Epidemiology and management of heart failure with reduced ejection fraction in a Tunisian university hospital.

Abstract

Despite considerable advances in treatment, heart failure (HF) remains a serious public health problem linked to a high rate of mortality. The aim of this work was to describe the epidemiological, clinical and evolutionary features of HF in a Tunisian university hospital. This was a retrospective study including 350 hospitalised patients diagnosed with HF with reduced ejection fraction (≤ 40%) during the period between 2013 and 2017. The average age was 59 ± 12 years. A male predominance was noted. The main cardiovascular risk factor was the use of tobacco (47%). The electrocardiogram showed atrial fibrillation in 41% of patients and left bundle branch block in 36% of patients. Laboratory results revealed an electrolyte disorder in 30 cases, renal insufficiency in 25% of patients and anaemia in 20%. Echocardiography revealed reduced ejection fraction, with an average of 34 ± 6% (range: 20-40%). The main causes of HF were ischaemic heart disease in 157 patients. The most commonly used medications were diuretics (90% of patients), angiotensin converting enzyme inhibitors (88%), beta-blockers (91%) and mineralocorticoid receptor antagonists (35%). Cardiac resynchronisation therapy was performed on 30 patients and cardioverter defibrillator implantation on 15 patients. The hospital mortality rate was 10% and the average hospital stay was 12 ± 5 days. During six months of follow up, 56 patients died and 126 were re-admitted. Multivariate model predictors of six-month mortality were: age [odds ratio (OR): 8, p = 0.003], ischaemic HF (OR: 1.63, p = 0.01) and diabetes (OR: 21, p = 0.004). This study illustrates the main characteristics of HF in our population. These include relatively young age, a predominance of males, ischaemic heart disease as the main aetiology, insufficient care strategies and a poor prognosis.