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Death from heart failure (HF) in high-income countries is largely a problem of the very elderly with ischaemic heart disease. For example, in Olmsted County, Minnesota in 1991, the mean age of newly diagnosed heart failure patients was around 75 and almost half were over 80 years old.1 Two-thirds of these people had heart failure from coronary atherosclerosis. Vast resources are available to optimise the outcomes for these individuals. In 2010, the USA, with an estimated heart failure prevalence of 2.8%, spent approximately US$24.7 billion on medical care for this condition, almost US$2900 per heart failure patient, or US$80 per capita.2
In stark contrast, heart failure in sub-Saharan Africa is more often a cause of death and suffering among the young due to a more varied set of conditions, of which coronary artery disease is still a very minor contributor. Although the resources applied to address these problems have not been quantified, according to the World Bank, the average per person expenditure on all healthcare in sub-Saharan Africa in 2012 (including middle-income countries) was US$95.3 Accordingly, the amount spent on all healthcare per person in this region was almost the same as the amount spent on heart failure alone in the USA.
Makubi et al4 report on the aetiology, treatment and 6-month outcomes of patients diagnosed with heart failure at Muhimbili National Hospital in Dar es Salaam, Tanzania, between 2012 and 2013. The authors’ findings are striking and consistent with dozens of reports from African referral hospitals since the 1950s: the main aetiologies of heart failure are hypertensive heart disease, cardiomyopathies and rheumatic heart disease (RHD). These findings, as well as the mean patient age of 55 years, are also consistent with a recent continental registry of new heart failure diagnoses …
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