Department of Medicine, Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Eur Heart J. 2013 Oct;34(40):3151-9. doi: 10.1093/eurheartj/eht393. Epub 2013 Sep 18.
Contrary to elderly patients with ischaemic-related acute heart failure (AHF) typically enrolled in North American and European registries, patients enrolled in the sub-Saharan Africa Survey of Heart Failure (THESUS-HF) were middle-aged with AHF due primarily to non-ischaemic causes. We sought to describe factors prognostic of re-admission and death in this developing population.
Prognostic models were developed from data collected on 1006 patients enrolled in THESUS-HF, a prospective registry of AHF patients in 12 hospitals in nine sub-Saharan African countries, mostly in Nigeria, Uganda, and South Africa. The main predictors of 60-day re-admission or death in a model excluding the geographic region were a history of malignancy and severe lung disease, admission systolic blood pressure, heart rate and signs of congestion (rales), kidney function (BUN), and echocardiographic ejection fraction. In a model including region, the Southern region had a higher risk. Age and admission sodium levels were not prognostic. Predictors of 180-day mortality included malignancy, severe lung disease, smoking history, systolic blood pressure, heart rate, and symptoms and signs of congestion (orthopnoea, peripheral oedema and rales) at admission, kidney dysfunction (BUN), anaemia, and HIV positivity. Discrimination was low for all models, similar to models for European and North American patients, suggesting that the main factors contributing to adverse outcomes are still unknown.
Despite the differences in age and disease characteristics, the main predictors for 6 months mortality and combined 60 days re-admission and death are largely similar in sub-Saharan Africa as in the rest of the world, with some exceptions such as the association of the HIV status with mortality.
与通常纳入北美和欧洲注册中心的老年缺血相关急性心力衰竭（AHF）患者不同，纳入撒哈拉以南非洲心力衰竭调查（THESUS-HF）的患者为中年，AHF 主要由非缺血性原因引起。我们旨在描述该发展中人群再入院和死亡的预后因素。
从 THESUS-HF 中收集的数据中建立了预后模型，THESUS-HF 是一项在撒哈拉以南非洲 9 个国家的 12 家医院中纳入 AHF 患者的前瞻性注册研究，主要在尼日利亚、乌干达和南非。排除地理区域后，预测模型中 60 天再入院或死亡的主要预测因素是恶性肿瘤和严重肺部疾病史、入院时收缩压、心率和充血体征（啰音）、肾功能（BUN）和超声心动图射血分数。在包括区域的模型中，南部地区风险更高。年龄和入院时钠水平与预后无关。180 天死亡率的预测因素包括恶性肿瘤、严重肺部疾病、吸烟史、收缩压、心率以及入院时充血的症状和体征（端坐呼吸、外周水肿和啰音）、肾功能障碍（BUN）、贫血和 HIV 阳性。所有模型的判别能力都较低，与欧洲和北美的模型相似，这表明导致不良结局的主要因素仍不清楚。
尽管年龄和疾病特征存在差异，但撒哈拉以南非洲地区 6 个月死亡率和 60 天再入院和死亡的主要预测因素与世界其他地区基本相似，但也存在一些例外，如 HIV 状况与死亡率的关联。
