Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.

<h4>Background</h4>The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings.<h4>Methods</h4>In a prospective observationa...

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Autores principales:	Sainikitha Prattipati, Francis M Sakita, Godfrey L Kweka, Tumsifu G Tarimo, Timothy Peterson, Blandina T Mmbaga, Nathan M Thielman, Alexander T Limkakeng, Gerald S Bloomfield, Julian T Hertz
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a040c1c887904811967dbb22ebe894a8
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spelling	oai:doaj.org-article:a040c1c887904811967dbb22ebe894a82021-12-02T20:15:24ZHeart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.1932-620310.1371/journal.pone.0254609https://doaj.org/article/a040c1c887904811967dbb22ebe894a82021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254609https://doaj.org/toc/1932-6203<h4>Background</h4>The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings.<h4>Methods</h4>In a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality.<h4>Results</h4>Of 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21-0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35-5.56, p = 0.006).<h4>Conclusion</h4>In a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting.Sainikitha PrattipatiFrancis M SakitaGodfrey L KwekaTumsifu G TarimoTimothy PetersonBlandina T MmbagaNathan M ThielmanAlexander T LimkakengGerald S BloomfieldJulian T HertzPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254609 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Sainikitha Prattipati Francis M Sakita Godfrey L Kweka Tumsifu G Tarimo Timothy Peterson Blandina T Mmbaga Nathan M Thielman Alexander T Limkakeng Gerald S Bloomfield Julian T Hertz Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.
description	<h4>Background</h4>The burden of heart failure is growing in sub-Saharan Africa, but there is a dearth of data characterizing care and outcomes of heart failure patients in the region, particularly in emergency department settings.<h4>Methods</h4>In a prospective observational study, adult patients presenting with shortness of breath or chest pain to an emergency department in northern Tanzania were consecutively enrolled. Participants with a physician-documented clinical diagnosis of heart failure were included in the present analysis. Standardized questionnaires regarding medical history and medication use were administered at enrollment, and treatments given in the emergency department were recorded. Thirty days after enrollment, a follow-up questionnaire was administered to assess mortality and medication use. Multivariate logistic regression was performed to identify baseline predictors of thirty-day mortality.<h4>Results</h4>Of 1020 enrolled participants enrolled from August 2018 through October 2019, 267 patients (26.2%) were diagnosed with heart failure. Of these, 139 (52.1%) reported a prior history of heart failure, 168 (62.9%) had self-reported history of hypertension, and 186 (69.7%) had NYHA Class III or IV heart failure. At baseline, 40 (15.0%) reported taking a diuretic and 67 (25.1%) reported taking any antihypertensive. Thirty days following presentation, 63 (25.4%) participants diagnosed with heart failure had died. Of 185 surviving participants, 16 (8.6%) reported taking a diuretic, 24 (13.0%) reported taking an antihypertensive, and 26 (14.1%) were rehospitalized. Multivariate predictors of thirty-day mortality included self-reported hypertension (OR = 0.42, 95% CI: 0.21-0.86], p = 0.017) and symptomatic leg swelling at presentation (OR = 2.69, 95% CI: 1.35-5.56, p = 0.006).<h4>Conclusion</h4>In a northern Tanzanian emergency department, heart failure is a common clinical diagnosis, but uptake of evidence-based outpatient therapies is poor and thirty-day mortality is high. Interventions are needed to improve care and outcomes for heart failure patients in the emergency department setting.
format	article
author	Sainikitha Prattipati Francis M Sakita Godfrey L Kweka Tumsifu G Tarimo Timothy Peterson Blandina T Mmbaga Nathan M Thielman Alexander T Limkakeng Gerald S Bloomfield Julian T Hertz
author_facet	Sainikitha Prattipati Francis M Sakita Godfrey L Kweka Tumsifu G Tarimo Timothy Peterson Blandina T Mmbaga Nathan M Thielman Alexander T Limkakeng Gerald S Bloomfield Julian T Hertz
author_sort	Sainikitha Prattipati
title	Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.
title_short	Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.
title_full	Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.
title_fullStr	Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.
title_full_unstemmed	Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.
title_sort	heart failure care and outcomes in a tanzanian emergency department: a prospective observational study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/a040c1c887904811967dbb22ebe894a8
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Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study.

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