Time to first cardiovascular hospitalization after guideline-based treatment optimization: A multicenter retrospective cohort study in northwest Ethiopia

Abstract

Background: Cardiovascular hospitalization is a leading cause of morbidity and mortality, especially in low-resource settings. Evidence on predictors in Ethiopia is limited, hindering targeted interventions. Objective: To assess the incidence and predictors of first cardiovascular hospitalization within one year of treatment optimization in Northwest Ethiopia. Methods: A retrospective cohort study was conducted at three tertiary hospitals. Baseline demographic, clinical, and treatment data were extracted from medical records of patients receiving optimized cardiovascular therapy. Multivariate Cox proportional hazards regression with robust standard errors identified independent predictors of first hospitalization. Results: Among 470 patients, 218 (46.4%) were hospitalized within 12 months; median time to first admission was 100 days (IQR 55-160). Independent predictors of shorter hospitalization-free survival included partial or no guideline-directed medical therapy (HR 1.71, 95% CI: 1.30-2.25), Charlson Comorbidity Index ≥3 (HR 1.62, 95% CI: 1.25-2.10), heart failure with reduced ejection fraction (HR 1.46, 95% CI: 1.10-1.94), chronic kidney disease (HR 1.41, 95% CI: 1.02-1.95), current smoking (HR 1.40, 95% CI: 1.01-1.95), low physical activity (HR 1.35, 95% CI: 1.03-1.77), age ≥65 years (HR 1.36, 95% CI: 1.05-1.76), and absence of a scheduled follow-up plan (HR 1.60, 95% CI: 1.18-2.16). Conclusions: Nearly half of patients experienced hospitalization within one year, mostly within 3-4 months. Ensuring guideline-directed therapy, structured follow-up, and addressing modifiable risk factors may reduce early cardiovascular admissions in low-resource settings.