Cardiovascular Journal of Africa: Vol 25 No 5 (September/October 2014)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 5, September/October 2014 222 AFRICA
intervention in HF management in our environment. This is
because studies have shown that ACE inhibitors,39 ARBs,40
and beta-blockers12 can improve survival in patients with HF.
Furthermore, the African-American Heart Failure trial has
shown the efficacy of the hydrallazine–isosorbide combination
in the treatment of HF in blacks.13
The main aetiological factors for HF in our cohort were
non-ischaemic in origin, with hypertensive heart disease being
responsible for over 75% of cases. It may be reasonable to
suggest that applying guidelines derived from clinical trials in
the Western world, where most HF is ischaemic in origin, may
be inappropriate in our population.
Limitations
Our study was a single-centre, hospital-based study conducted
in a cardiology unit and therefore may not have captured all
the patients with heart failure in the city during the study
period, although many referrals were received from surrounding
hospitals and clinics during the period due to the awareness that
was created of the study. The findings of the study may not be
extrapolated to the general population or the situation in other
Nigerian hospitals. A national HF registry is needed, as has been
done in many other countries.
The use of the Framingham criteria as a screening tool may
have missed some patients, especially the elderly with HF, as the
criteria are not sensitive in this population.
Due to cost consideration, our subjects did not have
NT-proBNP levels done as this has not become a routine
practice in the country. NT-proBNP has been shown to be a
strong predictor of prognosis in HF.41 Other prognostic variables,
such as exercise capacity (VO2 and six-minute walk) were also not
assessed in our patients.
Some of our patients were lost to follow up and this may have
affected the survival information in this study. However the rate
of attrition was similar to that in other follow-up studies.8,11 This
was complicated by the fact that there is no effective national
death registry in the country. We also could not ascertain the
exact cause of death for patients who died outside the hospital
environment.
Conclusions
The characteristics of the HF population in Nigeria are different
from similar populations in high-income countries. Our patients
are about 20 years younger and have non-ischaemic aetiological
risk factors for HF, especially hypertensive heart disease. Short-
or medium-term outcome is relatively lower than (or comparable
to) findings from high-income countries and have some similar
prognostic factors, such as renal function, anaemia, body
mass index, blood pressure parameters, as well as ECG and
echocardiographic variables. There is a need for a national HF
registry in the country to better understand the characteristics,
management and outcome of HF in the different regions of the
country.
We acknowledge the contributions of the medical and nursing staff of the
Federal Medical Centre, Abeokuta, Nigeria. There was no funding for this
study.
References
1. Damasceno A, Mayosi BM, Sani M, Ogah OS, Mondo C, Ojji D, et al .
The causes, treatment, and outcome of acute heart failure in 1006 afri-
cans from 9 countries. Arch Int Med 2012; 172: 1386–1394.
2. Al Suwaidi J, Asaad N, Al-Qahtani A, Al-Mulla AW, Singh R, Albinali
HA. Prevalence and outcome of middle-eastern Arab and south Asian
patients hospitalized with heart failure: Insight from a 20-year registry
in a middle-Eastern country (1991–2010). Acute Cardiac Care 2012; 14:
81–89.
3. Santhanakrishnan R, Ng TP, Cameron VA, Gamble GD, Ling LH,
Sim D, et al. The Singapore Heart Failure Outcomes and Phenotypes
(SHOP) study and Prospective Evaluation of Outcome in Patients with
heart failure with preserved Left ventricular Ejection fraction (PEOPLE)
study: Rationale and design. J Cardiac Fail 2013; 19: 156–162
4. Stewart S, Wilkinson D, Hansen C, Vaghela V, Mvungi R, McMurray
J, Sliwa K. Predominance of heart failure in the Heart of Soweto study
cohort: Emerging challenges for urban african communities. Circulation
2008; 118: 2360–2367.
5. Oliva F, Mortara A, Cacciatore G, Chinaglia A, Di Lenarda A, Gorini
M, et al, Investigators I-HO. Acute heart failure patient profiles,
management and in-hospital outcome: Results of the Italian registry on
heart failure outcome. Eur J Heart Failure 2012; 14: 1208–1217
6. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola
VP, et al. EuroHeart Failure survey II (EHFS II): A survey on hospital-
ized acute heart failure patients: Description of population. Eur Heart
J 2006; 27: 2725–2736.
7. Adams KF, Jr, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo
MR, Abraham WT, et al. Characteristics and outcomes of patients
hospitalized for heart failure in the United States: Rationale, design,
and preliminary observations from the first 100,000 cases in the Acute
Decompensated HEart failure national REgistry (ADHERE). Am
Heart J 2005; 149: 209–216.
8. Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade
M, Greenberg BH, et al. Characteristics, treatments, and outcomes of
patients with preserved systolic function hospitalized for heart failure:
A report from the OPTIMIZE-HF registry. J Am Coll Cardiol 2007;
50: 768–777.
9. Sato N, Kajimoto K, Keida T, Mizuno M, Minami Y, Yumino D, et al ,
investigators. Clinical features and outcome in hospitalized heart failure
in Japan (from the ATTEND registry). Circ J 2013; 77: 944–951.
10. Tsutsui H, Tsuchihashi-Makaya M, Kinugawa S, Goto D, Takeshita
A, Investigators. Clinical characteristics and outcome of hospitalized
patients with heart failure in Japan. Circ J 2006; 70: 1617–1623.
11. Sliwa K, Davison BA, Mayosi BM, Damasceno A, Sani M, Ogah OS, et
al. Readmission and death after an acute heart failure event: Predictors
and outcomes in sub-Saharan Africa: Results from the THESUS-HF
registry. Eur Heart J 2013; 34: 3151–3159.
12. Scott I, Jackson C. Chronic heart failure management in Australia –
time for general practice centred models of care? Austr Family Phys
2013; 42: 343–346.
13. Scalvini S, Giordano A. Heart failure. Optimal postdischarge manage-
ment of chronic HF. Nature Rev Cardiol 2013; 10: 9–10.
14. Teerlink JR, Cotter G, Davison BA, Felker GM, Filippatos G,
Greenberg BH, et al. Investigators REiAHF. Serelaxin, recombinant
human relaxin-2, for treatment of acute heart failure (RELAX-AHF): A
randomised, placebo-controlled trial. Lancet 2013; 381: 29–39.
15. World Health Organisation–International Society of Hypertension
guidelines for the management of hypertension.Guideline subcommitee.
J Hypertens 1999; 17: 151–183.
16. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more