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Research ArticleOpen Access

Heart Failure Demographic and Clinical Features: The Caribbean Perspective. A Single-Center 100-Case Series Discussion and Review of the Literature

Volume 1 - Issue 4

Felix Nunura1*, Edwin Tulloch-Reid1,2, Dainia S Baugh3 and Ernest C Madu1

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    • 1Division of Cardiovascular Medicine, Heart Institute of the Caribbean, Jamaica
    • 2Department of Interventional Cardiology, Heart Institute of the Caribbean, Jamaica
    • 3Department of Medicine, Heart Institute of the Caribbean, Jamaica

    *Corresponding author: Felix Nunura, Division of Cardiovascular Medicine, Heart Institute of the Caribbean, 23 Balmoral Avenue, Kingston, Jamaica

Received: August 15, 2017;   Published: September 07, 2017

DOI: 10.26717/BJSTR.2017.01.000332

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Background: Heart Failure with reduced Ejection Fraction (EF) is likely itself a heterogeneous entity within the same complex clinical syndrome. The relative contribution of various risk factors and etiological conditions involved in the development of heart failure with Midrange (HFmrEF) and Reduced Ejection Fraction (HFrEF) in the Caribbean population is unknown. We aimed to determine the impact of cardiac risk factors and etiological conditions associated with reduced EF and identify common and distinctive risk profiles between HFmrEF vs HFrEF in a series of cases of Afro-Caribbean population with heart failure.

Methods and Results: We report a case series of 100 consecutive patients (52 % male, age: 65.5 ± 15.3 years) with objective evidence of cardiac dysfunction (EF: 34.8±7.8 %) assessed in the Heart Institute of the Caribbean, Jamaica, over the past two years (2015-2017). The study population was categorized according to LVEF as follows: Overall patients with left ventricular systolic dysfunction (LVEF < 50 %, n=100); HF with midrange LVEF (40-49 %, HFmrEF; n=34, Group 1) and HF with reduced ejection fraction (< 40 %, HFrE; n=66, Group 2). The mean number of risk factors for heart failure (n=100) per case was 1.23±1.09; 36 % had 1, 35 % had 2 or more, while 29 % had none. For the overall group of patients Hypertension -HTN was the most common (68%), followed by Diabetes -DM (27%) but 31% was non-hypertensive and nondiabetic. LVEF < 50 % was associated in 48 % with ischemic heart disease -IHD (20 % with documented myocardial infarction) but in52% with non-ischemic conditions as follows: Dilated Hypertensive Heart Disease-DHHH (24 %), Dilated cardiomyopathy -DCM (14%), and others (10 %). Comparing Group 1 and Group 2, the most significant variable was age (73.8±11.9, Group 1 vs 61.4±15.2, Group 2; p 0.0001). Cases with HFmEF and HFrEF had similar (P > 0.05) clinical characteristics (HTN : 76.4 vs 63.6%; DM: 27.2 % vs 25.7%; dyslipidemia 11.7 % vs 15.1%; smoking 5.8%vs. 7.5 % , obesity 20.5% vs 9 % and atrial fibrillation (20.5% vs 13.6%) , however there were significant differences in the prevalence of DHHD (11% vs. 30.3 %) , IHD (61.7% vs 40.9%) , combined hypertensive and ischemic heart disease (52.9% vs 33%), DCM(2.9 vs. 21.2%) and the presence of wide QRS : LBBB (2.9% vs 22.7 %).

Conclusion: Afro-Caribbean patients with heart failure and reduced -abnormal, no preserved- ejection fraction- is mainly hypertensive with or w/o diabetes and half of them develop leftventricularsystolic dysfunction due to non-ischemic causes. In addition, they demonstrate a distinct etiological but similar clinical profile when they are classified in HFmrEF and HFrEF .The impact of these findings remains to be determined in a larger prospective study.

Keywords: Afro-Caribbean; Heart Failure; HFmrEF; HFrEF; Risk factors

Abbreviations: EF: Ejection Fraction; HFmrEF: Heart Failure With Midrange; HFrEF: Heart Failure Reduced Ejection Fraction; HF: Heart Failure; PAR: Population Attributable Risk; ARIC: Atherosclerosis Risk in Communities study; MESA: Multi-Ethnic Study of Atherosclerosis; DM: Diabetes Mellitus

Abstract| Introduction| Methods| Results| Discussion| Conclusions| References|