Congestive Heart Failure among the Libyan Population (North Africa); A Community Based Survey of Risk Factors and Complication

Congestive Heart failure (CHF) is a very common medical disorder and a major health problem in Libya. CHF is associated with an increase in the risk of stroke and hospitalization.

Objectives: To estimate and describe the main risk factors and complications of CHF among people with a particular interest in Libyan community.

Methodology: This project is classified as a community based descriptive cross-sectional study using the CHADS2 questionnaire as well as the local Libyan classification called the Community Stroke Risk Classification (CSRC).

Area; North Africa (North of Libya, the capital Tripoli).

Time; five years from 2010-2014

Population: Convenient sampling was done from a large cohort of individuals living in the Libyan community. 7497 individuals were screened for risk factors of stroke. CHF was one such factor which was studied in detail among the sample population and was diagnosed by taking detailed histories (including treatment), medical examinations and previous hospital confirmations.

Results: The prevalence of CHF among our participants (7497 individuals) was 15.2% (1139 patients) among the sample population as a total with males and females being 51.2% and 48.8% respectively (P=0.87). Among different age groups, females had higher rates than the males except for age interval from 60 to 79 where males had higher rates. The male to female ratio among the total population screened for CHF was 7.8%: 7.4% (583:556 respectively with males being higher).

CHF prevalence increased with the progress of age, with higher rates among age groups of over 40 (P <0.0001).

68.3% of CHF patients had hypertension (778 patients), 54.3% had DM (618 patients), 38.7% had transient ischemic attach (TIA) (441 patients), 27.2% had atrial fibrillation (AF) (310 patients), 25.9% had prior stroke (PS) (295 patients), All of these risk factors accompanying CHF increased with age (P<0.0001).

99.92% of CHF patients had risk points of stroke in CHADS2 scores (0.08% had no risk points), from whom 27.1% had intermediate scores (1-2 Risk Points) and 72.9% had high scores (≥3 risk points) (P<0.0001).

Results of the CSRC scores showed that 99.91% had risk factors of stroke (0.09% had no risk factors), from whom 29.5% had intermediate scores (1-2 Risk Factors) and 70.5% had high scores (≥3 risk factors) (P<0.0001).

Conclusion: CHF is a major risk factor of stroke among the Libyan population in North Africa of whom had very high CHADS2 risk scores. These scores are defined as a combination of six different risk points; 0 points being low risk, 1-2 being intermediate, and a score of 3 or more risk points is defined as being high risk. CHF appeared to dominate the high scores (≥3 risk points). Almost all CHF patients had risk factors of stroke on the CSRC scoring system of whom expressed intermediate and high scores with a significant proportion of high scores (≥3 risk factors of stroke). Hypertension, DM, AF and being aged of over 40 years were very important risk factors contributing to CHF. Both genders of male and female had similar chances of developing CHF in the Libyan community. CHADS2 & CSRC classification scores are very useful and simple tools to be used to classify and describe the risk factors of stroke in populations living within a community.