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Title: Heart Failure Etiologies and Challenges to Care in the Developing World: An Observational Study in the Democratic Republic of Congo
Authors: MALAMBA LEZ, Didier 
Ngoy-Nkulu, Dophra
Tshala-Katumbay, Desire
MULLENS, Wilfried 
Issue Date: 2018
Source: JOURNAL OF CARDIAC FAILURE, 24(12), p. 854-859
Abstract: Background: Limited data are available regarding causes and outcomes of heart failure as well as organization of care in the developing world. Methods and Results: We included consecutive patients diagnosed with heart failure from November 2014 to September 2016 in a university and private hospital of Lubumbashi, Democratic Republic Congo. Baseline data, including echocardiography, were analyzed to determine factors associated with mortality. Cost of hospitalization as well as challenges for care regarding follow-up were determined. A total of 231 patients (56 17 years, 47% men, left ventricular ejection fraction 29 15%, 20% atrial fibrillation) were diagnosed, more during heart failure hospitalizations (69%) than as outpatients (31%). Main risk factors for heart failure included hypertension (59%), chronic kidney disease (51%), alcohol abuse (38%), and obesity (32%). Dilated cardiomyopathy was the most prevalent etiology (48%), with ischemic cardiomyopathy being present in only 4%. In-hospital mortality rate was 19% and associated with an estimated glomerular filtration rate of <60 mL.min(-1).1.73 m(-2) (P <.01) and atrial fibrillation (P =.02). One hundred six patients (46%) were lost to follow-up, which was mainly related to lack of organization of care, poverty, and poor health literacy. Of the remaining 95 subjects, another 33 (35%) died within 1 year after presentation. The average cost of care for a 10-day hospitalization was higher in a private than in a university hospital (885 vs 409 USD). Conclusions: Patients admitted for heart failure in DRC have a high incidence of nonischemic cardiomyopathy and present late during their disease, with limited resources being available accounting for a high mortality rate and very high loss to follow-up.
Notes: [Malamba-Lez, Didier; Ngoy-Nkulu, Dophra] Univ Lubumbashi, Dept Internal Med, Fac Med, Lubumbashi, DEM REP CONGO. [Malamba-Lez, Didier] Hasselt Univ, Doctoral Sch Med & Life Sci, Diepenbeek, Belgium. [Steels, Paul; Mullens, Wilfried] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, Diepenbeek, Belgium. [Tshala-Katumbay, Desire] Oregon Hlth & Sci Univ, Dept Neurol, Portland, OR 97201 USA. [Tshala-Katumbay, Desire] Oregon Hlth & Sci Univ, Sch Publ Hlth, Portland, OR 97201 USA. [Mullens, Wilfried] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium.
Keywords: Heart failure; developing world; challenges to care;Heart failure; developing world; challenges to care
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ISSN: 1071-9164
e-ISSN: 1532-8414
DOI: 10.1016/j.cardfail.2018.10.008
ISI #: 000454671800008
Rights: 2018 Elsevier Inc. All rights reserved
Category: A1
Type: Journal Contribution
Validations: ecoom 2020
Appears in Collections:Research publications

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