Abel Makubi1, Camilla Hage2, Johnson Lwakatare3, Bruno Mmbando4, Peter Kisenge5, Lars H Lund2, Lars Rydén6, Julie Makani7. 1. School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Muhimbili National Hospital, Dar es Salaam, Tanzania. 2. Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. 3. School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Muhimbili National Hospital, Dar es Salaam, Tanzania. 4. National Institute of Medical Research, Tanga Centre, Tanzania Muhimbili Wellcome Programme, Dar es Salaam, Tanzania. 5. Muhimbili National Hospital, Dar es Salaam, Tanzania. 6. Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. 7. School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden Muhimbili Wellcome Programme, Dar es Salaam, Tanzania. Nuffield Department of Clinical Medicine, University of Oxford, London, UK.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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