiography and echocardiography were performed on study participants at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Sociodemographic data and information about the use of HAART or otherwise was obtained. The Chi and Fisher Exact tests were used to find the significance of difference in proportions of abnormalities between PLWHIV on HAART and treatment naïve groups. Statistical analyses were performed on SPSS version 25.0 and GraphPad Prism version 8.0. P-values less than 0.05 were considered to be statistically significant.

Results

Echocardiographic abnormalities in the HAART and treatment naïve groups were 54.1% and 60.7%, respectively. Electrographic abnormalities in the HAART and treatment naïve groups were 45.9% and 50%, respectively. Sinus bradycardia was the most prevalent ECG abnormality in the treatment naïve. Nonspecific T-wave changes (36.1%) and sinus tachycardia (30.6%) were the most common ECG abnormalities seen in HAART treated group. The common echocardiographic abnormalities were pulmonary hypertension (22.7%), pericardial effusion (22.2%) and left ventricular systolic dysfunction (17.8%). There was no significant difference in the proportions of echocardiographic abnormalities between PLWHIV on HAART and the treatment naïve groups (p > 0.05).

Conclusion

Cardiac abnormalities are common in PLWHIV regardless of treatment with HAART. Echocardiographic and electrographic assessments are highly recommended for all PLWHIV.

Secular Trends in Admissions and Mortality Rates from Diabetes Mellitus in the Central Belt of Ghana: A 31-Year Review

Introduction

Diabetes Mellitus is currently a leading cause of morbidity and mortality throughout the world, particularly in sub-Saharan Africa where a significant proportion of diabetes cases are now found. Longitudinal profiling of in-patient admissions and mortality trends from diabetes provide useful insights into the magnitude of the burden of diabetes, serve as a sentinel on the state of out-patient diabetes care and provide effective tools for planning, delivering and evaluating the health care needs relating to the disease in sub-Saharan Africa.

Objective

To evaluate the 31-year trend in diabetic admissions and mortality rates in central Ghana.

Methods

This is a retrospective analysis of data on diabetes admissions and deaths at a tertiary referral hospital in central Ghana between 1983 and 2014. Rates of diabetes admissions or deaths were expressed as diabetes admissions or deaths divided by the total number of admissions or deaths respectively. Yearly crude fatality rates for diabetes were calculated. Trends were analysed for in patient diabetes admissions and mortality for the period. Predictors of diabetes mortality were determined using multiple logistic regression.

Results

A total of 11,414 diabetes patients were admitted over the period with a female predominance; female:male ratio of 1.3:1.0. Over the study period, diabetes admission rates increased significantly from 2.36 per 1000 admissions in 1983 to 14.94 per 1000 admissions in 2014 (p<0.0001for linear trend), representing a 633% rise over the 31-year period. In-patient diabetes fatality rates increased from 7.6 per 1000 deaths in 1983 to 30 per 1000 deaths in 2012. The average 28-day mortality rate was 18.5%.

The median age of patients increased significantly over the period. So was the proportion of females admitted over the years. Predictors of in-patient mortality were increasing age- aOR of 1.23 (CI: 1.15–1.32) for age > 80 years compared with < 20 years, admissions in 2000s compared to 1980s-aOR of 1.56 (1.21–2.01), male gender-aOR of 1.45 (1.19–1.61), the presence of glycemic complications such as ketoacidosis- aOR-2.67(CI: 2.21–3.21), hyperosmolar hyperglycemic states- aOR 1.52 (1.33–1.73) symptomatic hypoglycemia- aOR 1.64 (1.24–2.17) and presence of end organ complications including peripheral neuropathic ulcers- aOR 1.31 (1.12–1.56), nephropathy- aOR -1.11 (1.03–1.23), cerebrovascular disease—aOR-1.52 (1.32–1.98), coronary artery disease- aOR-3.21 (1.91–5.15) and peripheral artery disease- aOR-1.15 (1.12–1.21) were associated with increased risk of death compared with normoglycemic diabetic admissions and admissions without end organ complications respectively.

Conclusion

Diabetes admission and mortality rates have increased significantly over the past three decades in central Ghana. More intensive education on the risk factors for diabetes, acute diabetes care as well as instituting hospital guidelines for diabetes control and reduction of modifiable risk factors for diabetes are urgently needed to reduce the poor case fatality associated with diabetes in resource-limited settings.