Heart Failure Etiologies and Challenges to Care in the Developing World: An Observational Study in the Democratic Republic of Congo

• Published in: Journal of cardiac failure Vol. 24; no. 12; pp. 854 - 859
• Main Authors: Malamba-Lez, Didier, Ngoy-Nkulu, Dophra, Steels, Paul, Tshala-Katumbay, Désiré, Mullens, Wilfried
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2018
• Subjects: Cardiomyopathy, Dilated - complications; Cardiomyopathy, Dilated - epidemiology; Cardiomyopathy, Dilated - physiopathology; challenges to care; Delivery of Health Care - standards; Democratic Republic of the Congo - epidemiology; Developing Countries; developing world; Echocardiography; Female; Follow-Up Studies; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - etiology; Hospital Mortality - trends; Humans; Hypertension - complications; Hypertension - epidemiology; Hypertension - physiopathology; Incidence; Male; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; Myocardial Ischemia - epidemiology; Prognosis; Retrospective Studies; Risk Factors; Stroke Volume; Survival Rate - trends; Time Factors; Democratic Republic of the Congo; Heart failure; developing world; challenges to care
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2018.10.008

Limited data are available regarding causes and outcomes of heart failure as well as organization of care in the developing world. 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). 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.