Abstract
CURRENT TRENDS OF TREATMENT AND OUTCOME OF PATIENTS WITH HEART FAILURE AT TERTIARY CARE CENTRE: A HOSPITAL BASED STUDY IN EASTERN NEPAL

Sahadeb Prasad Dhungana*, Kunjang Sherpa, Prahlad Karki and Sanjib Kumar Sharma

ABSTRACT

There is limited information on current trends of treatment and in-hospital outcome of patients with heart failure from Nepalese population. This is a prospective longitudinal study on 160 consecutive patients with New York Heart Association (NYHA) class III or IV symptoms of heart failure admitted from June 2015 to June 2016 at B.P. Koirala Institute of Health Sciences, Nepal. Mean age was 53.5 years. About one third of the cohort had hypertension and 20.6% had diabetes mellitus. Common precipitating factors for admission were non-compliance to drugs, atrial fibrillation, chest infection, uncontrolled hypertension, severe anemia, pregnancy and hypothyroidism. Ischemic cardiomyopathy, rheumatic heart disease, dilated cardiomyopathy, hypertensive heart disease, peripartum cardiomyopathy were common etiologies constituting 25%, 21.8%, 10.6%, 7.5%, 6.9% of cases respectively. At discharge, 86.2% patients were prescribed diuretics, 65.6% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 50% beta-blockers, 24.4% digoxin. Twenty patients died at hospital and they were of older age, had refractory symptoms, severe systolic dysfunction, had de novo heart failure due to acute coronary syndrome, severe rheumatic valvular heart disease. The mean length of hospital stay was 5.5 ± 3.5 days. Nineteen left against medical advice due to poor prognosis and socioeconomic reason. Fifteen patients were referred for valve replacement. Majority were discharged with improvement in symptoms and sleep quality. Heart failure is associated with significant morbidity and mortality because of associated comorbidities and underuse of proven therapy. Improvement in use of proven therapy, prompt diagnosis and treatment of precipitating factors are the key for better outcome.

Keywords: Heart failure, In-hospital outcome, treatment.


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