Time to Death And Its Predictors Among Patients With Chronic Heart Failure in Selected Public Hospitals, Addis Ababa, Ethiopia. 2024

Abstract

Abstract Introduction: Mortality due to chronic heart failure remains a global public health problem, despite the presence of advanced medical therapy. Africa has the highest case fatality rate from chronic heart failure of 34%, which is double the global average of 16.5%. Addressing mortality predictors is essential to overcome the problem. Objective: To determine time to death and its predictors among patients with chronic heart failure in selected public hospitals, Addis Ababa, Ethiopia, 2024 Methods: multi-center retrospective cohort study was conducted on 208 adult patients under follow up by reviewing their medical record from March to April, 2024. Five years medical record was reviewed (January 1, 2019to December 30, 2023). The collected data was entered into Epi-data version 4.6 and exported to STATA Version 18, and coding, cleaning, and analyses was done accordingly. Survival probability among patients with chronic heart failure from the starting date to the follow-up to the event was estimated using the Kaplan–Meier survival curve. To check for significant differences among categories of factors, the log-rank test was applied to all categorical variables. Variance inflation factor (VIf) was used to check for the presence of multicollinearity, the mean VIF was 2.71. The Cox proportional hazard regression model was used to identify significant predictors. All candidate variables with a P ≤ 0.25 in the bivariable analysis were included in a multivariable analysis. The Cox-proportional hazard model assumption was checked using a formal statistical test, the GLOBAL test. In the final model, hazard ratios with 95% confidence intervals (CIs) and P-values (< 0.05) was used to declare statistically significant predictors. Result: A total of 217 medical records of adult chronic heart failure patients were reviewed, of which 208(96%) medical records met the enrollment criteria in the final analysis. The median survival time was 30.7 months. Pneumonia (AHR=3.7; 95%CI: 1.59, 8.58), atrial fibrillation (AHR=4.9; 95%CI: 2.25, 10.7), paroxysmal nocturnal dyspnea (AHR=3.6; 95%CI: 1.16, 11.2), systolic dysfunction (AHR=14; 95%CI: 2.5, 78.7), NYHA functional class III (AHR=4.2; 95%CI: 1.26, 14), and anemia (AHR = 8.6; 95%CI: 1.95, 38) were independent predictors of death among chronic heart failure patients. Conclusion and recommendation The median survival time was 30.7 months, with a minimum and maximum follow-up time of 1 and 57.3 months respectively and factors such as; - anemia, atrial fibrillation, pneumonia, NYHA functional class, systolic dysfunction and paroxysmal nocturnal dyspnea were significant predictors of death among congestive heart failure patients, therefore concerned stakeholder should focus on those predictors of mortality. Early initiation of management for patients with chronic heart failure and adherence to treatment guide line is recommended. Key words: Censor, Death, Heart failure, Hospital, Survival