Heart Failure: Organization of Care after Hospitalization at the Abidjan Cardiology Institute

Introduction: The care pathway for heart failure (HF) patients is poorly documented in sub-Saharan Africa. A multidisciplinary management reduces hospitalizations and mortality. In our context of frequent rehospitalization of heart failure patients, the objective of this study was to analyse the post-hospital follow-up health care. Methods: We conducted a prospective study in the medical department of a Heart Institute from January 1st to December 31, 2015. Patients over 18 years of age, hospitalized for heart failure, consenting and followed up on an outpatient basis for 2 years were included. Results: We collected 396 patients hospitalized for HF. The mean age was 57.4 ± 16 years with a male predominance (59.3%). Retired and unemployed people represented 27% and 16.2% respectively. During the post-hospitalization follow-up, patients who were regularly followed up represented 10.8% of the cases. 74.1% of the cases were regular patients. Patients were not followed up by the usual practitioner (58.2%). Only 94 patients had undergone a cardiovascular rehabilitation programme, of which 21.3% for exercise rehabilitation and 78.7% for therapeutic education. Patients who had attended titration sessions (n = 59) had reached optimal doses of ACE inhibitors, ARB II and beta blockers in 67.8%, 7.3% and 38.5% respectively. The rates of decompensation (73.3%) and rehospitalization (49.5%) were higher. The paraclinic check-up (ECG, X-ray, Cardiac Doppler ultrasonography, Biology) was rarely requested. The probability of survival was higher in patients regularly monitored than in those irregularly monitored. Conclusion: The organisation of care and coordination between professionals should be structured or planned. Therapeutic strategies need to be intensified in order to optimise their long-term benefits.

Drug Prescription Analysis at Hospital Discharge for Heart Failure Patients at the Institute of Cardiology of Abidjan

Introduction: Understanding improvement of pathophysiology of heart failure has allowed therapeutic progress over the past two decades in the pathology management. Our patients should benefit from these new drugs that improve survival. Objective: To analyze the treatment of hospital discharge according to ESC (European Society of Cardiology) Guidelines. Methods: We carried out a retrospective and descriptive study which included completed survey of patients hospitalized for heart failure in Medicine Department of cardiology Institut of Abidjan between January 1st 2011 to December 31st 2012. We analyzed the drugs prescription during hospital discharge by using the register of hospitalization. Results: 92.9% of the 532 files retained were included. Patients had a mean age of 54.4 ± 16.4 years old. 36.3% of the cases had a heart failure history with an average of 5.7 ± 3.2 days of hospital stay. At the hospital discharge, patients had for prescription: a diuretic specially Furosemide (100%), angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blockers (ARB) (63.7%), a beta-blocker (17.9%) and a mineralocorticoids receptor antagonist (MRA) (51.2%). Diuretic, IEC or ARB and the MRA were prescribed systematically. Beta-blockers were lower prescribed to patients who showed no more signs of congestion. Conclusion: Our prescribing practices were adapted to the guidelines for heart failure management. However, the gaps will be corrected through sensitization and training.