Prevalence and prognostic implications of anaemia and iron deficiency in Tanzanian patients with heart failure

Abstract

Objective-To determine the prevalence, correlates and prognostic implications of anaemia and iron deficiency (ID) in patients with heart failure (HF) in Tanzania.Method-This was a cross-sectional and prospective observational study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were ≥18 years of age, with HF defined according to the Framingham criteria. The primary outcome was anaemia and the secondary outcome was a composite of hospitalisation for HF or all-cause mortality.Results-A total of 401 HF patients (median age 56 years, IQR 41-67 years; women 51%) were included. The prevalence of anaemia was 57%. The overall prevalence of ID was 49% distributed as 69% versus 21% in subjects with and without anaemia (p<0.001). Normocytic anaemia was seen in 18% of the patients while none had macrocytic anaemia. The risk of having anaemia was positively associated with residency outside Dar es Salaam (OR 1.72 (95% CI 1.02 to 2.89); p=0.038), atrial fibrillation (4.12 (1.60 to 10.61); p=0.003), LVEF <45% (2.70 (1.57 to 4.67); p<0.001) and negatively (ORs per unit decrease) with creatinine clearance (0.98 (0.97 to 0.99);Correspondence to: Dr Abel Makubi, Muhimbili University of Health and Allied, Sciences, School of Medicine, PO BOX 65001, Dar es Salaam, Tanzania; makubi55@gmail.com. Contributors All authors have made significant contributions to the design, execution, analysis and writing of this study and will share responsibility for the published material. Competing interests None. Ethics approval TaHeF was approved by the ethical review board of the Muhimbili University of Health and Allied Sciences (MUHAS). All patients provided written informed consent.Provenance and peer review Not commissioned; externally peer reviewed. Data sharing statementPatient-level data, full data set and statistical codes are available from the corresponding author. Informed consent for data sharing was not obtained, but the presented data are anonymised and risk of identification is low. Conclusions-ID anaemia was common in Tanzanian patients with HF and was independently associated with the risk for hospitalisation or death. Europe PMC Funders Group

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

“…The prevalence of anaemia was 57% and iron deficiency was seen in 69% of anaemic subjects and in 21% of those without anaemia (Makubi et al, 2015). Overall, 49% of the cohort was iron deficient, which emphasises the need for detailed assessment of iron status in those presenting with heart failure.…”

Heart failure and iron deficiency anaemia: a complex dance

“…In this cohort, 9% of patients had ischaemic heart failure, 35% had heart failure secondary to cardiomyopathies, 44% to hypertension and 12% to rheumatic heart failure 2. From this we know that at least 53% of patients had a non-communicable disease as the underlying determinant of their heart failure.…”

“…Makubi and colleagues2 report on a cohort of 401 consecutive patients with heart failure recruited from outpatient clinics (70%) and inpatient settings at a national referral centre in Dar es Salaam, Tanzania. Although their main objective is to describe the association between anaemia and iron deficiency with future risk of death and hospitalisation, the descriptive aspect of their analyses itself offers several insights into the pattern of heart failure in Tanzania and reveal several important research questions.…”

Bi treatment with hydralazine/nitrates vs. placebo in Africans admitted with acute HEart Failure (BA‐HEF)

“…Acute heart failure (AHF) is one of the most common reasons for admission to hospital and a major driver for health‐related costs worldwide. A number of recent studies from Soweto, South Africa; Abeokuta, Nigeria; Abuja, Nigeria; and Dar‐es‐Salaam, Tanzania have shown the prevalence to be high, with a 6‐month mortality >15%, despite the population being two decades younger than those in studies of higher income regions …”