Modelling factors associated with therapeutic inertia in hypertensive patients: Analysis using repeated data from a hospital registry in West Africa.

The proportion of poorly controlled hypertensives still remains high in the general African population. This is largely due to therapeutic inertia (TI), defined as the failure to intensify or modify treatment in a patient with poorly controlled blood pressure (BP). The objective of this study was to identify the determinants of TI. We conducted a retrospective cohort study from March 2012 to February 2014 of hypertensive patients followed during 4 medical visits. The TI score was the number of visits with TI divided by the number of visits where a therapeutic change was indicated. A random-effects logistic model was used to identify the determinants of TI. A total of 200 subjects were included, with a mean age of 57.98 years and 67% men. The TI score was measured at 85.57% (confidence interval [CI] 95% = [82.41-88.92]). Measured individual heterogeneity was significantly significant (0.78). Three factors were associated with treatment inertia, namely the number of antihypertensive drugs (odd ratios [OR] = 1.27; CI = [1.02-1.58]), the time between consultations (OR = 0.94; CI = [0.91-0.97]), and treatment noncompliance (OR = 15.18; CI = [3.13-73.70]). The random-effects model performed better in predicting high-risk patients with TI than the classical logistic model (P value < .001). Our study showed a high TI score in patients followed in cardiology in Burkina Faso. Reduction of the TI score through targeted interventions is necessary to better control hypertension in our cohort patients.

[Evaluation of patients' satisfaction in the department of cardiology at the University Hospital Yalgado Ouedraogo]. / Évaluation de la satisfaction des patients dans le service de cardiologie du CHU Yalgado Ouedraogo.

INTRODUCTION: Patients' satisfaction is an important component of health care quality evaluation. Patients and physicians are now care partners. This new relationship deserves to be evaluated. Our study aimed to evaluate the satisfaction of patients hospitalized in the Department of Cardiology at the University Hospital Yalgado Ouedraogo. METHODS: We conducted a cross-sectional descriptive study with a single data collection phase of all the patients hospitalized from 1 January to 30 June 2014. We administered SAPHORA questionnaire adapted to suit our context. The scores and the satisfaction rates were calculated according to the studied parameters. RESULTS: During the study period we collected data from 230 patients. The mean hospitalization time was approximately 10 days. 125 (53.2%) men were enrolled in the study, sex ratio was 1.1. 32% (n = 75) of patients were unschooled. Public servants accounted for 24.3% (n = 57) of our study population. The average age of our sample was 50.7 years. Patients over the age of 65 years accounted for 25.6% of the study population. 113 (48.1%) patients had been admitted as medical emergencies. 21 patients (8.9%) had a history of hospitalization in the Depatment of Cardiology. Dilated cardiomyopathy was the diagnosis made during hospitalization in 75 (32%) cases. The overall score of satisfaction of the patients treated in the Department of Cardiology was 78.3%. Satisfaction score on hospital admission was 68.1% and on patients' comfort was 65.8%. Satisfaction score on health care quality and on hospital discharge planning was 84.7% and 84.5% respectively. Patients' suggestions for improvement were based on comfort during hospital stay in 99 (42.1%) cases and on staff identification in 176 (74.9%) cases. CONCLUSION: The evaluation of the satisfaction is infrequent in our country. It is becoming increasingly frequent in western countries using common and validated tools. It is an important aspect that our hospitals should include in order to increase quality approach to accreditation.

Use of Vitamins K antagonists in non-valvular atrial fibrillation thromboembolic risk prevention in Burkina Faso.

INTRODUCTION: Atrial fibrillation is the commonest cardiac rythm disorder. Thromboembolic accidents are common complications that should be prevented by anticoagulant treatment. The aim of our study is to assess the use of vitamins K antagonists in the prevention of thromboembolic risk in atrial fibrillation. METHODS: It was a descriptive retrospective study of patients folders, performed in the cardiology department from January 1st 2010 to December 31st 2011. The study included all patients with non valvular atrial fibrillation. Thromboembolic risk was assessed through the CHA2DS2VASc score, and hemorrhagic risk through the HAS-BLED score. RESULTS: Atrial fibrillation accounted for 10.6% of all hospitalizations (103/970). Five patients had contra indication to anticoagulants. Non valvular AF was noticed in 68 cases (66%). The non valvular AF was chronic in 40 cases (59%) and paroxystic in eight cases (12%). The median age of the population was 64.5+13.8 years old. Median CHA2DS2VASc score was 3.9 + 1.6. Two patients had a score < 1. Sex, place of residence, age > 65, and cardiac failure did not interfere with prescription of vitamins K antagonists. Ischemic stroke and intra cavity thrombus were the indications for vitamins K antagonists' prescriptions. The median HAS-BLED score was 3.5 + 1.5. The rate of vitamins K antagonists use was 35.3%. One case of death due to hemorrhagic stroke was noticed. CONCLUSION: Guidelines on thromboembolic risk prevention are poorly used in the cardiology department. But the use of scoring systems allows the assessment of vitamins K antagonists treatment benefit/risk in atrial fibrillation, and minimizes the hemorrhagic risk.

Assessing causes of death in the Cardiology Department of Yalgado Ouédraogo University Hospital.

INTRODUCTION: Analysis of the underlying causes of death can develop action plans for prevention of death that could be avoided. The aim of our study was to analyse the causes of cardiovascular deaths in the cardiology department of Yalgado Ouedraogo University Hospital. METHODS: The study was a descriptive retrospective study over a 24 month period among patients who died in the department. RESULTS: Prevalence of death in the cardiology department was of 13.2%. Sex ratio was of 1.2 and 72.7% of patients were residing in Ouagadougou. Mean age of patients was 56.1 years and 59.4% of patients were under 65 years old. Hypertension was the major cardiovascular risk factor (46.1%) and 27.4% of patients had a medical history of dilated cardiomyopathy. Cardiogenic shock was the immediate cause of death in 55.5% of cases and the initial cause of death was hypertension and its complications in 46.1% of cases. Death was not notified in 18% of cases and no death had been medically certified. CONCLUSION: Death statistics are the most reliable data for public health interventions. However, it is necessary to establish an effective method of data gathering according to the WHO standards in order to facilitate international comparison.