[Characteristic and evolution of pacemaker complications in a Subsaharan Africa Heart Centre]. / Caractéristiques et évolution des complications de la stimulation cardiaque dans un centre de cardiologie de l'Afrique de Subsaharienne.

AIM OF THE STUDY: The working environment and the low rate of pacemaker insertions increase the risk of complications in sub-Saharan Africa. The objective of our work was to assess the impact of specific preventive measures on these complications over the long term. PATIENT AND METHODS: We conducted a retrospective study of all pacemaker implantations from June 2006 to June 2016 at the Abidjan Heart Institute. We evaluated the incidence of pacemaker complications, their risks factors and their impact on the overall prognosis of patients. RESULTS: Three hundred and two procedures were performed in 286 patients (49% male, mean age: 67±12 years), with a predominance of primary implantation (82.8%) of single-chamber ventricular pacemakers (66.6%). Twenty-five major complications (8.27%) and 14 minor (4.6%) occurred with a predominance of lead displacements (3.64%). The major complications were favored by the subclavian approach (P=0.018; OR=2.34; 95% CI [1.16-4.75]) and intraoperative incidents (P=0.02; OR=2.17; 95% CI [1.16-4.75]. The preventive measures taken made it possible to achieve a significant (P=0.017) and linear (P=0.009) reduction of these complications, with no effect the patients prognosis (Log-Rank=0.217; P=0.64). CONCLUSION: Quality cardiac stimulation is possible in Sub-Saharan Africa with preventive measures adapted to the environment.

[Burden of comorbidities in heart failure patients hospitalized at the Abidjan Heart Institute]. / Poids des comorbidités chez les insuffisants cardiaques hospitalisés à l'Institut de cardiologie d'Abidjan.

OBJECTIVE: The aim of our work was to appreciate the importance of comorbidities of heart failure individually and globally in patients hospitalized at the Cardiology Institute of Abidjan. PATIENTS AND METHODS: This was a prospective cohort study of adult heart failure patients hospitalized from January to December 2015, and followed up over 12 months. Co-morbidities were analysed through their prevalence, their relationship with the etiologies, and their impact on the prognosis. RESULTS: Three hundred and two patients (mean age: 55.5±16.9 years, 61.6 % male) were recruited. High blood pressure, anaemia and kidney dysfunction were the most common co-morbidities (48 %, 43.7 % and 41.3 % respectively). There was an average of 3.4±1.8 comorbidities per patient with an increase in the number of comorbidities with age (P<0.05) and a more frequent association with hypertensive and ischemic heart disease (P<0.001). During the one-year follow-up, 96 patients died. Apart from hepatic dysfunction (RR=1.97, 95 % CI [1,19-3.25], P=0.008, a high score of Charlson index appeared as a risk factor of death as much in univariate analysis (RR=4.15 95 % CI [2.32-7.41], P<0.001), as in multivariate analysis according to the Cox model (RR=2.48. 95 % CI [1.08-5.09], P=0.03) confirmed by Kaplan Meier curves (P<0.001). CONCLUSION: Comorbidities are common in our heart failure patients and significantly affect their prognosis.

[Obesity, high blood pressure and physical activity levels in a black African population]. / Obésité, hypertension artérielle et niveau d'activité physique dans une population noire africaine.

PURPOSE OF THE STUDY: To determine the prevalence of general and abdominal obesity and to describe their association with high blood pressure and physical activity levels in a peri-urban population in West Africa. METHODS: A cross-sectional study was conducted in Abidjan (Cote d'Ivoire) in the Anonkoi 3 district, from 24 April to 23 May 2014. Obesity, abdominal obesity and physical activity levels were assessed. Blood pressure was measured. The data were entered on the Epi data software (version 3.1) and analyzed with the R studio software version 1.1.447. The existence of associations was demonstrated by the Pearson Khi2 test at the 0.05 significance level. A multivariate analysis was performed. RESULTS: We recruited 486 adults 18 years of age and older, including 327 women and 159 men. The average age was 36.1 years with a standard deviation of 12.83 years. The prevalence of obesity was 14.8 %, that of abdominal obesity 50.8 % or more than half of the population. Females (P=0.000), ages 30 years and older (P=0.003), high blood pressure (P=0.000) and low activity (P=0.033) were significantly associated with obesity and abdominal obesity. Multivariate analysis showed that the relationship between female gender and abdominal obesity was very significant (OR=48.52; 95 % CI). CONCLUSION: This village located in a municipality of Abidjan has a heterogeneous population. This one adopts the sedentary habits of the city.

Facteurs de la mauvaise observance therapeutique de l'hypertendu en Côte d'Ivoire

Objectifs : Evaluer le niveau d'observance thérapeutique chez des patients hypertendus suivis en ambulatoire et rechercher les facteurs liés à une mauvaise observance. Méthodes : A travers une étude multicentrique réalisée dans deux villes de la Côte d'Ivoire, nous avons évalué l'observance thérapeutique de 332 hypertendus traités depuis plus de 6 mois. Cette évaluation s'est faite à l'aide d'un questionnaire appelé test d'évaluation de d'observance (TEO) permettant de définir des patients ayant une bonne observance thérapeutique, ceux ayant un minime problème d'observance et ceux ayant une mauvaise observance. Les facteurs de mauvaise observance ont été recherchés en analyse univariée puis en analyse multivariée à l'aide d'une régression logistique. Résultats : Dans notre population d'hypertendus, le TEO a objectivé 26,8% de patients bons observants, 53,8% ayant un minime problème d'observance et 19,6% de mauvais observants du traitement antihypertenseur. En analyse univariée, la mauvaise observance était associée à un plus jeune âge, au sexe féminin, à l'absence d'assurance-maladie et à la présence de complications cardiovasculaires. Mais en analyse multivariée, seule la présence de complications constitue un facteur de risque indépendant de mauvaise observance (OR = 0,44, IC [0,23 ; 0,87] p < 0,018). Conclusion : L'observance thérapeutique est mauvaise dans notre population d'hypertendus, particulièrement chez ceux qui ont déjà des complications liées à l'HTA. Il importe d'insister sur l'éducation thérapeutique dans les pays africains