Death prognosis factors of chronic heart failure in the elderly in Burkina Faso

Abstract

Background: Heart failure is the main reason for hospitalization in the cardiology department of Yalgado Ouédraogo University Hospital. The main causes of heart failure are arterial hypertension and myocardial ischemia. Mortality is high during hospitalization and can reach 48%. The follow-up of patients after hospitalization is difficult with many lost to follow-up. The medium and long term prognosis of chronic heart failure is not known in our country. Objective: Identify death prognosis factors of heart failure in elderly subjects aged at least 60 years old. Patients and Method: We conducted a retrospective, cross-sectional study that consisted of systematic inclusion from hospitalization registers of patients of both sexes aged at least 60 years, hospitalized in the cardiology department CHU Yalgado Ouédraogo from January 1 to December 31, 2016. We assessed the type of heart failure, electrocardiographic and echocardiographic parameters, comorbidities, etiologies of heart failure as well as the intra-hospital evolution during this hospitalization until discharge. After including these patients, they were called to participate in the study (which ran from December 1 to 31, 2020) by giving informed consent. We collected follow-up data (since discharge from the first hospitalization, i.e., one consultation each month for at least 42 months) from the patients’ individual follow-up diaries (rehospitalization, improvement, therapeutic compliance). We then performed a complete clinical examination, an electrocardiogram, a cardiac echography, and a biological workup including blood count, creatinine level, liver function tests, blood glucose and blood ionogram. Results: We included 87 elderly subjects representing 53.05% of all patients received for chronic heart failure in the cardiology department in 2016. The mean age was 71.49 ± 8.46 years and the sex ratio was 2. High blood pressure was the main cardiovascular risk factor in 62.07% of cases. In-hospital mortality was 20.69%, and factors associated with it included male sex (OR= 11.60 p < 0.01), renal dysfunction on admission (OR= 1.30 p= 0.03), and cardiogenic shock developed during hospitalization (OR= 10.30 p < 0.01). Mortality at approximately 4 years was 67.47% with a mean time to death of 13.60 months. No independent factor was found to predict death after discharge. Conclusion: The prognosis of heart failure in the elderly is poor in our context. The in-hospital death prognosis facteur are renal dysfunction, cardiogenic shock, An early and adapted management of this age group will improve survival.