Resting heart rate predicts all-cause mortality in sub-Saharan African patients with heart failure: a prospective analysis from the Douala Heart failure registry (Do-HF)

Background: Higher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies. We assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa. Methods: The Douala HF registry (Do-HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up. Results: Of 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher HR was 1.16 (1.04–1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs. those without (interaction P=0.044). Conclusions: HR was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated

Clinical outcome of patients with venous thromboembolism on Rivaroxaban versus vitamin K antagonists : A preliminary report from Douala, Cameroon

Background: Direct Oral Anticoagulants (DOACs) which are increasingly used for the management of Venous Thromboembolism (VTE) have demonstrated efficacy and safety in clinical trials. However, little is known on outcomes in those managed with DOACs compared to Vitamin K Antagonists (VKAs) in routine clinical practice in Africa. In this preliminary study, we sought to compare the non-fatal clinical outcomes in VTE patients managed with Rivaroxaban versus VKAs in Douala. Materials and Methods: This preliminary study analyzed medical records of VTE patients managed with oral anticoagulants over a 3-year retrospective period in Douala General Hospital and Douala Cardiovascular Center. Outcomes of interest included bleeding, recurrent VTE and post-thrombotic syndrome. Data was analyzed using SPSS version 23. Results: Eighty-seven medical records were identified; Deep venous thrombosis (DVT) was diagnosed in 36.8% and 13.8% had both DVT and pulmonary embolism. Rivaroxaban was prescribed in 77% of cases. We included 82 medical records for the outcome analysis. Adverse clinical outcomes were recorded in 19 (23.2%) medical records amongst which 15 (78.9%) in the Rivaroxaban group. All (4 patients) who bled, 6 (66.7%) patients who had VTE recurrence and 5 (71.4%) patients with post-thrombotic syndrome were managed with Rivaroxaban, however, these were not statistically significantly different from those managed with VKAs. No predictor of clinical outcome was identified. Though more outcomes occurred within 30 days of oral anticoagulation, this was not statistically significant. Conclusion: Three-quarters of VTE patients were managed with Rivaroxaban. Although more bleeding was observed with rivaroxaban group, clinical outcomes were similar with VKA group. This seeds the idea of a prospective study in real life with a larger sample size in Africa. Keywords: Outcomes, Deep vein thrombosis, pulmonary embolism, Venous thromboembolism, Oral anticoagulation, Cameroo

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally