Heart failure in sub-Saharan Africa: A contemporaneous systematic review and meta-analysis

Objective: To summarise available data on the prevalence, aetiology, treatment and prognosis of heart failure (HF) in sub-Saharan Africa (SSA). Setting: This systematic review and meta-analysis included data from individuals recruited in primary to tertiary health facilities in SSA. Participants: All published and unpublished literatures between January 1, 1996 and June 23, 2017, of individuals aged 12 years and older and residing in sub-Saharan Africa. They must be of African descent. Outcome: Number of heart failure admissions into general wards or HF clinics; number of cases of the different aetiologies of HF; number of participants on the different medications for HF; number of cases of all-cause mortality in participants with HF, and the predictors of all-cause mortality. Due to a limited word count, only results on the aetiologies of HF will be presented in the abstract. Results: Thirty five full text articles were selected after screening of an initial 3785 titles and abstract. Hypertensive heart disease (HHD) (39.2% [95% CI = 32.6–45.9]) was the commonest cause of HF in SSA, followed by cardiomyopathies (CMO) (21.4% [95% CI = 16.0–27.2]) and rheumatic heart disease (RHD) (14.1% [95% CI = 10.0–18.8]). Ischaemic heart disease (7.2% [95% CI = 4.1–11.0]) was rare. Conclusion: HHD, CMO and RHD are the most common causes of HF in SSA, with HHD and CMO responsible for over 50% of the cases. Also, the last two decades have witnessed a relative reduction in the prevalence of RHD below 15.0%.