This was a retrospective study conducted between January 2003 and December 2013 from the medical files of patients followed at the
intensive care and cardiovascular units of Douala General Hospital in Cameroon. Clinical, electrocardiographic, echocardiographic, and
biological data were collected from 142 patients (58.5% men; mean age 58 ± 14 years) hospitalized for ADHF with reduced ejection fraction (HFrEF), whose left ventricular ejection fraction was <50%, or alternatively whose shortening fraction was <28%, both assessed by echocardiography. The commonest risk factors associated with HFrEF were
hypertension (59.2%),
diabetes mellitus (16.2%), tobacco use (14.1%), and dyslipidaemia (7.7%), respectively. The major causes of HF in hospitalized patients were hypertensive
heart disease (40%, n = 57);
hypertrophic cardiomyopathy (33.8%, n = 48); and
ischemic heart disease (21.8%, n = 31). The most frequent comorbid conditions were
atrial fibrillation (25.4%, n = 36) and
chronic kidney disease (18.3%, n = 26). Major
biological abnormalities included increased
bilirubinemia >12 mg/L (87.5%, n = 124); hyperuricaemia >70 mg/L (84.9%, n = 121); elevated serum
creatinine (65.6%, n = 93); anaemia (59.1%, n = 84); hyperglycaemia on admission >1.8 g/L (42.3%, n = 60); and hyponatraemia <135 mEq/L (26.8%, n = 38). At admission, 33.8% (n = 48) of patients had no pharmacological treatment for HF. The most frequently used
therapies upon admission included
furosemide (50%, n = 71),
angiotensin-converting enzyme inhibitors (ACEIs; 40.1%, n = 57);
spironolactone (35.2%, n = 50);
digoxin (26%, n = 37); beta-blockers (17.7%, n = 25);
angiotensin-receptor blockers (ARBs; 7%, n = 10); and
nitrates (7.0%). The overall in-hospital mortality rate was 20.4%. Factors associated with poor prognosis were systolic blood pressure <90 mmHg [odds ratio (OR) 3.88; confidence interval (CI) 1.36-11.05, P = 0.011], left ventricular ejection fraction <20% (OR 7.48; CI 2.84-19.71, P < 0.001), decreased renal function (OR 1.03; CI 1.00-1.05, P = 0.026),
dobutamine use for
cardiogenic shock (OR 2.74;CI 1.00-7.47, P = 0.049), pleural fluid effusion (OR 3.46; CI 1.07-11.20, P = 0.038), and prothrombin time <50% (OR 3.60; CI 1.11-11.68, P = 0.033). The use of ACEIs/ARBs was associated with reduced in-hospital mortality rate (OR 0.17; CI 0.02-0.81, P = 0.006).
CONCLUSIONS: