Damasceno Albertino, Mayosi Bongani M, Sani Mahmoud, Ogah Okechukwu S, Mondo Charles, Ojji Dike, Dzudie Anastase, Kouam Charles Kouam, Suliman Ahmed, Schrueder Neshaad, Yonga Gerald, Ba Serigne Abdou, Maru Fikru, Alemayehu Bekele, Edwards Christopher, Davison Beth A, Cotter Gad, Sliwa Karen
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique, South Africa.
Arch Intern Med. 2012 Oct 8;172(18):1386-94. doi: 10.1001/archinternmed.2012.3310.
Acute heart failure (AHF) in sub-Saharan Africa has not been well characterized. Therefore, we sought to describe the characteristics, treatment, and outcomes of patients admitted with AHF in sub-Saharan Africa.
The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF) was a prospective, multicenter, observational survey of patients with AHF admitted to 12 university hospitals in 9 countries. Among patients presenting with AHF, we determined the causes, treatment, and outcomes during 6 months of follow-up.
From July 1, 2007, to June 30, 2010, we enrolled 1006 patients presenting with AHF. Mean (SD) age was 52.3 (18.3) years, 511 (50.8%) were women, and the predominant race was black African (984 of 999 [98.5%]). Mean (SD) left ventricular ejection fraction was 39.5% (16.5%). Heart failure was most commonly due to hypertension (n = 453 [45.4%]) and rheumatic heart disease (n = 143 [14.3%]). Ischemic heart disease (n = 77 [7.7%]) was not a common cause of AHF. Concurrent renal dysfunction (estimated glomerular filtration rate, <30 mL/min/173 m(2)), diabetes mellitus, anemia (hemoglobin level, <10 g/dL), and atrial fibrillation were found in 73 (7.7%), 114 (11.4%), 147 (15.2%), and 184 cases (18.3%), respectively; 65 of 500 patients undergoing testing (13.0%) were seropositive for the human immunodeficiency virus. The median hospital stay was 7 days (interquartile range, 5-10), with an in-hospital mortality of 4.2%. Estimated 180-day mortality was 17.8% (95% CI, 15.4%-20.6%). Most patients were treated with renin-angiotensin system blockers but not β-blockers at discharge. Hydralazine hydrochloride and nitrates were rarely used.
In African patients, AHF has a predominantly nonischemic cause, most commonly hypertension. The condition occurs in middle-aged adults, equally in men and women, and is associated with high mortality. The outcome is similar to that observed in non-African AHF registries, suggesting that AHF has a dire prognosis globally, regardless of the cause.
撒哈拉以南非洲地区的急性心力衰竭（AHF）尚未得到充分描述。因此，我们试图描述撒哈拉以南非洲地区因AHF入院患者的特征、治疗及预后情况。
撒哈拉以南非洲心力衰竭调查（THESUS-HF）是一项对9个国家12所大学医院收治的AHF患者进行的前瞻性、多中心观察性调查。在出现AHF的患者中，我们确定了随访6个月期间的病因、治疗及预后情况。
从2007年7月1日至2010年6月30日，我们纳入了1006例出现AHF的患者。平均（标准差）年龄为52.3（18.3）岁，511例（50.8%）为女性，主要种族为非洲黑人（999例中的984例[98.5%]）。平均（标准差）左心室射血分数为39.5%（16.5%）。心力衰竭最常见的病因是高血压（n = 453例[45.4%]）和风湿性心脏病（n = 143例[14.3%]）。缺血性心脏病（n = 77例[7.7%]）并非AHF的常见病因。分别有73例（7.7%）、114例（11.4%）、147例（15.2%）和184例（18.3%）患者存在并发肾功能不全（估计肾小球滤过率<30 mL/min/173 m²）、糖尿病、贫血（血红蛋白水平<10 g/dL）和心房颤动；500例接受检测的患者中有65例（13.0%）人类免疫缺陷病毒血清学呈阳性。中位住院时间为7天（四分位间距，5 - 10天），院内死亡率为4.2%。估计180天死亡率为17.8%（95%可信区间，15.4% - 20.6%）。大多数患者出院时接受肾素 - 血管紧张素系统阻滞剂治疗，但未接受β受体阻滞剂治疗。很少使用盐酸肼屈嗪和硝酸盐类药物。
在非洲患者中，AHF主要由非缺血性病因引起，最常见的是高血压。该疾病发生于中年成年人，男女发病率相同，且死亡率较高。其预后与非非洲AHF登记处观察到的情况相似，这表明无论病因如何，AHF在全球范围内预后都很严峻。
