| Popis: |
Background: Acute heart failure (AHF) in sub-Saharan Africahasnotbeenwellcharacterized.Therefore,wesought todescribethecharacteristics,treatment,andoutcomesof 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 enrolled1006patientspresentingwithAHF.Mean(SD)age was 52.3 (18.3) years, 511 (50.8%) were women, and the predominantracewasblackAfrican(984of999[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/173m 2 ),diabetesmellitus,anemia(hemoglobinlevel, 10g/dL),andatrialfibrillationwerefoundin73(7.7%), 114(11.4%),147(15.2%),and184cases(18.3%),respectively;65of500patientsundergoingtesting(13.0%)were seropositive for the human immunodeficiency virus. The medianhospitalstaywas7days(interquartilerange,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 -blockers at discharge. Hydralazine hydrochloride and nitrates were rarely used. Conclusions: In African patients, AHF has a predominantly nonischemic cause, most commonly hypertension.Theconditionoccursinmiddle-agedadults,equally in men and women, and is associated with high mortality. The outcome is similar to that observed in nonAfrican AHF registries, suggesting that AHF has a dire prognosis globally, regardless of the cause. |
