Burden of cognitive impairment and its associated factors among patients with rheumatic heart disease at a tertiary cardiac center in Tanzania: A hospital-based cross-sectional study.

BACKGROUND

Globally, rheumatic heart disease (RHD) affects 30-70 million people, with 90% in developing nations. In Tanzania, the RHD burden is 1%-3%. Patients with RHD show neuropsychiatric manifestations such as cognitive impairment (CI), which affects quality of life, but research in Tanzania is lacking. This study aimed to fill this gap.

OBJECTIVE

This study aimed to determine the burden of CI and its associated factors among patients with RHD at the Jakaya Kikwete Cardiac Institute (JKCI), Dar es Salaam, Tanzania.

METHODS

We conducted a hospital-based cross-sectional study at JKCI from November 2023 to February 2024. A sample of 216 patients with RHD 14 years or older provided informed consent or assent. Excluding those with preexisting mental illness, recruitment used consecutive sampling. A questionnaire collected sociodemographic and clinical data. The General Practitioner Assessment of Cognition tool assessed cognitive impairment. Data analysis used STATA version 15.1 (StataCorp LLC, College Station, TX). Ethical approval was obtained from the Muhimbili University of Health and Allied Sciences and the JKCI Research and Ethics Committee.

RESULTS

A total of 216 patients diagnosed with RHD were studied. The median age (interquartile range) was 27 (16.0-45.5) years, with a female predominance (51.4%, n = 111). More than half had attained a secondary level of education (56.9%, n = 123) and were insured (58.8%, n = 127), while less than half were employed (40.7%, n = 88). Regarding substance use, less than a quarter were cigarette smokers (5.6%, n = 12) and over a quarter were alcohol drinkers (28.2%, n = 61). The prevalence of cognitive impairment was 20.4% (n = 44). Old age (adjusted prevalence ratio [aPR] 1.04; 95% confidence interval 1.02-1.05; P < .0001), positive human immunodeficiency virus status (aPR 5.00; 95% confidence interval 1.85-13.53; P = .02), undernutrition (aPR 2.44; 95% confidence interval 1.39-4.29; P < .002), history of atrial fibrillation (aPR 3.16; 95% confidence interval 1.08-9.30; P = .036), and history of stroke (aPR 2.58; 95% confidence interval 1.43-4.68; P = .002) were independently associated with cognitive impairment.

CONCLUSION

Screening of all patients with RHD for cognitive impairment is recommended, particularly those with atrial fibrillation, human immunodeficiency virus, advanced age, undernutrition, and a history of stroke.