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Explaining Heart Failure Hyper-mortality in Sub Saharan Africa: Global Genomic and Environmental Contribution Review
Adesuyi A Ajayi1, Gbemiga G Sofowora2, Gani O Ladipo3
1Adjunct Professor, Department of Medicine, Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX, 77060, USA.
Insights
Heart failure (HF) mortality in Africa is double the global average, driven by genetics, comorbidities, and limited treatment access. Addressing these factors through prevention and improved healthcare is crucial to reduce HF
Area of Science:
- Cardiology
- Public Health
- Genetics
Background:
- Sub-Saharan Africa (SSA) faces a significantly higher heart failure (HF) mortality rate (34%) compared to global averages.
- This hyper-mortality is twice the world average and 3.7 times that of South America.
- Existing studies highlight a critical need to understand and address the unique factors contributing to HF outcomes in SSA.
Purpose of the Study:
- To investigate evidence-based explanations for the elevated heart failure mortality in Sub-Saharan African nations.
- To compare HF profiles between Sub-Saharan African nations and North American, Caribbean, and Afro-Brazilian populations.
- To propose amelioration strategies for reducing heart failure burden in SSA.
Main Methods:
- Comparative analysis of heart failure mortality rates and contributing factors across different global regions, focusing on SSA.
- Review of genetic predispositions, including single nucleotide polymorphisms (SNPs) linked to hypertension and left ventricular hypertrophy (LVH).
- Assessment of comorbidity burdens (e.g., valvular regurgitations, chronic kidney disease, anemia, infections) and their impact on HF.
- Correlation analysis between Gross Domestic Product (GDP-PPP) and intra-hospital/1-year HF mortality rates.
Main Results:
- 1-year HF mortality rates in SSA range from 29% to 58%, with intra-hospital mortality from 8% to 26%.
- Higher prevalence of HF with reduced Ejection Fraction (HFrEF) phenotype and a significant comorbidity burden are common in SSA.
- Sub-optimal use of guideline-directed medical therapy (GDMT) and unavailability of intracardiac devices (ICDs) were noted.
- Low GDP-PPP in SSA showed an inverse correlation with both intra-hospital and 1-year HF mortality.
Conclusions:
- Genetic factors, prevalent comorbidities, late disease presentation, and socioeconomic status significantly contribute to high HF mortality in SSA.
- Inadequate access to and utilization of optimal medical therapies and devices exacerbate the problem.
- Implementing localized primary prevention, early detection/treatment of risk factors, and improving healthcare infrastructure are essential.
Abstract:
The annual heart failure (HF) mortality rate in Africa is 34% according to the INTERHF study. This is twice the world average of 16.5% and 3.7 times that of South America, 9%. We review evidence-based explanations for the Hyper-mortality of HF, by comparison of North American, Caribbean, Afro-Brazilian with Sub-Saharan African (SSA) nations profiles, and suggest amelioration. 1 year HF mortality rates in SSA ranged from 29% to 58%, and intra-hospital mortality rate from 8 to 26% (n = 8). A clustering of adverse genetic single nucleotide polymorphisms (SNP) predisposing to hypertension and/or left ventricular hypertrophy (LVH) in the black diaspora may contribute. A higher prevalence of HF with reduced Ejection Fraction (HF r EF) phenotype, which is associated with greater mortality is more common in SSA nations. Additionally, a worse co-morbidity burden, especially valvular regurgitations causing LV remodeling (LVR), chronic kidney disease (CKD), anemia, lung disease, infections, late presentation in NYHA III/IV, right ventricular disease (RVD) were also common in SSA. Geographic variation in SSA, HF risk factors and co-morbidity was observed. There was sub-optimal use of guideline directed medical therapy (GDMT) and intracardiac device (ICD) unavailability. Gross Domestic Product -per purchasing power parity (GDP-PPP), which is low in SSA, was inversely correlated both to higher intra-hospital mortality rate % (r = -0.73, r 2 = 0.54 p = 0.038) and higher 1 year HF mortality rate % (r = -0.62, r 2 = 0.38, = 0.098). Localized primary prevention, early detection and prompt treatment of hypertension, diabetes, rheumatic fever, early cardiac valve repair and use of cardiovascular polypill, optimal use of GDMT, national health insurance scheme are advocated to stem the dismal mortality and cost burden of HF.
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