Isaac Kofi Owusu

Clinical characteristics and prognosis of patients admitted for heart failure: A 5-year retrospective study of African patients

BACKGROUND Mortality associated with heart failure (HF) remains high. There are limited clinical data on mortality among HF patients from African populations. We examined the clinical characteristics, long-term outcomes, and prognostic factors of African HF patients with preserved, mid-range or reduced left ventricular ejection fraction (LVEF). METHODS AND RESULTS We conducted a retrospective longitudinal cohort study of individuals aged ≥18years discharged from first HF admission between January 1, 2009 and December 31, 2013 from the Cardiac Clinic, Directorate of Medicine of the Komfo Anokye Teaching Hospital, Ghana. A total of 1488 patients diagnosed of HF were included in the analysis. Of these, 345 patients (23.2%) had reduced LVEF (LVEF<40%) [HFrEF], 265(17.8%) with mid-range LVEF (40%≥LVEF<50%) [HFmEF] and 878 (59.0%) had preserved LVEF (LVEF≥50%) [HFpEF]. Kaplan-Meier curves and log-rank test demonstrated better prognosis for HFpEF compared to HFrEF and HFmEF patients. An adjusted Cox analysis showed a significantly lower risk of mortality for HFpEF (hazard ratio (HR); 0.74; 95% confidence interval (CI) 0.57-0.94) p=0.015). Multivariate analyses showed that age, higher New York Heart Association (NYHA) functional class, lower LVEF, chronic kidney disease, atrial fibrillation, anemia, diabetes mellitus and absence of statin and aldosterone antagonist treatment were independent predictors of mortality in HF. Although, prognostic factors varied across the three groups, age was a common predictor of mortality in HFpEF and HFmEF. CONCLUSIONS This study identified the clinical characteristics, long-term mortality and prognostic factors of African HF patients with reduced, mid-range and preserved ejection fractions in a clinical setting.

Review of novel therapeutic targets for improving heart failure treatment based on experimental and clinical studies

Heart failure (HF) is a major public health priority due to its epidemiological transition and the world’s aging population. HF is typified by continuous loss of contractile function with reduced, normal, or preserved ejection fraction, elevated vascular resistance, fluid and autonomic imbalance, and ventricular dilatation. Despite considerable advances in the treatment of HF over the past few decades, mortality remains substantial. Pharmacological treatments including β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists have been proven to prolong the survival of patients with HF. However, there are still instances where patients remain symptomatic, despite optimal use of existing therapeutic agents. This understanding that patients with chronic HF progress into advanced stages despite receiving optimal treatment has increased the quest for alternatives, exploring the roles of additional pathways that contribute to the development and progression of HF. Several pharmacological targets associated with pathogenesis of HF have been identified and novel therapies have emerged. In this work, we review recent evidence from proposed mechanisms to the outcomes of experimental and clinical studies of the novel pharmacological agents that have emerged for the treatment of HF.

Statin Treatment and Clinical Outcomes of Heart Failure Among Africans: An Inverse Probability Treatment Weighted Analysis

Background Randomized control trials of statins have not demonstrated significant benefits in outcomes of heart failure (HF). However, randomized control trials may not always be generalizable. The aim was to determine whether statin and statin type–lipophilic or –hydrophilic improve long‐term outcomes in Africans with HF. Methods and Results This was a retrospective longitudinal study of HF patients aged ≥18 years hospitalized at a tertiary healthcare center between January 1, 2009 and December 31, 2013 in Ghana. Patients were eligible if they were discharged from first admission for HF (index admission) and followed up to time of all‐cause, cardiovascular, and HF mortality or end of study. Multivariable time‐dependent Cox model and inverse‐probability‐of‐treatment weighting of marginal structural model were used to estimate associations between statin treatment and outcomes. Adjusted hazard ratios were also estimated for lipophilic and hydrophilic statin compared with no statin use. The study included 1488 patients (mean age 60.3±14.2 years) with 9306 person‐years of observation. Using the time‐dependent Cox model, the 5‐year adjusted hazard ratios with 95% CI for statin treatment on all‐cause, cardiovascular, and HF mortality were 0.68 (0.55–0.83), 0.67 (0.54–0.82), and 0.63 (0.51–0.79), respectively. Use of inverse‐probability‐of‐treatment weighting resulted in estimates of 0.79 (0.65–0.96), 0.77 (0.63–0.96), and 0.77 (0.61–0.95) for statin treatment on all‐cause, cardiovascular, and HF mortality, respectively, compared with no statin use. Conclusions Among Africans with HF, statin treatment was associated with significant reduction in mortality.

Electrocardiographic Abnormalities in Heart Failure Patients at a Teaching Hospital in Kumasi, Ghana

The resting 12-lead Electrocardiogram (ECG) is very useful in the diagnosis, prognosis and treatment of heart failure. There are limited data on the prevalence of ECG abnormalities in heart failure in Ghana. This retrospective study was therefore designed to determine the prevalence of ECG abnormalities among heart failure patients attending a cardiac clinic at the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Medical records of 398 patients diagnosed with heart failure were selected from the cardiac clinic, using simple random sampling. The demographic, clinical and chest X-ray characteristics of the patients were examined. The 12-lead resting ECGs were obtained from 394 of the patients. The ECGs were abnormal in 93% (n=367) of the patients. The main ECG abnormalities included: left ventricular hypertrophy (43.7%), left axis deviation (39.6%), left bundle branch block (19.2%), and left atrial enlargement (25.6%). Arrhythmias seen included: ventricular extrasystoles (11.2%), atrial fibrillation (8.9%), complete heart block (5.3%), and ventricular tachycardia (3.6%). In conclusion, our study has shown that ECG abnormalities are very common among heart failure patients attending cardiac clinic in Kumasi, Ghana

Time series analysis of malaria in kumasi: using arima models to forecast future incidence

Abstract Malaria is a disease caused by the Plasmodium genus that is transmitted between humans by Anopheles mosquitoes. The study sought to assess the trends of Malaria incidence in Kumasi Metropolis and forecast future incidence. A retrospective comparative study design was employed using data from the Regional Health Directorate from January 2010 to December 2016. Trend of malaria prevalence was analysed and compared by years and months. Data used for the study was entirely secondary which was gathered from recorded monthly malaria cases at various hospitals in Kumasi. The Quadratic model was used for the forecasting of the half year incidence of Malaria while Auto regressive integrated moving average (ARIMA) (1, 1, 2) was used for forecasting monthly malaria incidence for the years 2018 and 2019 in Kumasi Metropolis. For the general pattern, July recorded the highest number of cases whereas January recorded the lowest cases in each year. Also, 2010 was the best performing year since it recorded the lowest number of malaria cases (10,336). The projected malaria cases for the first half year of 2018 is expected to be 61,371.8, while the second half year is expected to be 77,842.0. This model is recommended to the metropolitan health directorate and researchers who want to monitor the malaria reported cases in the metropolis and other parts of the world. It is suggested that measures should be put in place to curb malaria incidence during the period of the year when high incidence were recorded.

The Impact of a Comprehensive Medication Counseling and Education on Rehospitalization and Mortality of Advanced Heart Failure Patients in Ghana

The burden of advanced heart failure includes debilitating symptoms, frequent re-hospitalization and high rates of mortality. The most common causes of this preventable rehospitalization are patient’s failure to adhere to prescribed medicines and diet regimen. It is imperative that any medication counseling and educational program seeks to assess the patients understanding of their medical conditions and ability to appreciate the importance of medication compliance to their condition. A prospective cohort study involving 583 patients aged ≥ 30 years who met clinical criteria for presence of advanced heart failure on admission was done to assess the outcome of the program on mortality and re-hospitalization. 497 patients were discharge to the cardiac clinic for a 6-month follow up during which period they were taken through medication counseling and education on; Medication Compliance, Smoking, Alcohol, Diet and Nutrition, Salt restriction, Fluid intake, Weight loss and Exercise. The study showed 97.6% decrease in re-hospitalization rate and 12.4% decrease in mortality. Patients had also significantly improved in subjective and objective indices to functional status. 93.8% were classified within NYHA function class II and 6.2% in function class III. None of the patients remained in functional class IV as compared to 46.5% of the patients before discharge. The study showed that management of heart failure patients based on well structured medication education and counseling modalities can contribute to improved patients outcomes, including reduced morbidity and mortality rates, improved functional status and quality of life.

Post partum heart failure: a rare presentation to the intensive care unit of a teaching hospital in Ghana

Correspondence: Charles Anane Department of Pharmacy, Clinical Pharmacy Office Komfo Anokye Teaching Hospital P.O. Box 1934 Kumasi. Ghana West Africa Tel +0233 02