Heart failure, post-hospital mortality and renal function in Tanzania: A prospective cohort study

Abstract

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.

Data on the epidemiology of heart failure in Sub-Saharan Africa

“…All discrepancies the selection of studies were resolved through discussion or with the arbitrage of a third investigator. A total of 35 studies were included in this review [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] . A summary of the selection process is presented in the Fig.…”

Heart Failure in Sub-Saharan Africa

“…It is commoner between the third and fifth decade of life when the individuals are in the prime of their life. The mean age ranges from 36.5 to 61.5 years (Figure 2A) [15,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. In high-income countries, it is commoner in the seventh decade of life.…”

“…The reported in-hospital mortality is in the range of 3.8-25.2% (see Figure 5) [18,20,24,27,29,30,233]. Table 2.…”

Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa

“…878 titles and abstracts were screened; nine papers provided relevant information on etiologies of cardiac failure in SSA [20][21][22][23][24][25][26][27][28], nine additional papers were identified by reviewing references [18,[29][30][31][32][33][34][35][36].…”