title: Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF).
abstract: BACKGROUND
  Heart failure (HF) in developing countries is poorly described. We compare characteristics and prognosis of HF in Tanzania vs. Sweden.
  
  
  METHODS
  A prospective cohort study was conducted from the Tanzania HF study (TaHeF) and the Swedish HF Registry (SwedeHF). Patients were compared overall (n 427 vs. 51,060) and after matching 1:3 by gender and age±5years (n 411 vs. 1232). The association between cohort and all-cause mortality was assessed with multivariable Cox regression.
  
  
  RESULTS
  In the unmatched cohorts, TaHeF (as compared to SwedeHF) patients were younger (median age [interquartile range] 55 [40-68] vs. 77 [64-84] years, p<0.001) and more commonly women (51% vs. 40%, p<0.001). The three-year survival was 61% in both cohorts. In the matched cohorts, TaHeF patients had more hypertension (47% vs. 37%, p<0.001), more anemia (57% vs. 9%), more preserved EF, more advanced HF, longer duration of HF, and less use of beta-blockers. Crude mortality was worse in TaHeF (HR 2.25 [95% CI 1.78-2.85], p<0.001), with three-year survival 61% vs. 83%. However, covariate-adjusted risk was similar (HR 1.07, 95% CI 0.69-1.66; p=0.760). In both cohorts, preserved EF was associated with higher mortality in crude but not adjusted analysis.
  
  
  CONCLUSIONS
  Compared to in Sweden, HF patients in Tanzania were younger and more commonly female, and after age and gender matching, had more frequent hypertension and anemia, more severe HF despite higher EF, and worse crude but similar adjusted prognosis.
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania. Electronic address: makubi55@gmail.com.
authors.forename: Abel
authors.initials: A
authors.lastname: Makubi
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.
authors.forename: Camilla
authors.initials: C
authors.lastname: Hage
authors.affiliation: Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Sartipy
authors.affiliation: School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania.
authors.forename: Johnson
authors.initials: J
authors.lastname: Lwakatare
authors.affiliation: School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Janabi
authors.affiliation: Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania.
authors.forename: Peter
authors.initials: P
authors.lastname: Kisenge
authors.affiliation: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, 58191 Linköping, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Dahlström
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
authors.affiliation: School of Medicine, Muhimbili University of Health and Allied Sciences, PO BOX 65001, Dar es Salaam, Tanzania; Nuffield Department of Clinical Medicine, University of Oxford, OX3 7BN Oxford, London, United Kingdom; Muhimbili Wellcome Programme, PO Box 65001, Dar es Salaam, Tanzania.
authors.forename: Julie
authors.initials: J
authors.lastname: Makani
authors.affiliation: Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden.
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lund
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D013548:Sweden / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology
keywords: Heart failure; Mortality; Sub-Saharan Africa; Sweden; Tanzania