A clinical study of pattern and factors affecting outcome in Nigerian patients with advanced heart failure.

Background: Advanced heart failure (AHF) accounts for about 25% of all cases of heart failure in Nigeria and is associated with a high mortality rate.

Objective: To undertake a clinical study of the pattern and outcome of AHF in our hospitalised patients and to determine the parameters associated with mortality and survival in these patients.

Method: Eighty-two patients with AHF were studied between January 2003 and December 2005. Baseline blood chemistry and haemodynamics were determined. A congestion score, including orthopnoea, elevated jugular venous pressure, oedema, ascites and loud P2, was derived as well as a low perfusion score. Mortality was computed and risk estimated using the Pearson coefficient and log-ranking test. Cox regression analysis was used to identify the predictors of survival.

Results: AHF accounted for 43.6% of all hospitalised heart failure patients, with a total mortality of 67.1%. Hypertension was the commonest cause of AHF. The parameters associated with increased mortality rates included age (r = 0.671; p = 0.02), presence of atrial fibrillation (r = 0.532; p = 0.045) and estimated glomerular filtration rate (r = -0.486, p = 0.04). The majority of patients (54.8%) were in the 'wet and cold' congestion category. The congestion score correlated with mortality. The indices of survival included lower age, lower systolic blood pressure, being literate and lower congestion score.

Conclusion: AHF was common in our cohorts of hospitalised heart failure patients and it was associated with a high mortality rate.