Cardiovascular Journal of Africa: Vol 28 No 5 (September/October 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017 AFRICA 331
Anaemia and iron deficiency in heart failure:
epidemiological gaps, diagnostic challenges and
therapeutic barriers in sub-Saharan Africa
Abel Makubi, Johnson Lwakatare, Okechukwu S Ogah, Lars Rydén, Lars H Lund, Julie Makani
Abstract
Anaemia and iron deficiency (ID) are common and of prog-
nostic importance in heart failure (HF). In both conditions
the epidemiology, diagnosis and therapies have been exten-
sively studied in high-income countries but are still largely
unexplored in sub-Saharan Africa (SSA).
The lack of adequate and robust epidemiological data
in SSA makes it difficult to recognise the significance of
anaemia and ID in HF. From a clinical perspective, less
attention is paid by clinicians to screening for anaemia in
HF, and as far as interventions are concerned, there are no
clinical trials in SSA that provide guidance on the appropri-
ate interventional approach. Therefore studies are needed to
provide more insight into the burden and peculiarities of and
intervention for anaemia and ID in HF in SSA, where the
pathophysiology might be different from that in high-income
countries.
There is increasing appreciation that targeting ID may
serve as a useful additional treatment strategy for patients
with chronic HF in high-income countries. However, there is
limited information on the diagnosis of and therapy for ID
in HF in SSA, where infections and malnutrition are more
likely to influence the situation. This article reviews the pres-
ent epidemiological gap in knowledge about anaemia and ID
in HF, as well as the diagnostic and therapeutic challenges in
SSA.
Keywords: heart failure, anaemia, iron deficiency, review, epide-
miology, therapy, sub-Saharan Africa
Submitted 4/6/16, accepted 2/1/17
Cardiovasc J Afr 2017; 28: 331–337
DOI: 10.5830/CVJA-2017-001
The importance of anaemia in heart failure (HF) has attracted
considerable interest over the past two decades. Recently, iron
deficiency (ID) with or without anaemia has been recognised as
an emerging therapeutic target with prognostic implications. 1-5 In
both conditions, the epidemiology, diagnosis and therapies have
been extensively studied in developed countries but are largely
unexplored in sub-Saharan Africa (SSA), where infections and
malnutrition are common and may influence the situation. 1
This article focuses on the present epidemiological gap in
knowledge about anaemia and ID in HF, as well as the diagnostic
and therapeutic challenges in SSA. No formal search of Medline
or other search engines was performed; however, PubMed and
Cochrane were checked for all relevant articles. The criterion to
include an article was clinical relevance. Full versions of articles
rather than abstracts were assessed for inclusion.
Defining anaemia in the setting of HF in SSA
and its clinical relevance
The definition of anaemia has a definite impact on the burden
of anaemia in patients with HF, which also varies according to
the setting and population in which anaemia is being considered.
The precise cut-off values to define anaemia in HF are arbitrary
and there is no consensus as to the definition of anaemia specific
to patients with chronic diseases such as HF.
School of Medicine, Muhimbili University of Health and
Allied Sciences, Dar es Salaam, Tanzania
Abel Makubi, MD, MMed, MSc, PhD,
Johnson Lwakatare, MD, MRCP, FESC
Julie Makani, MD, FRCP, PhD
Cardiology Unit, Department of Medicine K2, Karolinska
Institutet, Stockholm, Sweden
Abel Makubi, MD, MMed, MSc, PhD
Lars Rydén, MD, PhD, FESC, FACC
Lars H Lund, MD, PhD
Muhimbili National Hospital, Dar es Salaam, Tanzania
Abel Makubi, MD, MMed, MSc, PhD
Johnson Lwakatare, MD, MRCP, FESC
Julie Makani, MD, FRCP, PhD
Division of Cardiology, Department of Medicine, University
College Hospital, Ibadan, Nigeria
Okechukwu S Ogah, MBBS, FESC
Department of Cardiology, Karolinska University Hospital,
Stockholm, Sweden
Lars H Lund, MD, PhD
Nuffield Department of Clinical Medicine, University of
Oxford, London, United Kingdom
Julie Makani, MD, FRCP, PhD
Review Article