Epidemiologic Transition and Heart Failure in Black African Adults

Abstract

The objective of this study is to report clinical, electrocardiographic, and echocardiographic data on heart failure for the evaluation of its cardiovascular risk factors and causes at the Institute of Cardiology of Abidjan and the National Police Hospital. Patients and Methods: The 12-month prospective study included 989 patients who were diagnosed with heart failure at the Institute of Cardiology of Abidjan and the Heart Department of the National Police Hospital in Cote d’Ivoire. Results: The mean age of the patients was 55 ± 12 years. Patients ≤ 50 years, aged 50 and 70 years, and ≥ 70 years were 42%, 60%, and 18%, respectively. The major cardiovascular risk factors were high blood pression (60%), smoking (19%), type 2 diabetes (11%), and hypercholesterolemia (8%). The status of 11% of HIV positive patients were ignored upon admission to the Heart Hospitals. Severe kidney failure (25%) was found in all hypertensive patients. Atrial fibrillation patients and sinus rhythm subjects were 20% and 80%, respectively. The average duration of QRS was 102 ± 24 ms. 20% of patients had a complete left bundle branch block. The mean of the left ventricular ejection fraction (LVEF) was 35.8% ± 13%. The LVEF was ≤ 45% in 57% of cases and ≤ 30% in 30% of cases. The identified causes of heart failure were ischemic heart disease (60%), hypertensive heart disease (20%), and rheumatic valvulopathy (12%). Among the patients with ischemic heart disease, 80% were infarction. The coronarography and the myocardial revascularization were performed in 50% of cases. The primitive cardiomyopathy was diagnosed in 15% of cases. The average follow-up was 12.6 ± 8 months. 18% of patients died, 14% of whom deceased within 1 year after the initial diagnosis and 5% of death occurred in 19 months following the first symptoms of heart failure. The end stage of heart failure (13%) was the most frequent cause of death followed by the sudden death (5%) and the terminal kidney failure (2%). The patients were rehospitalized for heart failure (28 cases) and for ischemic stroke during the follow-up. The functional New York Heart Association score of patients was II in 39%, III in 43%, and IV in 18% at 1 month after admission.Conclusion: The heart failure is a major public health issue in Cote d’Ivoire as in many other African countries. The prevalence of ischemic heart disease as the leading cause of heart failure is certainly the reflection of the epidemiologic transition and the advent of the coronarography in the technical platform of the Abidjan Institute of Cardiology. The rapid evolution of the epidemiologic pattern of the heart failure in association with the increasing frequency of cardiovascular risk factors should contribute to implement study and prevention strategies against cardiovascular diseases in Cote d’Ivoire and in Africa.