Thirty-day post-discharge outcome and associated clinical and treatment factors among hypertensive patients with acute heart failure at Uganda Heart Institute

Abstract

Back ground: Outcome of patients after hospitalization for AHF remains poor especially in the first month post-discharge. Determining the factors associated with poor post-discharge outcome will help identify patients at risk of deterioration, hence improve outcome. Objective: To describe the thirty-day post-discharge outcome and associated clinical and treatment factors among hypertensive patients with AHF at Uganda Heart Institute (UHI). Methods: We consecutively enrolled 174 adult hypertensive patients with AHF into this prospective study at UHI between November 2017 and October 2018. A pretested questionnaire was administered to study participants to collect information on admission, upon discharge and during the two follow up visits in outpatient department clinic. Data were entered using EPIDATA and then exported to STATA 14 for analysis. Continuous variables were summarized into means and standard deviations for normally distributed and medians with interquartile ranges for non-normally distributed data. Descriptive characteristics were summarized into frequencies and percentages. We generated binary variables for each outcome, and used logistic regression analysis to determine factors associated with each outcome. Results: A total of 174 participants were enrolled, with females 95(54.6%) more than males and median (IQR) age was 63.5(54-74). Ten (5.7%) participants died and 164(94.3%) were alive at the end of the thirty days post-discharge. Among those alive; clinical worsening was observed in 54(32.9%). Males had higher odds for death post-discharge (AOR7.347, xiv 95%Cl; 1.37-39.31, p-0.020). Participants who received digoxin had higher odds for clinical worsening post-discharge (AOR 3.469, 95%Cl; 1.45-8.29, p-0.005). Conclusion: Majority of participants were alive at thirty days post-discharge. 5.7% were dead and among those alive, a third had clinical worsening. Males had higher odds for death and participants who received digoxin were more likely have clinical worsening post-discharge. Recommendation: We recommend a more vigilant follow up system of patients discharged after AHF. The use of digoxin in certain patients with HF needs to be reviewed in light of our results and other recent studies indicating that digoxin use is associated with higher mortality.