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

Didier Malamba-Lez, Dophra Ngoy-Nkulu, Paul Steels, Daniel Tshala-Katumbay, Wilfried Mullens

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StateAccepted/In press - Jan 1 2018

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Democratic Republic of the Congo
Observational Studies
Heart Failure
Hospitalization
Cardiomyopathies
Atrial Fibrillation
Mortality
Organizations
Health Literacy
Costs and Cost Analysis
Aftercare
Private Hospitals
Lost to Follow-Up
Dilated Cardiomyopathy
Poverty
Hospital Mortality
Glomerular Filtration Rate
Chronic Renal Insufficiency
Stroke Volume
Alcoholism

Keywords

  • challenges to care
  • developing world
  • Heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Heart Failure Etiologies and Challenges to Care in the Developing World : An Observational Study in the Democratic Republic of Congo. / Malamba-Lez, Didier; Ngoy-Nkulu, Dophra; Steels, Paul; Tshala-Katumbay, Daniel; Mullens, Wilfried.

In: Journal of Cardiac Failure, 01.01.2018.

Research output: Contribution to journalArticle

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