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

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.

Figure 1

Flow chart of patients recruited into the Tanzania Heart Failure study.

Figure 2

Causes of heart failure in percentages within age groups. Dark blue=ischemic heart disease; red=hypertensive heart disease; green=cardiomyopathies; lilac=rheumatic heart disease; light blue=other reasons.

Figure 3

(A–D). Kaplan–Meier survival curves by different subgroups. (A) In the total cohort; (B) by the presence of anaemia; (C) by the presence of atrial fibrillation (AF); (D) in relation to educational level.

Figure 4

Multivariate HRs for all-cause mortality. BMI, body mass index; CV, cardiovascular; MAP, mean arterial pressure; NYHA, New York Heart Association functional classification.