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J Card Fail. 2014 Jan;20(1):45-52. doi: 10.1016/j.cardfail.2013.11.005. Epub 2013 Nov 20.

Prognostic significance of ECG abnormalities for mortality risk in acute heart failure: insight from the Sub-Saharan Africa Survey of Heart Failure (THESUS-HF).

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Douala General Hospital, Douala, and Buea Faculty of Health Sciences, Buea, Cameroon; Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Momentum Research, Durham, NC.
Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
Uganda Heart Institute, Kampala, Uganda.
Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria.
Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria.
Department of Medicine, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.
Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Soweto Cardiovascular Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa; Hatter Institute for Cardiovascular Research in Africa and Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa. Electronic address:



The aim of this study was to assess the predictive utility of 12-lead electrocardiogram (ECG) abnormalities among Africans with acute heart failure (HF).


We used the Sub-Saharan Africa Survey of Heart Failure, a multicenter prospective cohort study of 1,006 acute HF patients, and regression models to relate baseline ECG findings to all-cause mortality and readmission during a 6-month follow-up period. Of 814 ECGs available, 523 (49.0% male) were obtained within 15 days of admission, among which 97.7% showed abnormalities. Mean age was 52.0 years and median follow-up was 180 days, with 77 deaths (Kaplan-Meier 17.5%) through day 180 and 63 patients with death or readmission to day 60. QRS width, QT duration, bundle branch block, and ischemic changes were not associated with outcomes. Increasing ventricular rate was associated with increasing risk of both outcomes (hazard ratio [HR] 1.07 per 5 beats/min increase for 60-day death or readmission, 95% confidence interval [CI] 1.02-1.12; P = .0047), and the presence of sinus rhythm was associated with lower risk (HR 0.58, 95% CI 0.34-0.97; P = .0385). There was a strong association between survival and heart rate in patients in sinus rhythm, with heart rate >119 beats/min conveying the worst mortality risk.


ECG abnormalities are almost universal among Africans with acute HF, which may add to the immediate diagnosis of patients presenting with dyspnea. Although some ECG findings have prognostic value for risk of adverse outcomes, most of them are nonspecific and add little to the risk stratification of these patients.


Africa; electrocardiogram; heart failure; outcome; prognosis

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