Impact of co-morbidities on the prognosis and the quality of life of patients with chronic heart failure in Yaoundé

Abstract

BACKGROUND: Heart failure is a major public health problem which affects approximately 2% of the world’s population. These patients usually have co-morbidities which accelerate disease progression and worsen response to treatment. This leads to more frequent and longer hospitalizations which in the long run affect the mortality and quality of life of these patients. In order to mitigate and prevent this harmful effect, we aimed at assessing how co-morbidities affect heart failure patients in our milieu. OBJECTIVE: Determine the impact of comorbidities on the prognosis and quality of life of patients with heart failure in our setting. METHODS: We conducted a cross-sectional study of patients who presented in the hospital with chronic heart failure at Yaoundé Central Hospital, Yaoundé General Hospital, Yaoundé University Teaching Hospital, and Efoulan District Hospital. We included patients presenting with chronic heart failure above the age of 18, hospitalized or followed up in cardiology external consultation within the period of 3months from February to April. The variables studied were the sociodemographic, clinical, and paraclinical characteristics, prognosis and quality of life of patients with heart failure. The prognosis was evaluated with the Charlson Comorbidity Score while the quality of life was evaluated using the Minnesota living with heart failure questionnaire. To do that, we obtained ethical and administrative approval, and thereafter the patients’ consent was sort. SPSS version 26 was used for data entry and analysis, and a p-value of 0.05 with a 95% confidence interval was considered statistically significant. Pearson and Mann-Whitney U tests were used to analyse associations. RESULTS: We recruited a total of 86 patients. The mean age of the participants was 62 ± 14.2 years. The median duration of evolution of heart failure was 3,5[2-5] years. Sedentary behaviour was the main cardiovascular risk factor with the most found aetiologies for heart failure being hypertension (30.2%) and ischemia (22.1%). The mean LVEF was 39.13± 14.18% with more than half having HFrEF. 60.5% of our participants were in stage II of NYHA. The most predominant Charlson comorbidities were diabetes (16.3%) and CKD (10.5%). The mean 10-year survival rate was 51.30 ± 34.25% with 9.3% having a 0% survival rate. The mean score of quality of life was 30.06 ± 17.13 with more than half of the patients having a good quality of life (53.5%). We observed that an increase in NYHA classification stage (coefficient beta (β)=15.9; 95% confidence interval (CI), 12.3–19.6), HF of valvular origin (β=7.9; CI, 1.5–14.3), and presence of chronic kidney disease (β=16.1; CI, 9.5–22.7), were directly associated with poorer quality of life. We also found out that the prognosis of patients with HF was directly associated with quality of life (β=2.0; CI, 0.6–3.4). CONCLUSION: Most patients had a good prognosis and quality of life. CKD was the only comorbidity found to independently affect the quality of life of HF patients negatively. Likewise, an increase in NYHA stage, and HF of valvular origin were directly associated with poor quality of life. Additionally, we deduced that the poorer the quality of life, the poorer the prognosis.