http://archinte.jamanetwork.com/ en-us Wed, 21 Nov 2012 00:00:00 GMT Tue, 01 Jan 2013 00:45:12 GMT Silverchair editor@archinte.jamanetwork.com webmaster@archinte.jamanetwork.com http://archinte.jamanetwork.com/article.aspx?articleID=1356531 Mon, 08 Oct 2012 00:00:00 GMT Damasceno A, Mayosi BM, Sani M, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>Acute heart failure (AHF) in sub-Saharan Africa has not been well characterized. Therefore, we sought to describe the characteristics, treatment, and outcomes of patients admitted with AHF in sub-Saharan Africa.<div class="boxTitle">Methods</div>The Sub-Saharan Africa Survey of Heart Failure (THESUS–HF) was a prospective, multicenter, observational survey of patients with AHF admitted to 12 university hospitals in 9 countries. Among patients presenting with AHF, we determined the causes, treatment, and outcomes during 6 months of follow-up.<div class="boxTitle">Results</div>From July 1, 2007, to June 30, 2010, we enrolled 1006 patients presenting with AHF. Mean (SD) age was 52.3 (18.3) years, 511 (50.8%) were women, and the predominant race was black African (984 of 999 [98.5%]). Mean (SD) left ventricular ejection fraction was 39.5% (16.5%). Heart failure was most commonly due to hypertension (n = 453 [45.4%]) and rheumatic heart disease (n = 143 [14.3%]). Ischemic heart disease (n = 77 [7.7%]) was not a common cause of AHF. Concurrent renal dysfunction (estimated glomerular filtration rate, <30 mL/min/173 m²), diabetes mellitus, anemia (hemoglobin level, <10 g/dL), and atrial fibrillation were found in 73 (7.7%), 114 (11.4%), 147 (15.2%), and 184 cases (18.3%), respectively; 65 of 500 patients undergoing testing (13.0%) were seropositive for the human immunodeficiency virus. The median hospital stay was 7 days (interquartile range, 5-10), with an in-hospital mortality of 4.2%. Estimated 180-day mortality was 17.8% (95% CI, 15.4%-20.6%). Most patients were treated with renin-angiotensin system blockers but not β-blockers at discharge. Hydralazine hydrochloride and nitrates were rarely used.<div class="boxTitle">Conclusions</div>In African patients, AHF has a predominantly nonischemic cause, most commonly hypertension. The condition occurs in middle-aged adults, equally in men and women, and is associated with high mortality. The outcome is similar to that observed in non-African AHF registries, suggesting that AHF has a dire prognosis globally, regardless of the cause.</span> 172 18 1386 1394 10.1001/archinternmed.2012.3310 http://archinte.jamanetwork.com/article.aspx?articleID=1356531 http://archinte.jamanetwork.com/article.aspx?articleID=1356539 Mon, 08 Oct 2012 00:00:00 GMT Jamerson KA, Agodoa L. <span class="paragraphSection">When we think of the causes of cardiomyopathy in Africa, we tend to think of endemic diseases that are uncommon in the developed world, such as endomyocardial fibrosis, tuberculous pericarditis, and peripartum and idiopathic dilated cardiomyopathy. However, the preceding study shows that assumption to be outdated.</span> 172 18 1395 1396 10.1001/archinternmed.2012.4491 http://archinte.jamanetwork.com/article.aspx?articleID=1356539