Prevalence and prognostic implications of anaemia and iron deficiency in Tanzanian patients with heart failure
Abel MakubiCamilla HageJohnson LwakatareBruno P. MmbandoPeter KisengeLars H. LundLars RydénJulie Makani
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Abstract:
Objective
To determine the prevalence, correlates and prognostic implications of anaemia and iron deficiency (ID) in patients with heart failure (HF) in Tanzania.Method
This was a cross-sectional and prospective observational study conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. Patients were ≥18 years of age, with HF defined according to the Framingham criteria. The primary outcome was anaemia and the secondary outcome was a composite of hospitalisation for HF or all-cause mortality.Results
A total of 401 HF patients (median age 56 years, IQR 41–67 years; women 51%) were included. The prevalence of anaemia was 57%. The overall prevalence of ID was 49% distributed as 69% versus 21% in subjects with and without anaemia (p<0.001). Normocytic anaemia was seen in 18% of the patients while none had macrocytic anaemia. The risk of having anaemia was positively associated with residency outside Dar es Salaam (OR 1.72 (95% CI 1.02 to 2.89); p=0.038), atrial fibrillation (4.12 (1.60 to 10.61); p=0.003), LVEF <45% (2.70 (1.57 to 4.67); p<0.001) and negatively (ORs per unit decrease) with creatinine clearance (0.98 (0.97 to 0.99); p=0.012) and total cholesterol (0.78 (0.63 to 0.98); p=0.029). One-year survival free from a composite endpoint was 70%. The presence of ID anaemia increased the likelihood for an event (HR 2.67; 95% CI 1.39 to 5.07; p=0.003), while anaemia without ID did not influence the risk.Conclusions
ID anaemia was common in Tanzanian patients with HF and was independently associated with the risk for hospitalisation or death."Heart failure may be defined as the pathophysiologic state in which an abnormality of cardiac function is responsible for failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues. Heart failure occurs as the consequence of many forms of heart disease afflicting at least 4 million Americans of all ages."1 Heart failure also occurs with the failure of compensatory mechanisms such as myocardial hypertrophy, which may accompany dilatation of the ventricular chambers. Heart failure can be divided into left and right heart failure, although if the heart failure becomes chronic then left heart failure can result in right heart failure, so that both can occur concomitantly. Heart failure may be due to failure of myocardial contraction or it may be due to an excessive hemodynamic burden. The heart will compensate for this physiologically, but also pathologically with myocyte hypertrophy with or without ventricular dilatation. The rate of onset of heart failure also will in fluence the clinical and pathological manifestations.
Hypertensive heart disease
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Background Atrial fibrillation is an important risk factor for stroke but there are limited data on atrial fibrillation-related stroke from the Middle East. Methods We interrogated the Qatar Stroke Database to establish the occurrence, clinical features, and outcomes of atrial fibrillation-related stroke at Hamad General Hospital, the sole provider of acute stroke care in Qatar. Results A total of 4079 patients (81.4% male, mean age 55.4 ± 13.3 years) were enrolled in the stroke database between January 2014 and 21 October 2017. Atrial fibrillation was present in 260 (6.4%) patients, of whom 106 (2.6%) had newly diagnosed atrial fibrillation. The National Institute of Health Stroke Scale (NIHSS) was significantly higher (7.9 + 7.0 (median 6; IQR 11) vs. 5.9 + 6.4 (median 4; IQR 6), P < 0.001) in atrial fibrillation patients. The modified Rankin Score (mRS) (P < 0.001) and mortality at 90-day follow-up (P = 0.002) were significantly higher in atrial fibrillation compared to non-atrial fibrillation stroke patients. Conclusion We demonstrate a low rate of atrial fibrillation and stroke in Qatar, perhaps reflecting the relatively young age of these patients. Atrial fibrillation-related strokes had higher admission NIHSS, greater disability, and higher mortality at 90 days when compared to non-atrial fibrillation strokes.
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Objective To discuss the clinical effect of heart failure mixture in congestive heart failure.Methods Retrospective analysed clinical data of 30 cases patients with congestive heart failure accepted the treatment of heart failure mixture,and evaluated its efficacy.Results The original Western Medicine following the service on 21 cases of heart failure count not control,plus service with heart failure mixture,all effective;Nine cases with Western,the simple used of heart failure mixture,effective 7 cases,invalid 2 cases.Conclusion Heart failure mixture in congestive heart failure has significant clinical effect,without obvious adverse reaction.
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