Survival rate and predictors of 36-month mortality in patients with heart failure in Sub Saharan Africa: insights from the Douala Heart Failure Registry (Do-HF).

Background: Heart failure (HF) is a growing public health concern with a high mortality rate in sub-Saharan Africa. However, few studies have reported the long-term predictors of mortality in this region. This study sought to determine the 3-year mortality rate and the predictors of mortality amongst HF patients in Douala, Cameroon. Methods: We conducted a prospective analysis on patients recruited in the Douala Heart Failure (Do-HF) registry, an ongoing prospective data collection on patients with HF at four cardiology units in Douala, Cameroon. Patients included were followed for 36 months from the index date of inclusion, with all-cause mortality as the primary outcome. Cox proportional hazard regression models were used to determine predictors of mortality. Results: Out of the 347 participants included, 318 (91.6%) completed follow-up. The mean age was 64±14 years, 172 (49.6%) were men. Hypertensive cardiomyopathy and dilated cardiomyopathy were the most frequent causes of heart failure. The median follow-up was 33 months, and 150 (47.2%) patients died. Independent predictors of mortality included New York Heart Association functional class III & IV (aHR 2.23; 95% CI: 1.49-3.33; P<0.001), presence of pulmonary rales (aHR 1.87; 95% CI: 1.30-2.68; P=0.005), chronic kidney disease (aHR 2.92; 95% CI: 1.79-4.78; P<0.001), enrolment as inpatient (aHR1.96; 95% CI: 1.17-2.54; P=0.005), no formal education (aHR 2.06; 95% CI: 1.28-3.33; P=0.003), and a monthly income of at most three minimum wage (aHR 2.06; 95% CI: 1.28-3.33; P=0.003). Conclusions: This study shows that almost half of HF patients die after 36 months of follow-up. Also, late presentation and poverty-related conditions were associated with poor outcomes. These findings suggest prioritizing preventive strategies that target early diagnosis and socioeconomic status to improve the prognosis of HF.

Resting heart rate predicts all-cause mortality in sub-Saharan African patients with heart failure: a prospective analysis from the Douala Heart failure registry (Do-HF).

BACKGROUND: Higher resting heart rate (HR) is associated with mortality amongst Caucasians with heart failure (HF), but its significance has yet to be established in sub-Saharan Africans in whom HF differs in terms of characteristics and etiologies. We assessed the association of HR with all-cause mortality in patients with HF in sub-Saharan Africa. METHODS: The Douala HF registry (Do-HF) is an ongoing prospective data collection on patients with HF receiving care at four cardiac referral services in Douala, Cameroon. Patients included in this report were followed-up for 12 months from their index admission, for all-cause mortality. We used Cox-regression analysis to study the association of HR with all-cause mortality during follow-up. RESULTS: Of 347 patients included, 343 (98.8%) completed follow-up. The mean age was 64±14 years, 176 (50.7%) were female, and median admission HR was 85 bpm. During a median follow-up of 12 months, 78 (22.7%) patients died. Mortality increased steadily with HR increase and ranged from 12.2% in the lower quartile of HR (≤69 bpm) to 34.1% in the upper quartile of HR (>100 bpm). Hazard ratio of 12-month death per 10 bpm higher HR was 1.16 (1.04-1.29), with consistent effects across most subgroups, but a higher effect in participants with hypertension vs. those without (interaction P=0.044). CONCLUSIONS: HR was independently associated with increased risk of all-cause mortality in this study, particularly among participants with hypertension. The implication of this finding for risk prediction or reduction should be actively investigated.

Phlegmasia cerulea dolens: case report on a HIV-AIDS patient in a sub-saharian semi-urban practice.

Venous thromboembolism has also become a major health concern in sub-saharian Africa. Studies addressing at this issue are rare in Cameroon. Thus, the case reported here presents singular characteristics: its clinical form, phlegmasia cerulea dolens, a severe but uncommon complication of venous thromboembolism; and its infrequent recorded triggering factor, HIV-AIDS.

Prevalence, awareness, treatment and control of hypertension in a self-selected sub-Saharan African urban population: a cross-sectional study.

OBJECTIVES: Hypertension has been established as a major public health problem in Africa, but its specific contributions to disease burden are still incompletely understood. We report the prevalence and determinants of hypertension, detection, treatment and control rates among adults in major cities in Cameroon. DESIGN: Cross-sectional study. SETTINGS: Community-based multicentre study in major cities in Cameroon. PARTICIPANTS: Participants were self-selected urban dwellers from the Center, Littoral, North-West and West Regions, who attended on 17 May 2011 a screening campaign advertised through mass media. PRIMARY AND SECONDARY OUTCOMES MEASURES: Hypertension defined as systolic (and/or diastolic) blood pressure (BP)≥ 140 (90) mm Hg, or ongoing BP-lowering medications. RESULTS: In all, 2120 participants (1003 women) were included. Among them, 1007 (prevalence rate 47.5%) had hypertension, including 319 (awareness rate 31.7%) who were aware of their status. The prevalence of hypertension increased with age overall and by sex and region. Among aware hypertensive participants, 191 (treatment rate 59.9%) were on regular BP-lowering medication, and among those treated, 47 (controlled rate 24.6%) were at target BP levels (ie, systolic (and diastolic) BP<140 (90) mm Hg). In multivariable logistic regression analysis, male gender, advanced age, parental history of hypertension, diabetes mellitus, elevated waist and elevated body mass index (BMI) were the significant predictors of hypertension. Likewise, male gender, high BMI and physical inactivity were associated with poor control. CONCLUSIONS: High prevalence of hypertension with low awareness, treatment and control were found in this urban population; these findings are significant and alarming with consideration to the various improvements in the access to healthcare and the continuing efforts to educate communities over the last few decades.