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Title: Factors associated with the clinical class of heart failure among adult patients in Moi Teaching and Referral Hospital Eldoret, Kenya
Authors: Kamau, Peter Boro
Keywords: Clinical class
Heart failure
Unique medication
Issue Date: 2018
Publisher: Moi University
Abstract: Background: Heart failure (HF) is a major cause of morbidity and mortality globally with the prevalence rising in Sub-Saharan Africa. Diseases such as Human Immunodeficiency Virus and diabetes have been shown to impact heart failure severity. However, clinical correlates of heart failure classes haven’t been previously described in Kenya. Objective: To assess factors associated with heart failure classes in patients at Moi Teaching and Referral Hospital (MTRH). Methods: A cross-sectional study was done at MTRH cardiology clinic, a referral hospital for western Kenya. Participants more than 18 years of age with a diagnosis of HF who had been on follow up for more than three months were included. A pre-tested structured questionnaire was used to collect data regarding demographic information and potential correlates. Descriptive statistics such as measures of central tendency and measures of spread were used for continuous variables while frequency listings were used for categorical data. To assess for factors associated with New York Heart Association (NYHA) class, bivariate and multivariate analysis were carried out. In the multivariate analysis logistic regression model was used to determine statistically significant factors associated with NYHA class. Results: We enrolled 228 patients with heart failure in the study with a median age of 67 years with 33% being male. At diagnosis, 46 patients (20.2%) were in classes one and two whereas 182 patients (79.8%) were in classes three and four. At enrolment, 154 (67.6%) and 74 (32.5%) were in classes one and two and classes three and four, respectively. Over the last one year of illness, 133 (58.3%) patients had no admission whereas only 29 (12.7%) had two or more admissions. In the bivariate analysis, more than one admission/year, low blood pressures, and poor adherence to drugs were associated with worse NYHA classes (P-values = 0.006, 0.008 and 0.004 respectively). After multivariate analysis, older age, poor adherence to drugs, and underweight were significantly associated with worse NYHA classes. Conclusions: The study population had high proportions of severe heart failure who had adherence related problems. Increasing age and low body mass index were associated with the severity. Recommendation: We recommend further studies on factors affecting adherence to drugs as this is associated with advanced heart failure classes. Larger studies to assess effects of underweight on heart failure classes are also warranted.
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