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Prevalence and prognostic implications of anaemia and iron deficiency in Tanzanian patients with heart failure
  1. Abel Makubi1,2,3,
  2. Camilla Hage2,4,
  3. Johnson Lwakatare1,3,
  4. Bruno Mmbando5,6,
  5. Peter Kisenge3,
  6. Lars H Lund2,4,
  7. Lars Rydén2,
  8. Julie Makani1,2,6,7
  1. 1School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  2. 2Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
  3. 3Muhimbili National Hospital, Dar es Salaam, Tanzania
  4. 4Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
  5. 5National Institute of Medical Research, Tanga Centre, Tanzania
  6. 6Muhimbili Wellcome Programme, Dar es Salaam, Tanzania.
  7. 7Nuffield Department of Clinical Medicine, University of Oxford, London, UK
  1. Correspondence to Dr Abel Makubi, Muhimbili University of Health and Allied Sciences, School of Medicine, PO BOX 65001, Dar es Salaam, Tanzania; makubi55{at}


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); p=0.012) and total cholesterol (0.78 (0.63 to 0.98); p=0.029). One-year survival free from a composite endpoint was 70%. The presence of ID anaemia increased the likelihood for an event (HR 2.67; 95% CI 1.39 to 5.07; p=0.003), while anaemia without ID did not influence the risk.

Conclusions ID anaemia was common in Tanzanian patients with HF and was independently associated with the risk for hospitalisation or death.

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