Title

Long-term outcomes and factors associated with mortality among patients with moderate to severe pulmonary hypertension in Kenya

Date of Award

5-30-2018

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Mzee Ngunga

Second Supervisor/Advisor

Dr. Anders Barasa

Third Supervisor/Advisor

Dr. Mohamed Jeilan

Department

Internal Medicine (East Africa)

Abstract

Background: Pulmonary hypertension (PH) is a condition that carries significant morbidity and mortality. Studies done in sub-Saharan Africa have reported poor short-term outcomes. However, data on long-term outcomes and prognostic factors are lacking.

Objectives: This study sought to determine the one and two-year survival rates and prognostic factors associated with mortality in patients with moderate to severe PH.

Methods: A retrospective review of moderate to severe PH patients [pulmonary artery systolic pressure (PASP), ≥45 mmHg] diagnosed at Aga Khan University Hospital, Nairobi from 2014 to 2017 was carried out. Demographic, clinical and in hospital outcome data were extracted from medical charts; and telephone interviews were conducted to determine out of hospital outcomes. Kaplan-Meier method was used for survival analysis and log rank tests were done to assess for differences between subgroups. Cox regression modelling with multivariable adjustment were used to identify factors associated with all-cause mortality.

Results: A total of 659 patients were enrolled in this study, of which 50 (7.6 per cent) were lost to follow-up. The median PASP was 56 mmHg (interquartile range, 49–68 mmHg). After a median follow-up of 626 days, the one and two-year overall survival rates were 73.8 and 65.9 per cent, respectively. Using multivariate cox regression analyses, mortality was significantly associated with age, diabetes mellitus, atrial fibrillation, WHO functional class III and IV, severe pulmonary artery systolic pressures, right ventricular and left v ventricular systolic dysfunction. However, gender, systemic arterial hypertension, rheumatic heart disease and presence of significant valvular abnormalities had no significant association with mortality.

Conclusion: Pulmonary hypertension is associated with poor long-term outcomes in African patients with overall survival rate of 65.9 per cent at two years. Identification of poor prognostic factors can assist in identifying high-risk patients.

This document is available in the relevant AKU library

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