Heart failure care and outcomes in a Tanzanian emergency department: A prospective observational study

An retrospective study on the effects of deep learning model-based optimization emergency nursing on treatment compliance and curative effect of patients with acute left heart failure

BACKGROUND

Based on explainable DenseNet model, the therapeutic effects of optimization nursing on patients with acute left heart failure (ALHF) and its application values were discussed.

METHOD

In this study, 96 patients with ALHF in the emergency department of the Affiliated Hospital of Xuzhou Medical University were selected. According to different nursing methods, they were divided into conventional group and optimization group. Activity of daily living (ADL) scale was used to evaluate ADL of patients 6 months after discharge. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were employed to assess patients' psychological state. 45 min improvement rate, 60 min show efficiency, rescue success rate, and transfer rate were used to assess the effect of first aid. Likert 5-level scoring method was adopted to evaluate nursing satisfaction.

RESULTS

The optimization group showed shorter durations for first aid, hospitalization, electrocardiography, vein channel establishment, and blood collection compared to the conventional group. However, their SBP, DBP, and HR were inferior. On the other hand, LVEF and FS were significantly better in the optimization group. After nursing intervention, SAS and SDS scores were lower in the optimization group. Additionally, the optimization group had higher 45-minute improvement rates, 60-minute show efficiency, rescue success, and transfer rates. They also performed better in 6-minute walking distance and ADL scores 6 months post-discharge. The optimization group had better compliance, total effective rates, and satisfaction than the conventional group.

CONCLUSION

It was demonstrated that explainable DenseNet model had application values in the diagnosis of ALHF. Optimization emergency method could effectively shorten the duration of first aid, relieve anxiety, and other adverse emotions, and improve rescue success rate and short-term efficacy. Nursing intervention has a positive impact on the total effective efficiency and patient satisfaction.

Prevalence and predictors of poor heart failure treatment outcomes in Ethiopia: a systematic review and meta-analysis

Background

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Various factors can exacerbate disease progression in patients with HF and negatively impact treatment outcomes. This study aims to evaluate the pooled prevalence and contributing factors associated with poor heart failure treatment outcomes in Ethiopia.

Methods

A systematic review and meta-analysis were conducted using five databases: Google Scholar, ScienceDirect, Hinari, PubMed, and Scopus. In total, 12 studies met the eligibility criteria for inclusion in this analysis. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Data extraction was performed using a Microsoft Excel spreadsheet, and statistical analysis was conducted with STATA 14. The Joanna Briggs Institute Meta-analysis of Statistics Assessment and Review Instrument was utilized for quality assessment. Heterogeneity among the studies was evaluated using the I 2 statistic and the Cochrane Q test. Publication bias was assessed using Begg's test, Egger's weighted regression, and funnel plots.

Results

The pooled prevalence of poor HF treatment outcomes was found to be 16.67% [95% confidence interval (CI): 10.67-22.67]. No significant heterogeneity was observed across the included studies (I 2 = 0.0%, p = 0.962). Significant predictors of a poor treatment outcome were smoking cigarettes [adjusted odds ratio (AOR) = 10.74; 95% CI: 3.24-35.63] and medication-related problems (AOR = 3.99; 95% CI: 1.90-8.37).

Conclusion

The prevalence of poor HF treatment outcomes in Ethiopia was found to be high. Smoking cigarettes and medication-related problems are significant predictors of these adverse outcomes. Comprehensive health education and improved clinical pharmacy services are essential for addressing these issues.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437397, PROSPERO (CRD42023437397).

Prevalence and risk factors of mortality among heart failure patients in low resource setting hospitals: a multicenter prospective observational study

Background

Heart failure is a significant worldwide health problem that leads to mortality. Therefore, this study aimed to evaluate treatment outcomes and associated factors of heart failure patients who were admitted to hospitals in the southwest of Ethiopia.

Methods and participants

A multicenter prospective observational study was conducted from 1 February to 1 August 2021. Drug therapy problems were assessed as per the Cipolle, Strands, and Morley drug therapy problems classification method. The drug therapy was registered by using the drug-related problem registration format. The results of logistic regression analysis was interpreted as crude odds ratio and adjusted odds ratio (AOR) at 95% confidence interval (CI) to determine the association between dependent and independent variables.

Results

In our study settings, a total of 205 (85.1%) heart failure patients showed improvement and 36 (14.9%) died at hospital discharge. Being ≥65 years (AOR = 7.14, 95% CI: 2.04-.25.01, P = 0.002), a previous hospitalization (AOR = 6.20, 95% CI: 1.81-21.21, P = 0.004), and the presence of medication-related problems (AOR = 3.65, 95% CI: 1.13-11.73, P = 0.03) were the predictors of mortality.

Conclusion

The prevalence of in-hospital mortality among heart failure patients was found to be high. Previous hospitalization, older age, and the presence of drug therapy problems were the predictors of mortality among heart failure patients. Therefore, proper attention should be given to the management of elderly and re-admitted heart failure patients in addition to their regular care. In addition, hospitals should implement clinical pharmacy services to address any drug-related problems.

Patterns of comorbidity and multimorbidity among middle-aged and elderly women in peri-urban Tanzania

Background

Multimorbidity poses an increasing challenge to health care systems in Sub-Saharan Africa. We studied the extent of multimorbidity and patterns of comorbidity among women aged 40 years or older in a peri-urban area of Dar es Salaam, Tanzania.

Methods

We assessed 15 chronic conditions in 1528 women who participated in a cross-sectional survey that was conducted within the Dar es Salaam Urban Cohort Study (DUCS) from June 2017 to July 2018. Diagnoses of chronic conditions were based on body measurements, weight, blood testing, screening instruments, and self-report.

Results

The five most prevalent chronic conditions and most common comorbidities were hypertension (49.8%, 95% CI 47.2 to 52.3), obesity (39.9%, 95% CI 37.3 to 42.4), anemia (36.9%, 95% CI 33.3 to 40.5), signs of depression (32.5%, 95% CI 30.2 to 34.9), and diabetes (30.9%, 95% CI 27.6 to 34.2). The estimated prevalence of multimorbidity (2+ chronic conditions) was 73.8% (95% CI 71.2 to 76.3). Women aged 70 years or older were 4.1 (95% CI 1.5 to 10.9) times mores likely to be affected by multimorbidity and had 0.7 (95% CI 0.3 to 1.2) more chronic conditions than women aged 40 to 44 years. Worse childhood health, being widowed, not working, and higher food insecurity in the household were also associated with a higher multimorbidity risk and level.

Conclusion

A high prevalence of multimorbidity in the general population of middle-aged and elderly women suggests substantial need for multimorbidity care in Tanzania. Comorbidity patterns can guide multimorbidity screening and help identify health care and prevention needs.