Management of heart failure at Chris Hani Baragwanath academic hospital
Heart failure with a reduced ejection fraction (HFrEF) is defined as heart failure with an ejection fraction of less than or equal to 45%. Guideline-based treatment of HFrEF has a significant impact on morbidity and mortality. Therefore, the adequacy of pharmacological treatment of HFrEF at the Chris Hani Baragwanath Academic Hospital (CHBAH) Medical Outpatients Department (MOPD) was assessed retrospectively between 2013 and 2014. In addition, the prevalence of aetiologies, comorbidities and complications of HFrEF were determined. Mean age of 299 patients was 53 ± 15.4 (55% females). 67.1% received beta blockers, 76.9% received angiotensin converting enzyme inhibitors, 94% received furosemide and 65% received spironolactone. None were on hydralazine and isosorbide dinitrate combination therapy. Hypertensive heart disease, human Immunodeficiency virus associated cardiomyopathy, idiopathic dilated cardiomyopathy and diabetes were the aetiology of HFrEF in 65%, 23%, 13% and 10.4% of patients, respectively. In conclusion, treatment of HFrEF was found to be suboptimal. Dissemination of national HF guidelines, doctors’ education and improved organisation of care are potential solutions to effect improvement of service and patient care.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Masters in Medicine in the branch of Internal Medicine Johannesburg, 2016