Abstract
Background:A wide knowledge gap exists on the clinical profiles and outcomes of heart failure (HF) in sub-Saharan Africa.Objectives:To determine the clinical profiles and outcomes of HF patients from five African countries.Methods:The INTERnational Congestive Heart Failure Study (INTER-CHF) is a prospective, multicenter cohort study. A total of 1,294 HF patients were consecutively recruited from Nigeria (383 patients), South Africa (169 patients), Sudan (501 patients), Uganda (151patients), and Mozambique (90 patients). HF was defined according to the Boston criteria for diagnosis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) score.Results:Of the 1294 patients, 51.4% were recruited as out-patients, 53.7% had HF with reduced ejection fraction (EF), 30.1% had HF with mid-range EF and 16.2% had HF with preserved EF (16.2%). The commonest etiologies of HF were hypertensive heart disease (35%) and ischemic heart disease (20%). The mean MoCA score was highest in Uganda (24.3 ± 1.1) and lowest in Sudan (13.6 ± 0.3). Prescriptions for guideline-recommended HF therapies were poor; only 1.2% of South African patients received an Implantable Cardioverter Defibrillator, and none of the patients received Cardiac Resynchronised Therapy. The composite outcome of death or HF hospitalization at one year among the patients was highest in Sudan (59.7%) and lowest in Mozambique (21.1%). Six variables were associated with higher mortality risk, while digoxin use (adjusted hazard ratio [aHR]: 0.69; 95% confidence interval [CI]: 0.49–0.97; p = 0.034) and 10mmHg unit increase in systolic blood pressure (aHR 0.86; 95%CI 0.81–0.93; p < 0.001) were associated with lower risk for mortality.Conclusions:This is the largest HF study in Africa that included in- and out-patients from the West, East, North, Central and South African sub-regions. Clinically relevant differences, including cognitive functional impairment, were found between the involved countries.
Highlights
Heart failure (HF) is a major health problem affecting about 64.3 million persons globally, with an epidemiology that varies widely within and between countries [1]
In the African cohort, 51.9% were males, 48.6% were recruited during a heart failure (HF) hospitalization, 42.9% were illiterate, 66.9% had no health insurance, 29.6% were recruited from Nigeria, 13.1% from South Africa, 38.7% from Sudan, 11.7% from Uganda, and 7.0% from Mozambique
We described the clinical profiles and outcomes of 1294 chronic and acutely decompensated HF patients recruited from Nigeria, Sudan, Mozambique, Uganda and South Africa in the INTER-CHF study
Summary
Heart failure (HF) is a major health problem affecting about 64.3 million persons globally, with an epidemiology that varies widely within and between countries [1]. It was the first major study to systematically acquire data on in- and out-patients with HF in these regions, which were hitherto under-represented in previous global HF studies It revealed that mortality rate was highest in Africa (34%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%), and the regional differences persisted after multivariable adjustment [4]. Prior to the INTER-CHF study, investigators of The Sub-Saharan Africa Survey of Heart Failure (THESUS–HF) had commendably reported on the morbidity and mortality of 1006 acute HF patients from ten African countries, but 42.7% of the patients were recruited from Nigeria alone and the follow-up period was relatively short (180 days) [5]. Relevant differences, including cognitive functional impairment, were found between the involved countries
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
