title: The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9 countries.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique, South Africa.
authors.forename: Albertino
authors.initials: A
authors.lastname: Damasceno
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Sani
authors.forename: Okechukwu S
authors.initials: OS
authors.lastname: Ogah
authors.forename: Charles
authors.initials: C
authors.lastname: Mondo
authors.forename: Dike
authors.initials: D
authors.lastname: Ojji
authors.forename: Anastase
authors.initials: A
authors.lastname: Dzudie
authors.forename: Charles Kouam
authors.initials: CK
authors.lastname: Kouam
authors.forename: Ahmed
authors.initials: A
authors.lastname: Suliman
authors.forename: Neshaad
authors.initials: N
authors.lastname: Schrueder
authors.forename: Gerald
authors.initials: G
authors.lastname: Yonga
authors.forename: Serigne Abdou
authors.initials: SA
authors.lastname: Ba
authors.forename: Fikru
authors.initials: F
authors.lastname: Maru
authors.forename: Bekele
authors.initials: B
authors.lastname: Alemayehu
authors.forename: Christopher
authors.initials: C
authors.lastname: Edwards
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.forename: Gad
authors.initials: G
authors.lastname: Cotter
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
mesh_terms: D000208:Acute Disease; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis