Heart Failure in Sub-Saharan Africa

Abstract

The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs.

Prevalence and Aetiology of Heart Failure in Patients Seen at a Teaching Hospital in Ghana

“…In other parts of sub-Saharan Africa, heart failure has been found to account to 5% to 10% of hospital admissions [16,17,22,23]. Some authors have also shown that heart failure is a major cause of cardiovascular disorder in Africa [24,25]. Heart failure is a major clinical problem worldwide.…”

Clinical Pattern and Outcome of Acute Heart Failure at the Yaounde Central Hospital

“…Heart failure (HF) is a major public health problem worldwide [1]. It is more of a syndrome than a primary diagnosis, with several potential etiologies, various presentations and clinical subtypes.…”

“…The prevalence of AHF in sub-Saharan Africa continues to increase due to the aging of the population and the presence of hypertension [1]. In Cameroon, there is no national AHF register, but only a few studies on HF are conducted in selected hospitals [3] [4].…”

Pattern and Outcome of Congestive Heart Failure in the Intensive Care Unit of the Yaoundé University Teaching Hospital: A Cross-Sectional Study

“…Congestive heart failure (CHF) represents a major public health problem in sub-Saharan Africa [1] [2]. Although there is a lack of national level data on disease trends in these countries, several hospital based studies have shown that CHF has a hospital prevalence in internal medicine services of at least 30% [3] [4] [5].…”