Heart failure is a significant public health issue in high income countries and recent evidence suggests that its burden on health services in low and middle-income countries (LMICs) is substantial.1 Heart failure in LMICs is commonly caused by communicable and non-communicable disease, which makes the design and implementation of appropriate responses to this common condition even more challenging than in high income countries. However, data remain sparse, particularly with regards to different heart failure phenotypes and their outcomes in LMICs.

Makubi and colleagues2 report on a cohort of 401 consecutive patients with heart failure recruited from outpatient clinics (70%) and inpatient settings at a national referral centre in Dar es Salaam, Tanzania. Although their main objective is to describe the association between anaemia and iron deficiency with future risk of death and hospitalisation, the descriptive aspect of their analyses itself offers several insights into the pattern of heart failure in Tanzania and reveal several important research questions.

The first striking findings are the age distribution and the very high prevalence of anaemia. The median age of patients was 56 years (IQR 41–67 years) which is almost two decades younger than patients tend to present in high-income countries. The …