Joint Modeling of Longitudinal Pulse Rate and Time-to-Default from Treatment of Congestive Heart Failure Patients

Background. Heart failure is a progressive condition marked by worsening symptoms such as shortness of breath, coughing, exhaustion and lethargy, fluid retention with swelling of the legs and abdomen, and a reduced ability to exercise. As a result, this study aims to use a joint model application to determine the joint risk factors of longitudinal change in pulse rate and time to death of congestive heart failure patients and their association admitted to a hospital. Methods. A retrospective study was undertaken on congestive heart failure patients admitted to the Debre Tabor Referral Hospital from January 2016 to December 2019. A statistical joint modeling strategy was employed to match the repeated biomarker pulse rate and a survival outcome at the same time. A total of 271 patients with congestive heart failure were chosen. Data were analyzed with R statistical software via joineRML. Results. According to the findings, the association between longitudinal changes in pulse rate and time to death in heart failure patients is statistically significant. Sex, residence, left ventricular injection fraction, New York Heart Association class, and diabetes mellitus were all found to be significant risk factors for congestive heart failure patients’ short survival time to death. Age, sex, residence, hypertension, left ventricular injection fraction, congestive heart failure, diabetes mellitus, tuberculosis, and etiology were all significant contributors in pulse rate progression. Conclusion. The computed association parameters revealed subject-specific values. The subject-specific linear time slope of PR measurement was positively related to the hazard rate of time to death of CHF patients in the study area. To reduce the risk level of CHF, health professionals, governmental organizations, and nongovernmental organizations must promote and allocate a suitable amount of budget for the treatment of CHF patients.

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Determinants of Pulse Rate change and Time-To Default from Treatment among Congestive Heart Failure Patients in Felege- Hiwot Referral Hospital, Bahir Dar, Ethiopia; comparison of separate and joint models

10.21203/rs.3.rs-228538/v1 ◽

2021 ◽

Author(s):

Yikeber Abebaw Moyehodie ◽

Kasim Mohammed Yesuf ◽

Adem Aragaw Sied ◽

Bezanesh Melese Masresha

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Pulse Rate ◽

Nyha Class ◽

Referral Hospital ◽

Bahir Dar ◽

Joint Models ◽

Heart Failure Patients ◽

Felege Hiwot Referral Hospital

Abstract Background: Globally, heart failure is a rapidly growing public health issue with an estimated prevalence of >37.7 million individuals. It is a shared chronic phase of cardiac functional impairment secondary to many etiologies. The main purpose of this study was to identify factors that affect the longitudinal changes of pulse rate and survival endpoints, time-to default among Congestive Heart Failure Patients in Felege- Hiwot Referral Hospital, Bahir Dar, Ethiopia.Methods: Hospital based retrospective studies were conducted among 302 congestive heart failure patients who were 15 years old or older and who were on treatment follow-up from the first February 2016 to thirty-one December 2018 in Felege-Hiwot Referral Hospital, Bahir Dar, Ethiopia. First, data were analyzed using linear mixed model and survival models separately, and then the joint models of both sub-models were analyzed by linked their shared unobserved random effects using a shared parameter model. Results: Out of the total 302 CHF treatment followers, 103 (34.1%) of the patients were defaulting from treatment. The mean pulse rate of female and male patients was 87.25 and 90.20, respectively. Averagely 51.12 % of blood in the left ventricle is pushed out with each heartbeat. The results for separate and joint models were quite similar to each other but not identical. However, the estimated association parameter (α) in the joint model is (HR=1.0311, 95%CI: 1.0033,1.0597, P=0.0278), providing there is evidence of a positive association between the survival and the longitudinal sub-models. Thus, defaulting is more likely to occur in patients with higher pulse rates. Patients, being male, hypertensive, CKD, pneumonic, and NYHA class IV patients were associated with a higher risk of defaulting. Age, LVIF, follow-up time in a month had a negative significant effect and NYHA class, and male gender had a positive significant effect on average evaluation of pulse rate of patients. Conclusions: The patient who are male, NYHA class IV, had low LVIF and comorbid with hypertensive, CKD, pneumonia were risk factors of pulse rate change and defaulting from treatment of CHF patients. The joint model was preferred for simultaneous analyses of repeated measurement and survival data.

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