Contemporary aetiology, clinical characteristics and prognosis of adults with heart failure observed in a tertiary hospital in Tanzania: the prospective Tanzania Heart Failure (TaHeF) study

Abstract

Objective This study aimed to describe the contemporary aetiology, clinical characteristics and mortality and its predictors in heart failure (HF) in Tanzania. Methods Design; Prospective observational study. Setting; Cardiovascular Center of the Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients ≥18 years of age with HF defined by the Framingham criteria. Main outcome measure All-cause mortality. Results Among 427 included patients, 217 (51%) were females and the mean (SD) age was 55 (17) years. HF aetiologies included hypertension (45%), cardiomyopathy (28%), rheumatic heart disease (RHD) (12%) and ischaemic heart disease (9%). Concurrent atrial fibrillation (AF), clinically significant anaemia, diabetes, tuberculosis and HIV were found in 16%, 12%, 12%, 3% and 2%, respectively, while warfarin was used in 3% of the patients. The mortality rate, 22.4 per 100 person-years over a median follow-up of 7 months, was independently associated with AF, HR 3.4 (95% CI 1.6 to 7.0); in-patient 3.2 (1.5 to 6.8); anaemia 2.3 (1.2 to 4.5); pulmonary hypertension 2.1 (1.1 to 4.2) creatinine clearance 0.98 (0.97 to 1.00) and lack of education 2.3 (1.3 to 4.2). Conclusions In HF in Tanzania, patients are younger than in the developed world, but aetiologies are becoming more similar, with hypertension becoming more and RHD less important. Predictors of mortality possible to intervene against are anaemia, AF and lack of education.

Global Public Health Burden of Heart Failure

“…4,18 In South America the HF prevalence is 1 % and in Australia it ranges between 1 % and 2 %, similar to Western countries (see Figure 2). 19,20 Although aetiologies and clinical characteristics have been studied in Sub-Saharan Africa, 21 there are actually no population studies providing insight into prevalence or incidence . are considered (see Figure 3).…”

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

“…A recent study in patients with heart failure from Tanzania (Tanzania Heart Failure (TaHeF) showed a prevalence of iron deficiency in heart failure at the upper end of these estimates and highlights the high prevalence of iron deficiency in non-anaemic patients (Makubi et al, 2014). The study comprised 427 adults with heart failure defined by the Framingham criteria of McKee et al (1971).…”

“…idiopathic dilated cardiomyopathy, peri-partum cardiomyopathy and endomyocardial fibrosis) (Damasceno et al, 2012;Makubi et al, 2014) Nevertheless, ischaemic heart disease is increasingly recognised as a cause of heart failure, particularly in older age groups and in higher income groups and higher income countries, for example, affluent groups in Nigeria, Kenya and South Africa (Damasceno et al, 2012).…”

Almanac 2015: atrial fibrillation research in Heart

“…A study in Tanzania showed that AF attributed to at least 16% cases of clinical heart failure presenting to tertiary-care hospital. 41 This is an interesting finding if compared with the EPOCH (Epidemiology, Practice, Outcomes, and Costs of Heart Failure) study conducted in the USA in 2004 that compared epidemiological characteristics of hospitalised patients with heart failure and association of various comorbidities with different ethnicities, which showed AF was prevalent in 19.7% of African-Americans with heart failure as compared with 38.3% in Caucasian patients with heart failure. 42 The report illustrates the global impact of AF and heart failure.…”