Epidemiology, management, and outcomes of heart failure in Tunisia: Results from the Nature-HF registry

Abstract

Contemporary data on the epidemiology of heart failure (HF) in Tunisia are scarce. The Nature-HF Registry was designed to investigate clinical characteristics, management, and outcomes of patients hospitalized for HF in Tunisia. Data were collected prospectively on patients with a primary discharge diagnosis of HF who were enrolled from 19 participating hospitals from OCTOBER 2017 to January 2019. A total of 2040 patients were enrolled. The mean age was 63.6 ± 12.6 years, 70.9% were male, and 7.7% had preserved ejection fraction. Common comorbidities included hypertension (42.1%), coronary artery disease (46.2%), and atrial fibrillation (19.5%). The overall use of diuretics, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), and β-blockers at admission was 55%, 67.8%, and 65.1%, respectively, which was lower than in other registries. For patients discharged alive, ACEI/ARB, β-blocker, and mineralocorticoid receptor antagonist use in patients with reduced ejection fraction was 35.0%, 37.2%, and 21.5%, respectively; device use was much lower. The median length of hospital stay was 6 days (range 2 days-55 days) days, and in-hospital mortality at inclusion was 0.25%. Predictors of mortality included age, diuretics use, low use of ACE or ARB, QRS length > 120 ms and rehospitzalisation. Several important findings in patient profile and treatment patterns among Tunisian patients with HF were noted. We identified key areas for improving hospital-based HF medical care in Tunisia. These data also underscore the need for specific regional characterization of HF.