五个非洲国家心力衰竭的临床特征和结局：INTER-CHF 研究结果。
Clinical Profiles and Outcomes of Heart Failure in Five African Countries: Results from INTER-CHF Study.
机构信息
Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, NG.
Department of Public Health and Clinical Medicine, Umea University, SE.
出版信息
Glob Heart. 2021 Jul 30;16(1):50. doi: 10.5334/gh.940. eCollection 2021.
BACKGROUND
A wide knowledge gap exists on the clinical profiles and outcomes of heart failure (HF) in sub-Saharan Africa.
OBJECTIVES
To determine the clinical profiles and outcomes of HF patients from five African countries.
METHODS
The INTERnational Congestive Heart Failure Study (INTER-CHF) is a prospective, multicenter cohort study. A total of 1,294 HF patients were consecutively recruited from Nigeria (383 patients), South Africa (169 patients), Sudan (501 patients), Uganda (151patients), and Mozambique (90 patients). HF was defined according to the Boston criteria for diagnosis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) score.
RESULTS
Of the 1294 patients, 51.4% were recruited as out-patients, 53.7% had HF with reduced ejection fraction (EF), 30.1% had HF with mid-range EF and 16.2% had HF with preserved EF (16.2%). The commonest etiologies of HF were hypertensive heart disease (35%) and ischemic heart disease (20%). The mean MoCA score was highest in Uganda (24.3 ± 1.1) and lowest in Sudan (13.6 ± 0.3). Prescriptions for guideline-recommended HF therapies were poor; only 1.2% of South African patients received an Implantable Cardioverter Defibrillator, and none of the patients received Cardiac Resynchronised Therapy. The composite outcome of death or HF hospitalization at one year among the patients was highest in Sudan (59.7%) and lowest in Mozambique (21.1%). Six variables were associated with higher mortality risk, while digoxin use (adjusted hazard ratio [aHR]: 0.69; 95% confidence interval [CI]: 0.49-0.97; p = 0.034) and 10mmHg unit increase in systolic blood pressure (aHR 0.86; 95%CI 0.81-0.93; p < 0.001) were associated with lower risk for mortality.
CONCLUSIONS
This is the largest HF study in Africa that included in- and out-patients from the West, East, North, Central and South African sub-regions. Clinically relevant differences, including cognitive functional impairment, were found between the involved countries.
背景
撒哈拉以南非洲地区在心力衰竭（HF）的临床特征和结局方面存在广泛的知识差距。
目的
确定来自五个非洲国家的 HF 患者的临床特征和结局。
方法
国际充血性心力衰竭研究（INTER-CHF）是一项前瞻性、多中心队列研究。从尼日利亚（383 例）、南非（169 例）、苏丹（501 例）、乌干达（151 例）和莫桑比克（90 例）连续招募了 1294 例 HF 患者。HF 根据波士顿标准进行诊断。认知功能使用蒙特利尔认知评估（MoCA）评分进行评估。
结果
在 1294 例患者中，51.4%为门诊患者，53.7%为射血分数降低性心力衰竭（HF-REF），30.1%为射血分数中间值心力衰竭，16.2%为射血分数保留性心力衰竭（HF-PEF）（16.2%）。HF 的常见病因是高血压性心脏病（35%）和缺血性心脏病（20%）。MoCA 评分最高的是乌干达（24.3 ± 1.1），最低的是苏丹（13.6 ± 0.3）。指南推荐的 HF 治疗处方很差；只有 1.2%的南非患者接受了植入式心脏复律除颤器，没有患者接受心脏再同步治疗。患者一年内心脏衰竭死亡或心力衰竭住院的复合结局在苏丹最高（59.7%），在莫桑比克最低（21.1%）。有 6 个变量与更高的死亡风险相关，而地高辛的使用（调整后的危险比[aHR]：0.69；95%置信区间[CI]：0.49-0.97；p=0.034）和收缩压增加 10mmHg 单位（aHR 0.86；95%CI 0.81-0.93；p<0.001）与死亡率降低相关。
结论
这是非洲最大的 HF 研究，包括来自西非、东非、北非、中非和南非次区域的门诊和住院患者。在所涉及的国家之间发现了包括认知功能障碍在内的具有临床意义的差异。
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