Types and Outcomes of Arrhythmias in a Cardiac Care Unit in Western Kenya: A Prospective Study

Joan Kiyeng; Constantine Akwanalo; Wilson Sugut; Felix Barasa; Ann Mwangi; Benson Njuguna; Abraham Siika; Rajesh Vedanthan

doi:10.5334/gh.1261

Types and Outcomes of Arrhythmias in a Cardiac Care Unit in Western Kenya: A Prospective Study

Volume 18 (2023): Issue 1

By: Joan Kiyeng , Constantine Akwanalo , Wilson Sugut , Felix Barasa , Ann Mwangi , Benson Njuguna , Abraham Siika and Rajesh Vedanthan

Open Access

|Sep 2023

Figures & Tables

Flow diagram showing study recruitment schema.

Table 1

Patients’ characteristics.

PARTICIPANTS’ BASELINE CHARACTERISTICS	ALL	ARRHYTHMIA		P VALUE
PARTICIPANTS’ BASELINE CHARACTERISTICS	N = 160	YES (N = 70)	NO (N = 90)	P VALUE
Median age in years (IQR)	46 (31, 68)	46 (29, 70)	46 (31, 63)	0.873
Female gender—n (%)	95 (59.4)	48 (68.6)	47 (52.2)	0.037
Heart failure at admission—n (%)	137 (85.6)	62 (88.6)	75 (83.3)	0.349
NYHA Class				0.195
I	12 (8.8)	3 (4.8)	9 (12.0)
II	34 (24.8)	13 (21.0)	21 (28.0)
III	73 (53.3)	35 (56.5)	38 (50.7)
IV	18 (13.1)	11 (17.7)	7 (9.3)
Medical history—n (%)
Heart failure	80 (50)	41 (58.6)	39 (43.3)	0.056
Hypertension	28 (17.5)	11 (15.7)	17 (18.9)	0.6
Rheumatic heart disease	27 (16.9)	24 (34.3)	3 (3.3)	<0.001
Arrhythmia	18 (11.2)	18 (25.7)	0 (0.0)	<0.001
Diabetes mellitus	8 (5)	2 (2.9)	6 (6.7)	0.273
Stroke	2 (1.2)	1 (1.4)	1 (1.1)	0.858
Ischemic heart disease	1 (0.6)	1 (1.4)	0 (0.0)	0.255
Kidney disease	1 (0.6)	1 (1.4)	0 (0.0)	0.255
Thyroid disease	1 (0.6)	0 (0.0)	1 (1.1)	0.376
On oral anticoagulation	21 (13.1)	13 (34.2)	6 (15.8)	0.064
Implantable cardioverter defibrillator	0	0	0	0
Family and social history—n (%)
Smoking history	18 (11.2)	8 (11.4)	10 (11.1)	0.95
Alcohol use	43 (26.6)	13 (18.6)	30 (33.3)	0.037
Indoor air pollution	73 (45.6)	37 (52.9)	36 (40.0)	0.105
Family history of sudden cardiac death	1 (0.6)	1 (1.4)	0 (0.0)	0.255
Nutrition status—n (%)				0.247
Underweight	35 (23.3)	20 (31.2)	15 (17.4)
Normal	76 (50.7)	30 (46.9)	46 (53.5)
Overweight	29 (19.3)	10 (15.6)	19 (22.1)
Obese	10 (6.7)	4 (6.2)	6 (7.0)
Vital signs at admission—median (IQR)
SBP	110 (90, 120)	100 (90, 120)	110 (92, 130)	0.127
DBP	69.5 (60, 80)	60 (60, 80)	70 (60, 80)	0.071
Heart rate	102 (85, 121)	113 (89.7, 138.2)	95.5 (84, 110.7)	0.002
Temperature	36.3(36, 36.5)	36.2 (36, 36.6)	36.3 (36.1, 36.5)	0.791
Respiratory rate	23 (20, 28)	24 (20, 28.7)	22 (20, 27)	0.293
SPO2	94 (91, 96)	95 (91, 97.2)	93 (92, 96)	0.083
Baseline lab parameters—mean (SD)
Serum creatinine—umol/L	128 (100.7)	133 (100)	124 (101.6)	0.574
Urea—mmol/L	11.6 (9.74)	12.7 (10.9)	10.7 (8.7)	0.209
WBC—10^9/L	9.9 (14.97)	11.7 (22.1)	8.5 (4.9)	0.199
Hemoglobin—g/dL	13.3 (10.63)	14.5 (15.9)	12.4 (2.5)	0.222
Platelets—10^9/L	228 (100.3)	217 (104.1)	236 (97.1)	0.249
Potassium—mmol/L	4.7 (1.07)	4.7 (1.1)	4.6 (1)	0.534
Sodium—mmol/L	131 (11.7)	131 (9.2)	131 (13.4)	0.843
Albumin (g/L)	32 (6.6)	33 (6.7)	31.7 (6.5)	0.178
RBS—mmol/L	6.6 (3.42)	6.7 (3.7)	6.6 (3.2)	0.912
TSH—uMU	3.7 (4.88)	4.6 (6.5)	3.2 (3.6)	0.328
COVID-19 Positive—n (%)	16 (10)	3 (4.3)	13 (14.4)	0.1
Requiring vasoactive medicine at admission—n (%)	50 (31.2)	27 (38.6)	23 (25.6)	0.078
Norepinephrine	30 (18.8)	22 (31.4)	9 (10.0)
Dobutamine	19 (11.9)	17 (24.2)	21 (23.3)
Milrinone	1 (0.6)	0 (0)	1 (0.01)
Left ventricular ejection function—n (%)
≥50%	80 (50)	34 (48.6)	46 (51.1)	0.153
>40–<50%	29 (19.0)	17 (24.3)	12 (13.3)
≤40%	44 (28.8)	18 (25.7)	26 (28.9)
Not available (NA)	7 (4.4)	1 (1.4)	6 (6.7)
Diastolic dysfunction—n (%)	27 (17.8)	7 (10.3)	20 (23.8)	0.03
Right ventricular function
Normal	73 (47.7)	27 (39.1)	46 (54.8)	0.13
Mildly reduced	12 (7.8)	6 (8.7)	6 (7.1)
Moderately reduced	22 (14.4)	9 (13.0)	13 (15.5)
Severely reduced	46 (30.1)	27 (39.1)	19 (22.6)

Table 2

Admission diagnosis.

ADMISSION DIAGNOSIS—N (%)	ARRHYTHMIA
ADMISSION DIAGNOSIS—N (%)	YES (N = 70)	NO (N = 90)
Rheumatic heart disease (RHD)	35 (50)	11 (12.2)
Ischemic cardiomyopathy (IHD)	2 (2.9)	10 (11.1)
Cor pulmonale	3 (4.3)	12 (13.3)
Other cardiomyopathy	9 (12.9)	4 (4.4)
Pericardial disease	1 (1.4)	6 (6.7)
Congenital heart disease	3 (4.3)	1 (1.1)
Uncharacterized dilated cardiomyopathy	6 (8.6)	12 (13.3)
Hypertensive heart disease	6 (8.6)	10 (11.1)
Alcoholic dilated cardiomyopathy	1 (1.4)	7 (7.8)
Peripartum cardiomyopathy	1 (1.4)	6 (6.7)
Pulmonary embolism	0	5 (5.6)

Table 3

Management among patients with arrhythmias and incidence of arrhythmias in CCU.

PATIENT MANAGEMENT	FREQUENCY (%)
Electrical (synchronized/defibrillation)—n (%)	22 (31)
Medical therapy—n (%)
Digoxin	35 (50)
Amiodarone	13 (18.6)
Metoprolol	4 (5.7)
Pacing—n (%)	1 (1.4)
Resolution of arrhythmias at discharge—n (%)	13 (18.6)
New onset arrhythmia in CCU—n (%)
Supraventricular tachyarrhythmias	3 (0.03)
Bradyarrhythmia	0 (0)
Ventricular tachyarrhythmias	0 (0)

Types and proportion of cardiac arrhythmias.

Table 4

30-day outcomes among the patients.

OUTCOME	ARRHYTHMIA (N = 70)	NO ARRHYTHMIA (N = 90)	P VALUE
Survival to 30 days—n (%)			0.638
Alive	47 (67.1)	62 (68.9)
Dead	23 (32.9)	27 (30.0)
Unknown	0	1 (1.1)
Survival to discharge—n (%)			0.821
Alive	51 (72.7)	67 (74.4)
Dead	19 (27.1)	23 (25.6)
Length of stay—median (IQR)	8 (4,12)	9 (6,14)	0.044
30-day all-cause readmission—n (%)	4 (8.2)	1 (1.5)	0.087

Table 5

30-day outcome stratified by gender among the participants.

VARIABLE	MALE			FEMALE
	ARRHYTHMIA	NO ARRHYTHMIA	P VALUE	ARRHYTHMIA	NO ARRHYTHMIA	P VALUE
	N = 22	N = 43		N = 48	N = 47
Survival to discharge—n(%)			0.232			0.609
Alive	15 (68.2)	36 (83.7)		35 (72.9)	32 (68.1)
Dead	7 (31.8)	7 (16.3)		13 (27.1)	15 (31. 9)
Survival to 30 days—n (%)						0.474
Alive	15 (68.2)	34 (79.1)		32 (66.7)	28 (59.6)
Dead	7 (31.8)	8 (18.6)		16 (33.3)	19 (40.4)
Unknown	0 (0)	1 (2.3)		0 (0)	0 (0)
Length of stay—median (IQR)			0.819			0.04
	8.5 (7.25, 16.75)	11 (5.3, 17.5)		7 (4,10)	9 (6.1, 13.25)
30-day all-cause readmission—n (%)			0.123			0.365
Yes	1 (6.7)	0 (0)		3 (8.8)	1 (3.3)

Table 6

Multivariate analysis of factors associated with 30-day mortality.

VARIABLE	HAZARD RATIO	P VALUE	LOWER LIMIT[95% CONF.	UPPER LIMITINTERVAL]
Arrhythmia (yes vs no)	1.096	0.813	0.513	2.344
Age	1.001	0.883	0.984	1.019
Gender (female vs male)	1.496	0.294	0.705	3.176
Heart failure present (yes vs no)	0.775	0.688	0.223	2.69
NYHA (3,4 vs 1,2)	1.844	0.174	0.763	4.455
RHD present (yes vs no)	1.118	0.843	0.371	3.368
HTN present (yes vs no)	0.568	0.31	0.191	1.692
History of arrhythmia (yes vs no)	0.844	0.741	0.308	2.308
LVEF >40–<50% vs >50%	0.358	0.049	0.129	0.997
LVEF ≤40% vs >50%	0.463	0.137	0.168	1.277
LVEF NA vs >50%	0.864	0.826	0.236	3.169
Valvular (NA vs mild/normal)	1.550	0.346	0.622	3.860
Valvular (moderate/severe vs mild/normal)	1.548	0.314	0.661	3.627
Vasoactive meds (yes vs no)	2.924	0.002	1.486	5.754
RV function (moderate/severe vs mild/normal)	1.431	0.352	0.672	3.046
Creatinine (abnormal vs normal)	1.472	0.314	0.694	3.123
Urea (abnormal vs normal)	1.943	0.085	0.912	4.138
Sodium (abnormal vs normal)	0.865	0.693	0.42	1.781
Albumin (abnormal vs normal)	0.59	0.123	0.301	1.153

Kaplan-Meier curve showing overall 30 days survival by arrhythmia status at admission.

References

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DOI: https://doi.org/10.5334/gh.1261 | Journal eISSN: 2211-8179

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Language: English

Submitted on: Sep 1, 2022

Accepted on: Aug 8, 2023

Published on: Sep 21, 2023

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Arrhythmias,

Atrial Fibrillation,

Cardiac Care Unit

© 2023 Joan Kiyeng, Constantine Akwanalo, Wilson Sugut, Felix Barasa, Ann Mwangi, Benson Njuguna, Abraham Siika, Rajesh Vedanthan, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 18 (2023): Issue 1

Types and Outcomes of Arrhythmias in a Cardiac Care Unit in Western Kenya: A Prospective Study

Figures & Tables

Figure 1

Table 1

Table 2

Table 3

Figure 2

Table 4

Table 5

Table 6

Figure 3

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