Objective To determine one-year, post-hospital mortality and the predictors of mortality in Tanzanian adults with heart failure (HF) compared to other admitted adults. Methods In this prospective cohort study we consecutively enrolled medical inpatients admitted during a 3-month period, screened for HF and followed until 12 months after hospital discharge. Standardized history, physical examination, echocardiography and laboratory investigations were obtained during hospital presentation. The primary outcome was one-year post-discharge mortality. The secondary outcome was in-hospital mortality. Cox regression adjusted for age and sex was used. Results During the study period, we enrolled 558 adults; 145 had HF and 107 of these survived until discharge. Patients with HF had a higher one-year post-hospital discharge mortality than all other diagnoses (62/107 (57.9%) vs 150/343 (43.7%), respectively, HR=1.57[1.13–2.18]). In-hospital mortality was similar. Markers of renal disease were more common in adults with HF (40/107 (37.4%) and were the strongest independent predictors of post-hospital mortality: low eGFR (HR=2.94[1.62–5.31]) and proteinuria (HR=2.03, [95%CI 1.13–3.66]). No patients discharged with the combination of low eGFR/proteinuria survived to the one-year endpoint. Of note, 79/145 (54.5%) of adults admitted with HF were newly diagnosed during hospital admission. Conclusions Over half of adults discharged with HF died within 12 months after discharge. Adults with HF had higher post-hospital mortality compared to other medical inpatients. Markers of renal disease were the strongest predictor of this mortality. Innovative interventions are needed to reduce post-hospital mortality in adults with HF and should focus on those with renal disease.

Introduction Little is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, post-hospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality. Methods In this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at one, three, six, and 12 months to determine outcomes. Predictors of in-hospital and post-hospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital. Results We enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIV-infected adults died in-hospital vs. 104/494 (21.1%) of the HIV-uninfected. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Post-hospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected (adjusted p=0.006). The 66/105 (62.9%) of HIV-infected who attended clinic within one month after discharge had significantly lower mortality than other HIV-infected adults (adjusted hazards ratio = 0.17 [0.07–0.39], p<0.001). Adults admitted to a nearby government hospital had similarly high rates of post-hospital mortality. Conclusions Post-hospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The post-hospital period may offer a window of opportunity to improve survival in this population. Interventions are urgently needed and should focus on increasing post-hospital linkage to primary HIV care.

Introduction-Little is known about outcomes after hospitalization for HIV-infected adults in sub-Saharan Africa. We determined 12-month, post-hospital mortality rates in HIV-infected vs. uninfected adults and predictors of mortality.Methods-In this prospective cohort study, we enrolled adults admitted to the medical wards of a public hospital in northwestern Tanzania. We conducted standardized questionnaires, physical examinations, and basic laboratory analyses including HIV testing. Participants or proxies were called at one, three, six, and 12 months to determine outcomes. Predictors of in-hospital and posthospital mortality were determined using logistic regression. Cox regression models were used to analyze mortality incidence and associated factors. To confirm our findings, we studied adults admitted to another government hospital.Results-We enrolled 637 consecutive adult medical inpatients: 38/143 (26.6%) of the HIVinfected adults died in-hospital vs. 104/494 (21.1%) of the HIV-uninfected. Twelve-month outcomes were determined for 98/105 (93.3%) vs. 352/390 (90.3%) discharged adults, respectively. Post-hospital mortality was 53/105 (50.5%) for HIV-infected adults vs. 126/390 (32.3%) for HIV-uninfected (adjusted p=0.006). The 66/105 (62.9%) of HIV-infected who attended clinic within one month after discharge had significantly lower mortality than other HIVinfected adults (adjusted hazards ratio = 0.17 [0.07-0.39], p<0.001). Adults admitted to a nearby government hospital had similarly high rates of post-hospital mortality.Conclusions-Post-hospital mortality is disturbingly high among HIV-infected adult inpatients in Tanzania. The post-hospital period may offer a window of opportunity to improve survival in