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.
Highlights
Heart failure (HF) is a major public health problem worldwide
Due to the unique genetic variants found in South Africa, patients with Hypertrophic cardiomyopathy (HCM) referred for genetic testing are usually screened for the 3 most common variants before further extensive testing [139]. Such testing is recommended for first-degree relatives of HCM patients who do not have HCM or for patients with atypical presentations [144] but is not widely available in subSaharan Africa (SSA)
While ischemic heart disease is the predominate in highincome countries, the most common etiologies in SSA are distinct with hypertension, valvular heart disease and nonischemic cardiomyopathies being the most commonly reported forms
Summary
Heart failure (HF) is a major public health problem worldwide. The most common underlying cause of HF in high-income countries is coronary artery disease [2]. In subSaharan Africa (SSA), the predominant causes have traditionally been ascribed to rheumatic heart disease, hypertensive heart disease and cardiomyopathy [3-5]. Recent data from the sub-Saharan African Survey of Heart Failure (THESUS-HF) underscore the significant contribution of hypertension [6]. Coronary artery disease was once a rarity on the African continent [7, 8] leading some to posit immunity to coronary atherosclerosis among black Africans well into the 1970s [9, 10]. Newer data confirm the beginnings of an epidemiologic transition to more degenerative forms of HF [11]. Other forms of HF which are not unique to SSA but are commonly found include human immunodeficiency virus (HIV) associated cardiomyopathy, tuberculous pericardial disease, cor pulmonale and peripartum cardiomyopathy among other causes
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