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Epidemiology of heart failure in sub-Saharan Africa
Ntobeko B A Ntusi1, Bongani M Mayosi
1Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. ntobekon@yahoo.com
Insights
Heart failure is a major cardiovascular disease in Africa, predominantly non-ischemic. Causes include hypertension and cardiomyopathies, impacting younger individuals, necessitating urgent research and interventions.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Heart failure is a significant and growing cardiovascular disease in Africa.
- It disproportionately affects young, economically active populations, carrying substantial social and economic burdens.
- The etiology of heart failure in African populations is predominantly non-ischemic.
Purpose of the Study:
- To summarize the current understanding of heart failure etiology in Africa.
- To highlight the key contributors to cardiac failure in sub-Saharan Africa.
- To emphasize the need for epidemiological studies and targeted interventions.
Main Methods:
- Review of existing literature on heart failure in African populations.
- Analysis of etiological factors contributing to heart failure.
- Discussion of demographic and epidemiological trends.
Main Results:
- Hypertension, cardiomyopathy, rheumatic heart disease, chronic lung disease, and pericardial disease account for over 90% of heart failure cases.
- Hypertensive heart disease complications are more frequent and occur in younger individuals in Africa.
- Endemic cardiomyopathies (dilated, peripartum, endomyocardial fibrosis) are prevalent, while non-endemic types occur at similar rates globally.
Conclusions:
- Non-ischemic causes dominate heart failure in Africa, with hypertension and cardiomyopathies being primary drivers.
- Coronary artery disease is currently uncommon but rising due to urbanization and lifestyle changes.
- Population-based studies and registries are crucial for understanding heart failure epidemiology and developing effective interventions in sub-Saharan Africa.
Abstract:
Heart failure has emerged as a dominant form of cardiovascular disease in Africa, and has great social and economic relevance owing to its high prevalence, mortality and impact on young, economically active individuals. The causes of heart failure in Africans remain largely nonischemic. Hypertension, cardiomyopathy, rheumatic heart disease, chronic lung disease and pericardial disease are the main contributors to the etiology of cardiac failure in sub-Saharan Africa, accounting for over 90% of cases. Hypertensive heart disease complications occur more frequently in Africans and the majority of affected patients are younger. Endemic cardiomyopathies include dilated cardiomyopathy, peripartum cardiomyopathy and endomyocardial fibrosis. Nonendemic cardiomyopathies apparently occur with the same frequency as in other parts of the world, and include hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia/cardiomyopathy. Coronary artery disease and its complications remain uncommon in Africa, but the situation is changing due to modifications in lifestyle, risk-prone behavior, diet, cultural attitudes and other consequences of rapid urbanization. As the prevalence of heart failure is expected to rise substantially in sub-Saharan Africa, the authors call for population-based studies and registries of the epidemiology of heart failure in Africans and the urgent study of interventions that will decrease morbidity and mortality from the causes of heart failure, with a focus both on nonischemic and ischemic risk factors.
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