The SA Journal Diabetes & Vascular Disease Vol 13 No 1 (July 2016)

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VOLUME 13 NUMBER 1 • JULY 2016 25
SA JOURNAL OF DIABETES & VASCULAR DISEASE RESEARCH ARTICLE
al.38 reported a total mortality rate of 30% at three years in the
placebo group of ischaemic HF patients compared to a rate of
15% in the non-ischaemic HF group.
The poorer outcome of women in our study may be because
the women were less educated and more likely to be unemployed
and dependent than the men, and may not be able to pay for HF
medications. Clinic follow up may also be poorer in the women.
The finding of low frequency of use of some disease-modifying
drugs in our cohort is an opportunity for future 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.8,42 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 is 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.
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