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Int J Cardiol. 2016 Oct 1;220:750-8. doi: 10.1016/j.ijcard.2016.06.239. Epub 2016 Jun 29.

Heart failure in Tanzania and Sweden: Comparative characterization and prognosis in the Tanzania Heart Failure (TaHeF) study and the Swedish Heart Failure Registry (SwedeHF).

Author information

1
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.
2
Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.
3
Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
4
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.
5
Jakaya Kikwete Cardiac Institute, PO BOX 65000, Dar es Salaam, Tanzania.
6
Department of Cardiology and Department of Medical and Health Sciences, Linköping University, 58191 Linköping, Sweden.
7
Cardiology Unit, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden.
8
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.

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.

KEYWORDS:

Heart failure; Mortality; Sub-Saharan Africa; Sweden; Tanzania

PMID:
27393861
PMCID:
PMC5553107
DOI:
10.1016/j.ijcard.2016.06.239
[Indexed for MEDLINE]
Free PMC Article

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