Szymanski P Z, Badri M, Mayosi B M
Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
S Afr Med J. 2018 Feb 1;108(2):94-98. doi: 10.7196/SAMJ.2017.v108i2.12519.
There is limited information on acute heart failure (AHF) and its treatment in sub-Saharan Africa.
To describe the clinical characteristics and causes of heart failure (HF), adherence to HF treatment guidelines, and mortality of patients with AHF presenting to Groote Schuur Hospital (GSH), Cape Town, South Africa.
This sub-study of The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF) was a prospective and observational survey that focused on the enrolment and follow-up of additional patients with AHF presenting to GSH and entered into the existing registry after publication of the primary THESUS-HF article in 2012. The patients were classified into prevalent (existing) or incident (new) cases of HF.
Of the 119 patients included, 69 (58.0%) were female and the mean (standard deviation) age was 49.9 (16.3) years. The majority of prevalent cases were patients of mixed ancestry (63.3%), and prevalent cases had more hypertension (70.0%), diabetes mellitus (36.7%), hyperlipidaemia (33.3%) and ischaemic heart disease (IHD) (36.7%) than incident cases. The top five causes of HF were cardiomyopathy (20.2%), IHD (19.3%), rheumatic valvular heart disease (RHD) (18.5%), cor pulmonale (11.8%) and hypertension (10.1%), with the remaining 20.1% consisting of miscellaneous causes including pericarditis, toxins and congenital heart disease. Most patients received renin-angiotensin system blockers and loop diuretics on discharge. There was a low rate of beta-blocker, aldosterone antagonist and digoxin use. Rehospitalisation within 180 days occurred in 25.2% of cases. In-hospital mortality was 8.4% and the case fatality rate at 6 months was 26.1%.
In Cape Town, the main causes of AHF are cardiomyopathy, IHD and RHD. AHF affects a young population and is associated with a high rate of rehospitalisation and mortality. There is serious under-use of beta-blockers, aldosterone antagonists and digoxin. Emphasis on the rigorous application of treatment guidelines is needed to reduce readmission and mortality.
关于撒哈拉以南非洲地区急性心力衰竭（AHF）及其治疗的信息有限。
描述南非开普敦格罗特舒尔医院（GSH）收治的急性心力衰竭患者的心力衰竭（HF）临床特征、病因、对HF治疗指南的依从性及死亡率。
这项撒哈拉以南非洲心力衰竭调查（THESUS-HF）的子研究是一项前瞻性观察性调查，重点关注2012年THESUS-HF主要文章发表后新收治并纳入现有登记册的GSH医院的AHF患者。患者被分为HF的现患（已存在）或新发病例。
纳入的119例患者中，69例（58.0%）为女性，平均（标准差）年龄为49.9（16.3）岁。大多数现患病例为混血血统患者（63.3%），与新发病例相比，现患病例有更多的高血压（70.0%）、糖尿病（36.7%）、高脂血症（33.3%）和缺血性心脏病（IHD）（36.7%）。HF的前五大病因是心肌病（20.2%）、IHD（19.3%）、风湿性瓣膜性心脏病（RHD）（18.5%）、肺心病（11.8%）和高血压（10.1%），其余20.1%由包括心包炎、毒素和先天性心脏病在内的其他病因组成。大多数患者出院时接受肾素-血管紧张素系统阻滞剂和襻利尿剂治疗。β受体阻滞剂、醛固酮拮抗剂和地高辛的使用率较低。180天内再住院率为25.2%。住院死亡率为8.4%，6个月时病死率为26.1%。
在开普敦，AHF的主要病因是心肌病、IHD和RHD。AHF影响年轻人群，且与高再住院率和死亡率相关。β受体阻滞剂、醛固酮拮抗剂和地高辛的使用严重不足。需要强调严格应用治疗指南以降低再入院率和死亡率。
