Therapeutic Itinerary of Patients with Chronic Heart Failure at the Bafoussam Regional Hospital, West Region, Cameroon

Abstract

Background: Cardiovascular diseases have emerged as a growing public health problem worldwide, with heart failure being the end point of a greater majority of poorly diagnosed and managed heart diseases. In Sub-Saharan Africa, traditional medicine still has a remarkable influence on health care systems, and in Cameroon, the referral/counter-referral system thought to be implemented is not efficiently applied. Heart failure patients fall amongst the group of victims affected by this problem. Many studies have been carried on heart failure in Cameroon, but data on this subject remains sparse. Objective: To identify the therapeutic itinerary adopted by symptomatic patients with chronic heart failure seen at the Bafoussam Regional Hospital (BRH) and determine the outcome following management by cardiologists, so as to provide results-driven interventions to increase the rate of  early management of heart failure by appropriate health services and limit complications due to wrong therapeutic orientations. Methods: A hospital-based cross-sectional descriptive study was carried, from February 2019 to May 2019 at the Bafoussam Regional Hospital. A consecutive sampling technique using objective-related structured questionnaire was used to select patients aged above 18 years seen at the study site.  Data was analyzed using SPSS (Statistical Package for Social Sciences) version 23. A p-value less than 0.05 was considered statistically significant. Results: The BRH Cardiologist consultation was the 1st station sought by 32 (23.7%) of patients. We found 14.8% of cases and 8.9% who had as first therapeutic stations home management and traditional healers respectively. Majority of participants went through a total of 2 stations, 60 (44.4%), and only 5 (3.7%) went through 5 therapeutic stations. Most participants (36.3%), delayed for 1-3 weeks after onset of symptoms before seeking a means of intervention. NYHA (New York Heart Association) stages were generally improved after cardiologists’ follow up (54.1% and 26.7% for stages I and II respectively), compared to that before entry (0.7% stage I, 41.5% stage II, 38.5% stage 3, and 19.3% stage IV), which was statistically significant with P < 0.0005. Conclusion: There is a high proportion of HF patients who do no adopt an ideal therapeutic itinerary following the health pyramid from the onset of symptoms, hence the need to educate the population on cardinal signs of heart failure, especially patients with known risk factors, and to encourage the referral of patients in order to limit complications between the onset of symptoms till cardiologist consultation.