Clinical Profile of Heart Failure Patients Followed Up In Outpatient Cardiac Clinic At King Faisal Hospital

Abstract

Introduction: Heart failure is a disease that exerts great stress on patients, caregivers, and healthcare systems. In sub-Saharan Africa, it causes multiple readmissions and a high-cost economic burden; this is not different from Rwanda. This study aims are to have a clinical profile of HF patients in outpatient cardiac clinic, to assess the adherence to guideline recommended medical therapy in chronic heart failure with reduced, mid-range and Preserved Ejection fraction with eccentric Left ventricular remodeling, and to have an insight into the need for cardiac device therapy in the studied population, in a country with a scarce resource on advanced therapy. Method: This was a prospective observational study conducted at King Faisal Hospital, Kigali, Heart failure enrolled patients from June 1, 2020, to January 31, 2021, were followed up for a period of 6 months. We recorded their social demographic status, class of heart failure, comorbidities, initial NYHA functional status, three and six months NYHA functional status, medications used, combination anti-remodeling modalities, up-titrated and target maximum anti-remodeling medication at enrollment, at three and 6 months in heart failure with reduced, mid-range and Preserved ejection fraction with LV remodeling. Results: 86 participants were enrolled in the study, 10 were lost to follow-up, 3 died and 3 didn't sign the consent. The median age was 51 years, female made the majority 53 % of the studied population,44 % were overweight,69% were coming from the city of Kigali. 37%,24%,20%,19 %, are percentages of HFrEF, HFpEF, HFmrEF, and Right-sided heart failure respectively, among all HF patients; cardiomyopathies was the most prevalent, followed with Rheumatic heart disease with (64 %,21%) respectively. Hypertension and diabetes were highly predominant comorbidities with 26% and 16% of the population respectively. The majority in this cohort, came initially in NYHA class II (44%) and class III (41%) there was improved functional status at 6 months with 66% in NYHA class I and 28% in NYHA class II. In HFrEF/HFmrEF/Preserved EF with LV remodeling; the use of anti-remodeling was used during the whole 6 month‘s follow-up with RAS I (average 96 %), Bblocker (average 92%), MRA (86% average), SGLT-2 I (2% average). In HFrEF, ACE I+ Bblocker +MRA was the predominant combination at enrollment,3 and 6 months with 65%,50%, and 42%, respectively. At 3 months, only 2 classes of anti-remodeling attain maximum target doses; in HFrEF patients, those on aldactone attain maximum with 86% followed with ACE I with 50% at target maximum dose for those in the group of HFrEF/HFmrEF/Preserved EF with LV remodeling.

At 6 months, 3 classes of anti- remodeling attain maximum target doses; in HFrEF patients, those on aldactone attain a maximum with 91 % followed by Bblocker attain target maximum dose of 68 % and with ACE I that attain a maximum of 62% in the group of HFrEF/HFmrEF/Preserved EF with LV remodeling. The need for device therapy was found to be low (CRT 15%, ICD 7%). Conclusion: We found that HFrEF was the most prevalent subtype of heart failure, cardiomyopathies was the leading class. The functional status went improving during the follow-up with NYHA Class I being the most prevalent at 6 months, the need for cardiac devices was found to be low and the adherence to GDMT in chronic heart failure in HFrEF/HFmrEF/Preserved EF with LV remodeling is relatively satisfactory, though the dosage to achieve the target is suboptimal especially at 3months.