Prognostic Factors for Acute Heart Failure (AHF) in the Cardiology Intensive Care Unit (ICU) of the University Hospital Point G (UH Pt G)

Background and Aim: The absence of data in our context motivates this study aiming to determine the frequency of AHF at the ICU, assess the in-hospital evolution of the disease and to find out poor prognosis.Material and Methods: It was an observational and descriptive study covering the time from January 1, 2014 to March 30, 2017 involving all inpatient records in ICU. From January 2014 to December 2017, collected data included those on socio-demographic, history of diseases and physical examination, and some labor dataincluding Pro BNP, serum creatinine, blood ionogram,?cardiac enzymes and blood count. Also data electrocardiography, echocardiography and in-hospital evolution were collected. Statistical Analysis:Statistical analysis was performed using SPSS (IBM Inc) version 18. Results: AHF occured in 47.36% with a mean age of 58.74 ± 18.407 and extremes of 17 and 90 years, women representing 53.1% (sex ratio Male:Female = 0.88). Hypertension and diabetes were the predominant cardiovascular risk factors with respectively 67.4% and 18.4%. At admission?44%, 37.7% and 17.9% of patients were respectively hypertensive,?normotensive and hypotensive. The clinical expression was mainly global heart failure with 42.6% followed by left heart failure and right heart failure with respectively 37% and 20.4%. The coronary syndromes (all forms) was the first cause of ICA with 34% of cases followed by pulmonary embolism and hypertension with respectively 25.3% and 24.1%. Mean hospital stay was 5.61 ± 3.527 days (1 to 25 days). Complications were recorded in 18.5% of patients with cardiogenic shock in half of all cases. In multi-variate analysis, only hypotension at admission was shown to be the independent factor of poor prognosis with p = 0.016 and OR = 4.453 (1.322 - 14.996). Conclusion: As a common manifestation heart failure can be rapidly fatal in presence of collapsus or hypotension at admission. These factors should be accurately managed to reduce mortality, which remains high in our context.

ECG and Echocardiographic Findings of Female Hypertension (fHTN) in the Cardiology Department of the University Hospital Gabriel Touré (UH-GT)

Introduction: In our setting there is a lack of publications on female hypertension in general population motivating this study to look for electro- and echocardiographic findings of female hypertension. Methods: We performed a cross-sectional study during 6 months in the cardiology department of the UH-GT including 324 female patients aged 18 and more seen in the outpatient unit and by whom the diagnosis of hypertension was set. All patients consented to be study participants after receiving clearly information about the study and that care giving will not be affected by their eventual refusal. Data collection has been done with all needed confidentiality rules. A survey formular was used to collect data in order to record them in an Access database. Analysis was done using IBM SPSS software. Quantitative data are presented as mean with standard deviation and qualitative as proportion. Level of significance for statistic test was set at 5%. Results: During the study time 324 among 524 hypertensive patients visited our outpatient unit giving a prevalence of fHTN of 61.8%. The means for age, body mass index (BMI) in female hypertensive patients were respectively 52 ± 14.461 years and 27.35 ± 06.585 Kg/m2. Main ECG findings were left ventricular hypertrophy (LVH) and sinus tachycardia with respectively 93.6% and 46.4% followed by isolated ventricular extrasystole with 33.7%. Echocardiography findings included LVH, relative wall thickness (RWT) and reduced ejection fraction (EF) in respectively 41.05%, 37.35% and 21.91%. The left ventricular mass (LV) mass and geometry were abnormal in 44.4% and 37.3%. Remodeling as geometry modification (18.2%) and mitral flow Type 2 (90.4%) have been the most abnormal findings. Conclusion: Hypertension induced modifications mainly LVH in ECG and Echocardiography in female patients less than encountered among male hypertensive patients.

Screening, Treatment and Control of High Blood Pressure on Five Sites in Mali

Introduction: High blood pressure is defined as blood pressure greater than or equal to 140 mm Hg for systolic and or 90 mm Hg for diastolic. It constitutes a major public health problem, the leading chronic disease in the world. The objective was to determine the prevalence, treatment rate and control of hypertension. Methods: This was a cross-sectional and descriptive study which took place over a period of 6 months in a hospital environment and in the general population. Results: Of the 1000 participants, 637 had hypertension, giving a prevalence of 63.70% with a female predominance. Thirty-three percent (33%) were unaware of their high blood pressure. The age group 60 and more was the most represented (44%). A proportion of 33 and 23.20 were overweight and obese participants, respectively. Male subjects were more overweight than female, unlike obesity which was more common among female subjects. Sixty-two percent (62%) of hypertensives were treated, of whom 44% were non-compliant. The excessively high cost and consumption of medications as needed were the main factors in therapeutic non-compliance. Twenty-two percent (22%) of all hypertensive patients and 35% of treated hypertensive patients were controlled. Women were more treated but less observant and less controlled than men. Therapeutic coverage and combination therapy rates were lower in rural areas. Hypertensives who had a high level of education were better treated and controlled than those who had no level. Conclusion: High blood pressure remains a real public health problem in Mali. It is more common in people aged 60 and over and in females. One in three hypertensives were unaware of their hypertension. The majority received antihypertensive treatments, but only a minority of them had their hypertension controlled.

ECG and Echocardiographic Findings of Athletes in Bamako—A Study among 227 Footballers

Background: A cardiovascular assessment is rarely performed among athletes despite more and more frequently reported fatal events. Most of these accidents are of cardiovascular origin. Moreover, data on ECG or Echocardiography are rare in our context justifying our study to assess electrical and echocardiographic pattern among high-level footballer in Bamako. Methods: It was a cross-sectional study conducted in Bamako from April 2015 to?March 2016 among high-level footballers aged 14 to 35 years old without distinction of sex with at least 10 hours weekly training since one year. The ECG and echocardiographies were recorded respectively with a 12-lead CONTEC and an ATL 5000 echocardiographic machine. Each ECG record was analyzed by a cardiologist in accordance with the Seattle 2013 criteria and those pathological reviewed by a second cardiologist according to the same criteria and definitively classified as normal (physiological) or abnormal ECG (requiring complementary explorations). A third cardiologist was associated in case of discordance of the first results. The collected data were inserted in a Microsoft Excel sheet and analyzed with SPSS version 20. Chi Square and Fisher statistical tests were used to compare our results. The significance level was set at 0.05. Results: We collected data of 227 top footballers with male sex represented in 90.3% giving a sex ratio of 3.04. Means for age, weight, height, body mass index (BMI) were respectively 22 years, 69.90 kg, 177.21 cm and 22.21 kg/m2. Sinus bradycardia was found in a proportion of 45.8% more represented in the age group of 30 and more years (p = 0.275). First-degree atrioventricular block (AVB) was present in 19.4%. Short PR was found in 0.4% of the sample. Left ventricular hypertrophy (LVG) according to the Sokolow index was found in 70.5% (96.9% males and 3.1% females) with p Conclusion: Many electrical and echocardiographic signs of cardiac adaptation were found in our sample and must lead to a closer follow-up of these trained footballers to avoid or prevent dramatic cardiovascular events.

Management of Hypertension (HTN) in a Cardiology Department in Bamako (Mali): Financial Aspects

Background: Studies on financial aspects of High blood pressure management are rare and old without differentiating categories of expenses. On the other hand there is an evolution in health system with the introduction of a medical insurance. Objective: We performed this study to estimate costs related to insurance status. Methodology: The prospective study on patients aged 15 years and older extended from 01 May to 31 August 2016 and was carried out in the cardiology department of the University Hospital Gabriel Touré. Only newly detected or untreated hypertensive patients were included. Sociodemographic data, those on physical examination and financial management (transport, consultation, labor tests and purchase of drugs) were collected. Regarding costs, patients were directly asked about: how much did you spend for transport, consultation, labor tests and drugs? Data analysis was carried out by comparing patients with health insurance (Ins+) and those without it (Ins?). The recorded data were inserted in a MS Access database, preliminarily processed by MS Excel and imported to SPSS version 20 for analysis. Results: Mean total cost of care was 57,018 FCFA [50,139 - 63,897] (around 92 USD). It was 50,072 [42,182 - 57,963] for the Ins? group against 79,670 [66,777 - 92,563] for the Ins+ group with a p value 0.0001. Highest amounts for spending were for cardiovascular medication and labor tests with means of 19,255 FCFA (32 USD) and 18,813 FCFA (30 USD). Mean consultation fee was significantly higher for Ins+ patients: 4064 FCFA with IC (95%) [3210 - 4917] versus 3124 with IC (95%) [2774 - 3474] for Ins? patients and p = 0.018. For ECG, however, mean costs were higher for Ins? patients with 6460 [5944 - 6976] against 5115 [4871 - 5360] for Ins+ patients, p = 0.001. Conclusion: Health insurance has few subscribers compared to patients requiring medical care. It increases the global costs of care while facilitating access to care for those who benefit from it.

ECG and Echocardiography Findings: A Comparative Study between Sportive and Sedentary Female Patients (Bamako, Mali)

Objective: To study cardiovascular cardiac and echocardiographic features in high-level footballers and sedentary women in Bamako. Materials and Methods: This was a cross-sectional study conducted in Bamako from April 2015 to March 2016 among 14 to 35 years old high-level footballers and a group of untrained women. Data including socio-demographic, physical examination, ECG record and echocardiogram was inserted in Microsoft Excel and analyzed with IBM SPSS. Chi Square and Fisher statistical tests were used to compare our results. The significance level was p 0.05. Results: Forty-three female subjects, 51% being sedentary were recruited. Mean age, weight and height were significantly higher in sportswomen than in sedentary women with respectively p of <0.0001, 0.003 and 0.036. Bradycardia was found in sports subjects in 28.6% and sedentary tachycardia in 18.2%. Left ventricular hypertrophy and dilatation and left atrial dilatation were predominant in sportswomen. Conclusion: Bradycardia, left ventricle hypertrophy and dilatation were found more in sportswomen. These changes acquired through physical training are aspects of cardiac adaptation that we found in our sample. Other aspects were not found probably due to the small size of the sample.