title: Prevalence and prognostic implications of anaemia and iron deficiency in Tanzanian patients with heart failure.
abstract: OBJECTIVE
  To determine the prevalence, correlates and prognostic implications of anaemia and iron deficiency (ID) in patients with heart failure (HF) in Tanzania.
  
  
  METHODS
  This was a cross-sectional and prospective observational study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were ≥ 18 years of age, with HF defined according to the Framingham criteria. The primary outcome was anaemia and the secondary outcome was a composite of hospitalisation for HF or all-cause mortality.
  
  
  RESULTS
  A total of 401 HF patients (median age 56 years, IQR 41-67 years; women 51%) were included. The prevalence of anaemia was 57%. The overall prevalence of ID was 49% distributed as 69% versus 21% in subjects with and without anaemia (p < 0.001). Normocytic anaemia was seen in 18% of the patients while none had macrocytic anaemia. The risk of having anaemia was positively associated with residency outside Dar es Salaam (OR 1.72 (95% CI 1.02 to 2.89); p = 0.038), atrial fibrillation (4.12 (1.60 to 10.61); p=0.003), LVEF < 45% (2.70 (1.57 to 4.67); p < 0.001) and negatively (ORs per unit decrease) with creatinine clearance (0.98 (0.97 to 0.99); p = 0.012) and total cholesterol (0.78 (0.63 to 0.98); p = 0.029). One-year survival free from a composite endpoint was 70%. The presence of ID anaemia increased the likelihood for an event (HR 2.67; 95% CI 1.39 to 5.07; p = 0.003), while anaemia without ID did not influence the risk.
  
  
  CONCLUSIONS
  ID anaemia was common in Tanzanian patients with HF and was independently associated with the risk for hospitalisation or death.
authors.affiliation: School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Abel
authors.initials: A
authors.lastname: Makubi
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Camilla
authors.initials: C
authors.lastname: Hage
authors.affiliation: School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Johnson
authors.initials: J
authors.lastname: Lwakatare
authors.affiliation: National Institute of Medical Research, Tanga Centre, Tanzania Muhimbili Wellcome Programme, Dar es Salaam, Tanzania.
authors.forename: Bruno
authors.initials: B
authors.lastname: Mmbando
authors.affiliation: Muhimbili National Hospital, Dar es Salaam, Tanzania.
authors.forename: Peter
authors.initials: P
authors.lastname: Kisenge
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
authors.affiliation: School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Muhimbili Wellcome Programme, Dar es Salaam, Tanzania. Nuffield Department of Clinical Medicine, University of Oxford, London, UK.
authors.forename: Julie
authors.initials: J
authors.lastname: Makani
mesh_terms: D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007501:Iron / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013636:Tanzania / Q000453:epidemiology
chemical_list: D007501:Iron