An Assessment of Cardiovascular Functional Capacity of a Group of Chronic Heart Failure Patients Using the 6-Minute Walk Test in a Cameroonian Urban Setting

Background: Chronic heart failure is a public health problem worldwide. It has a high mortality rate and is accompanied by a decreased functional capacity and alteration of the quality of life. Objective: This study aimed to assess the cardiovascular functional capacity of a group of patients suffering from heart failure using the 6-minute walk test (6 MWT). Methods: This was a cross-sectional study carried out in the cardiology unit of Douala’s general hospital for 4 months. We included all eligible patients aged 18 years or more who had stable chronic heart failure and gave informed consent. Those who had an acute coronary syndrome (≤1 month), tachycardia (HR ≥ 120 bpm), high blood pressure (SBP ≥ 180 mmHg and/or DBP ≥ 100 mmHg) and reduced mobility due to orthopaedic reasons were excluded. A 6 MWT was done according to the American Thoracic Society guidelines. The 6 MWT result was considered poor for - 450 m and good for >450 m. Results: We recruited a total of 81 patients (61.7% women) with a mean age of 65.9 ± 10.6 years. The most frequent risk factor for heart failure was high blood pressure (77.8%), alcohol consumption(69.1%) and a sedentary lifestyle (53.1%). The left ventricular ejection fraction was mostly preserved (42.0%) or mildly altered (46.9). The 6 MWT results were poor in 55.6% of cases, average in 19.8% of cases and good in only 24.7% of cases. More than half (59.3%) of the participants perceived the effort as being difficult. The cardiovascular functional capacity was significantly associated with age, heart failure stage and physical activity (p Conclusion: Most patients suffering from chronic stable heart failure in the general hospital of Douala have poor cardiovascular functional capacity.

Evaluation of the Functional Capacity of a Group of Patients Aged over 65 Years: A Cross-Sectional Study at the YaoundéCentral Hospital

Background: The functional capacity of elderly patients decreases with age due to a combination of age-related decline in physiologic functions and chronic diseases. A severe decrease leads to an inability to carry out activities of daily living leading to a loss of autonomy and increased dependence. The aim of this study was to evaluate the functional capacity of the elderly followed at the Yaoundé Central Hospital. Methods: We carried out a non-probabilistic consecutive sampling of elderly patients that consulted in Yaoundé Central Hospital during a five-month’ period. Data was taken concerning their chronic conditions, use of medication, and presence of depressive symptoms (evaluated using the Geriatric Depression Scale (GDS) questionnaire). The presence of any cognitive impairment was evaluated using the Mini-Mental State Examination (MMSE). Cardiac ultrasonography and electrocardiograms were done to evaluate the cardiac morphology and physiology. Their functional capacity was assessed with the WHO Global Physical Activity Questionnaire and the six-minute walk test. A self-paced step test was equally done to estimate the maximum oxygen consumption during aerobic exercise. We carried out aunivariate, and then multivariate analyses to identify factors associated with an altered functional status. Statistical analysis was performed using the SPSS software 23.0. The threshold of significance was set at 0.05. Results: 66 participants were included (35 women) with a median age of 70 (IQR: 67 - 75) years. Among them, 39.4% were found to have an altered functional capacity, about 87.8% had at least one chronic condition and 47% had two or more. The most prevalent chronic condition was hypertension (71.2%) followed by heart failure (24.2%) and osteoarthritis (12.1%). Mild depressive symptoms were present in 1.5% of our study population. The factors associated with an altered functional capacity include age ≥ 75 years (OR = 2.9 p heart failure (OR: 3.2, p ), osteoarthritis (OR: 5.1, p ), and poor gait and balance (OR: 3.7, p ). Conclusion: There is a high prevalence of altered functional capacity among elderly patients consulting at the Yaoundé Central Hospital. Heart failure, osteoarthritis, and an increased risk of falls are associated with an altered functional capacity.

Epidemiology, Clinical Presentations and In-Hospital Mortality of Venous Thromboembolism at the Douala General Hospital: A Cross-Sectional Study in Cameroon, Sub-Saharan Africa

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide. It is also the most common complication in hospitalized patients. Aims:?To?study the in-hospital prevalence of VTE, describe the socio-demographic characteristics of patients, determine the frequency of risk factors, describe the clinical presentations, and determine the short term outcome of VTE in hospitalized patients in a low-income tertiary hospital setting.?Methods: We carried out a cross-sectional descriptive retrospective study over a period of 6 years and 4 months (January 2008 to April 2014) in the Douala General Hospital—Cameroon. Patients were cases of confirmed venous thromboembolic disease (VTE).?Results: A total of 78 case files were retained for this study, giving an in-hospital prevalence of 4.4 per 1000 admissions. There were 42 (53.8%) males and 36 (46.1%) females. Their ages ranged from 18 to 89 years (median: 53 years, [IQR: 40?-?61]).?There were 37 (47.4%) cases of Deep Vein Thrombosis (DVT), 31 (39.7%) cases of Pulmonary Embolism (PE), and 10 (12.8%) cases of PE associated with DVT (12.8%). The main risk factors were obesity (44.9%), hypertension (37.2%), immobility (20.5%), and long-haul travel (17.9%). The most frequent clinical presentations in PE were dyspnea (80.5%) and chest pain (65.9%). There were 8 (10%) in-hospital deaths. Conclusion: About twelve cases of VTE are seen yearly at the DGH, with an in-hospital mortality of ten percent. Obesity and hypertension were the main risk factors, with dyspnea and chest pain being the main clinical manifestations in PE, and lower limb swelling the main symptom in DVT.

Prevalence and Risk Factors of Peripheral Artery Disease in a Group of Apparently Healthy Young Cameroonians: A Cross-Sectional Study

Background: The?burden of peripheral artery disease (PAD) is not well known among apparently healthy people in Africa. Aim: To determine the prevalence and associated risk factors of PAD in a group of blood donors seen at the Douala General Hospital—Cameroon. Methods: Between 1st November 2015 and 30th April 2016, we carried out a cross-sectional study. Participants were consenting adults of both sexes, aged ≥ 21 years who presented for blood donation, and were tested HIV negative. We collected socio-demographic data and their past history. We carried out a physical examination and measured their Ankle-Brachial Index (ABI). We defined PAD as an ABI Results: We recruited 103 participants, 55.4% males. The mean age was 33 ± 10 years. The mean ABI on left and right leg was 1.04 ± 0.1 and 1.02 ± 0.1respectively. ABI was higher in males than females both legs (p 0.05). PAD was seen in 11 (10.7%) participants. This was higher in females than males (3.6% versus 19.2%, p = 0.026). Among those with PAD, 8 (72.7%) were asymptomatic (Males: 100% versus Females: 66%, p = 0.9). After adjusting for age and gender, sedentary lifestyle (aOR: 7.14, [95% CI: 1.38 - 33.3], p = 0.019), and female gender (aOR: 6.2, [95% CI: 1.26 - 30.5], p = 0.025) were significantly associated with PAD. Conclusion: The prevalence of PAD was high in this group of HIV negative blood donors, most of whom were asymptomatic. This was associated with females, and a sedentary lifestyle.

Epidemiology of Venous Thrombo-Embolic Disease in Yaounde: A Cross-Sectional Study in Sub-Saharan Africa

Background: Venous thromboembolic disease (VTE) is one of the main causes of cardiovascular death and a public health problem worldwide. It is?one of the most complications in admitted patients, particularly inlow-income settings. The epidemiological data on VTE are still lacking. Methods: We carried out a cross-sectional study in three hospitals in Yaoundé. We retrospectively reviewed records of patients admitted for VTE from January 2013 to December 2017. We collected data on socio-demography, clinical presentation, venous Doppler/pulmonary CT scan, and outcome. Results: We included 93 patients (43 males) with VTE. Their mean age was 53.3 ± 16.6 years. There were 46 (49.5%) cases of Deep Vein Thrombosis (DVT), 36 (38.7%) cases of Pulmonary Embolism (PE), and 11 (11.8%) cases of PE associated with DVT. The main risk factors were obesity/overweight (58.1%), immobility (43%), HIV infection (22.6%), prior admission (22.6%), and long trip (19.4%). The most frequent clinical presentation for PE was dyspnea (100%), tachypnea (87.2%), and chest pain (70.2%). For DVT, limb pain (93%), calf stiffness (86%), limb volume > 3 cm (82.4%) were the most common presentation. There were 9 (9.7%) in-hospital deaths. Mean hospital stay was 20.7 ± 30.8 days. Conclusion:VTE is underdiagnosed in our setting. Obesity and immobility were the main risk factors. Dyspnea and tachypnea were the main clinical presentation for PE whereas limb pain and calf stiffness were the main symptoms for DVT. In-hospital mortality is still high.

Clinical Presentations and Outcome of Cardiovascular Emergencies in Yaounde: A Cross-Sectional Study

Background: Cardiovascular emergencies have become a public health problem with a high burden in low-income settings. This is due to the high rates of cardiovascular risk factors that are fast reaching epidemic?proportions. There is paucity of data on cardiovascular emergencies to guide repost strategies in our setting. Our aim was to determine the clinical presentation and outcome of cardiovascular emergencies at Yaounde Emergency Center.?Methods: We carried out this cross-sectional study between June 2015 and May 2017. We included all patients with confirmed cardiovascular emergency. We consecutively collected data on socio-demography, symptoms on admission, past history, clinical findings, and final diagnosis at discharge or in the event of death. Results: Of the 8285 patients admitted for medical emergencies, 388 (4.7%) were cardiovascular emergencies. Their mean age was 59.5 ± 13.8 years, and 59% were males. The Medical Emergency Aid Service was the means of transporting 4% of patients. The median time of arrival at the hospital was 48 hours. Symptoms on admission were mainly weakness of a limb (43.8%), and altered consciousness (33.5%). The most common cardiovascular emergencies were ischemic stroke (30.9%), hypertensive emergency (21.4%), and hemorrhagic stroke (16.5%). The most common comorbidity was diabetes (21.9%). The death rate in the 24 - 72 hours was 14.4%. The causes of death were hypertensive emergency (35.7%), and hemorrhagic stroke (30.3%). Conclusion: Stroke and hypertensive emergency were the most frequent cardiovascular emergencies. The early mortality was high. Hemorrhagic stroke and hypertensive emergencies accounted for most cases of death.

Parasympathetic Dysfunction in Black African Patients with Heart Failure:A Cross-Sectional Study in Sub-Saharan Africa

Background: Heart Failure (HF) is a major public health problem worldwide. Neurohormonal changes associated with HF are current therapeutic targets. The parasympathetic system in HF has not been well studied especially in black Africans. Aim: This study aimed to report on the prevalence and determinants of parasympathetic dysfunction in patients with heart failure in sub-Saharan Africa. Methods: We conducted a cross-sectional study between December 2017 and April 2018 in the outpatient and inpatient departments in two teaching hospitals in Yaounde-Cameroon. Cases were patients with HF matched with controls without HF according to age, sex, and risk factors (hypertension, diabetes, and obesity). We assessed the parasympathetic function via the Deep Breathing Test using an electrocardiograph. Results: We recruited 35 patients in each group. The mean age was 57 ± 11.68 years. Vagal dysfunction was seen in 51.4% of cases and 11.4% of controls (aOR: 10.1 [95% CI: 2.7 - 38.3], p = 0.001). This risk increased with the severity of HF-aOR: 11.8, [95% CI: 1.8 - 77.9], p = 0.01 for dyspnea stage III-IV, and aOR: 9.27, [95% CI: 1.3 - 65.3], p = 0.025) for HF with reduced Ejection fraction. This risk was not associated with the classic cardiovascular risk factors. Conclusion: Parasympathetic dysfunction as assessed with the Deep Breathing Test was seen in over half of the patients with HF and this was associated with the severity and type of HF.

Effect of Therapeutic Group Education on Adherence and Blood Pressure Control among Uncontrolled Hypertensive Patients in Sub Saharan Africa

Background: Hypertension is the leading cardiovascular risk factor worldwide, with the greatest burden in low-income settings. Blood pressure (BP) control is usually low resulting in high rates of uncontrolled patients and complications. Low awareness resulting in poor therapeutic adherence represents an important factor for insufficient blood pressure control in developing countries. Methods: This was a three months non-randomized control trial at the cardiology clinic of the Yaoundé Central Hospital. We included adults with essential and uncontrolled hypertension. The intervention consisted of group educative sessions every week focusing on knowledge of hypertension risk factors, complications, treatment, comorbidities, home self-monitoring of BP. Home blood pressure figures, drug compliance, and knowledge regarding hypertension were evaluated before and after. Results: 17 participants (8 women) with a mean age 56.2 ± 8.1 years. During intervention, mean SBP decreased by 30 mmHg while mean DBP drooped by 11 mmHg using home BP measures. Knowledge regarding hypertension, adherence and drug compliance increased by 36.5%, 88.2% and 81.4% respectively. Conclusion: Therapeutic group education resulted in a significant improvement in BP control amongst uncontrolled hypertensive patients in sub Saharan Africa.