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Contemporary aetiology, clinical characteristics and prognosis of adults with heart failure observed in a tertiary hospital in Tanzania: the prospective Tanzania Heart Failure (TaHeF) study
  1. Abel Makubi1,2,
  2. Camilla Hage1,3,
  3. Johnson Lwakatare2,4,
  4. Peter Kisenge4,
  5. Julie Makani2,5,
  6. Lars Rydén1,
  7. Lars H Lund1,3
  1. 1Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden
  2. 2School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  3. 3Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
  4. 4Cardiovascular Center, Muhimbili National Hospital, Dar es Salaam, Tanzania
  5. 5Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  1. Correspondence to
    Dr Abel Makubi, Cardiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden; makubi55{at}gmail.com

Abstract

Objective This study aimed to describe the contemporary aetiology, clinical characteristics and mortality and its predictors in heart failure (HF) in Tanzania.

Methods Design; Prospective observational study. Setting; Cardiovascular Center of the Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients ≥18 years of age with HF defined by the Framingham criteria.

Main outcome measure All-cause mortality.

Results Among 427 included patients, 217 (51%) were females and the mean (SD) age was 55 (17) years. HF aetiologies included hypertension (45%), cardiomyopathy (28%), rheumatic heart disease (RHD) (12%) and ischaemic heart disease (9%). Concurrent atrial fibrillation (AF), clinically significant anaemia, diabetes, tuberculosis and HIV were found in 16%, 12%, 12%, 3% and 2%, respectively, while warfarin was used in 3% of the patients. The mortality rate, 22.4 per 100 person-years over a median follow-up of 7 months, was independently associated with AF, HR 3.4 (95% CI 1.6 to 7.0); in-patient 3.2 (1.5 to 6.8); anaemia 2.3 (1.2 to 4.5); pulmonary hypertension 2.1 (1.1 to 4.2) creatinine clearance 0.98 (0.97 to 1.00) and lack of education 2.3 (1.3 to 4.2).

Conclusions In HF in Tanzania, patients are younger than in the developed world, but aetiologies are becoming more similar, with hypertension becoming more and RHD less important. Predictors of mortality possible to intervene against are anaemia, AF and lack of education.

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