Recent advances in the epidemiology, pathogenesis and prognosis of acute heart failure and cardiomyopathy in Africa

Abstract

This review addresses recent advances in the epidemiology, pathogenesis and prognosis of acute heart failure and cardiomyopathy based on research conducted in Africa. We searched Medline/PubMed for publications on acute decompensated heart failure and cardiomyopathy in Africa for the past 5 years (ie, 1 January 2008 to 31 December 2012). This was supplemented with personal communications with colleagues from Africa working in the field. A large prospective registry has shown that acute decompensated heart failure is caused by hypertension, cardiomyopathy and rheumatic heart disease in 90% of cases, a pattern that is in contrast with the dominance of coronary artery disease in North America and Europe. Furthermore, acute heart failure is a disease of the young with a mean age of 52 years, occurs equally in men and women, and is associated with high mortality at 6 months (∼18%), which is, however, similar to that observed in non-African heart failure registries, suggesting that heart failure has a dire prognosis globally, regardless of aetiology. The molecular genetics of dilated cardiomyopathy, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy in Africans is consistent with observations elsewhere in the world; the unique founder effects in the Afrikaner provide an opportunity for the study of genotype-phenotype correlations in large numbers of individuals with cardiomyopathy due to the same mutation. Advances in the understanding of the molecular mechanisms of peripartum cardiomyopathy have led to promising clinical trials of bromocriptine in the treatment of peripartum heart failure. The key challenges of management of heart failure are the urgent need to increase the use of proven treatments by physicians, and the control of hypertension in primary care and at the population level.

Prevalence and Aetiology of Heart Failure in Patients Seen at a Teaching Hospital in Ghana

“…This study supports available data which show that rheumatic heart disease, hypertensive heart disease and cardiomyopathy are the main contributors to the aetiology of heart failure in Africa, accounting for over 80% of cases [9][10][11]24,30]. Rheumatic heart disease and hypertensive heart disease are largely preventable causes of heart failure.…”

“…In other parts of sub-Saharan Africa, heart failure has been found to account to 5% to 10% of hospital admissions [16,17,22,23]. Some authors have also shown that heart failure is a major cause of cardiovascular disorder in Africa [24,25]. Heart failure is a major clinical problem worldwide.…”

Heart failure: preventing disease and death worldwide

“…111 Furthermore, even when facilities are available, they are not always used. For example, all published guidelines agree that diagnosis should involve ultrasound imaging to assess heart function, but 10-25% of patients admitted to hospital with a primary diagnosis of heart failure in Europe and the USA do not undergo ultrasonography.…”

Heart failure in sub-Saharan Africa: A clinical approach

“…In contrast to other parts of the world, non-ischaemic aetiologies are predominant, with hypertension, rheumatic heart disease (RHD) and cardiomyopathy accounting for two-thirds of cases of HF in hospitalised patients in the region. [1,5] …”

“…[4,5,8] Young hypertensive patients should be investigated for secondary causes of hypertension (Table 1). Standard anti-failure therapy and blood pressure control are the mainstays of therapy.…”