Table 5.
Aetiologies of heart failure across sub-Saharan Africa (1996–2017).
| First name of author, publication year | Country | Region | Area | Study design | Study setting | Data collection | Study population | Random sampling | Male (%) | Mean age (in years) | Age range (in years) | Sample size | Criteria for diagnosis of HF | Aetiology of heart failure | Diagnostic criteria of IHD | Study quality |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Oyoo, 1999 [1] | Kenya | Eastern | Urban | Cross-sectional | Hospital-based | Prospective | Patients ≥13 years admitted for congestive heart failure | No | 48.4 | NR | ≥13 | 91 | NR | Rheumatic heart disease (32%); Cardiomyopathy (25.2%); Hypertensive heart disease (17.6%), pericardial disease (13.2%); Cor pulmonale (7.7%); Ischaemic heart disease (2.2%); Congenital heart disease (2.2%). | ECG and 2D Doppler Echocardiography | Moderate |
| Thiam, 2003 [2] | Senegal | Western | Urban | Cross-sectional | Hospital- based | Prospective | Patients suffering from heart failure | No | NR | 50.0 | 12–91 | 170 | NR | Hypertension heart disease (34%); Valvular heart diseases (45%); Chronic renal failure (14.5%); Ischaemic heart disease (18.9%); Pulmonary embolism with Right heart failure (3.5%) and aetiology unspecified (6%) | Clinical presentation ECG and Echocardiography | High |
| Kingue, 2005 [3] | Cameroon | Central | Urban | Cross-sectional | Hospital-based | Retrospective and prospective | Patients presenting with clinical and echocardiographic signs of heart failure | No | 59.3 | 57.3 | ≥16 | 167 | NR | Hypertensive heart disease (54.5%); Cardiomyopathies (26.3%); Rheumatic heart disease (24.6%), Valvular heart diseases (24.6%), Ischaemic heart disease (2.4%). | 12-lead ECG and Echocardiography | Moderate |
| Familoni, 2007 [4] | Nigeria | Western | Semi-urban | Cross-sectional | Hospital-based | Prospective | Patients presenting with acute heart failure | No | 61.7 | 57.6 | NR | 82 | NR | Hypertensive heart disease (43.4%); Dilated cardiomyopathy (28%); Rheumatic heart disease (9.8%), Endomyocardial fibrosis (2.2%); Cor pulmonale (3.7%); Ischaemic heart disease (8.5%); others (3.5%) | NR | Moderate |
| Owusu, 2007 [5] | Ghana | Western | Urban | Cross-sectional | Hospital-based | Prospective | Patients above 12 years admitted with diagnosis of heart failure | No | 51.5 | 51.1 | 13–90 | 167 | Framingham criteria | Hypertensive heart disease (42.5%); Rheumatic heart disease (21.6%); Dilated cardiomyopathy (17.4%); pericardial disease (4.2%); Ischaemic heart disease (3.6%); Cor pulmonale (2.4%) and Congenital heart disease (2.4%) | 12-lead ECG and Echocardiography | High |
| Stewart, 2008 [6] | South Africa | Southern | Urban | Cross-sectional | Hospital-based | Prospective | Novo presentations in patients with heart failure and related cardiomyopathies | No | 43 | 55.0 | NR | 884 | ESC | Dilated cardiomyopathy (35%); Hypertensive heart disease (33%); Right heart failure (27%); Ischaemic heart disease (9%) and Valvular heart disease (8%) | 12-lead ECG; echocardiography; stress test; cardiac nuclear imaging and cardiac catheterization | High |
| Ogah, 2008 [7] | Nigeria | Western | Urban | Cross-sectional | Hospital-based | Retrospective | All cases of echocardiography done in the department of medicine between September 2005 and February 2007 | No | 51.6 | 54.0 | 15–90 | 1441 | NR | Hypertensive heart disease (56.7%); Rheumatic heart disease (3.7%); Dilated cardiomyopathy (3.0%); Pericardial disease (1.8%); cor pulmonale (1.6%); Ischaemic heart disease (0.6%); Congenital heart disease (0.4%); diabetic heart disease (0.4%); thyroid heart disease (0.1%); Sickle cell cardiopathy (0.1%). | NR | High |
| Onwuchekwa, 2009 [8] | Nigeria | Western | NR | Cross-sectional | Hospital-based | Retrospective | Congestive cardiac failure cases admitted and/or discharged from the medical wards | No | 57.2 | 54.4 | 18–100 | 423 | Framingham criteria | Hypertensive heart disease (56.3%); Cardiomyopathies (12.2%); Chronic renal failure (7.80%); Severe anemia (4.72%); Rheumatic heart diseases (4.26%). Cor pulmonale (2.13%); Congenital valvular heart disease (0.24%); Ischemic heart disease (0.24%); Missing (11.11%) | 12-lead ECG; echocardiography | Moderate |
| Damasceno, 2012 [10] | The THESUS-HF registry | SSA | – | Cohort | Hospital-based | Prospective | Patients admitted with acute heart failure | No | 49.2 | 52.3 | ˃12 | 1006 | European Society of Cardiology (ESC) guidelines on HF | Hypertensive heart disease (45.4); Idiopathic dilated cardiomyopathy (18.8%); Rheumatic heart disease (14.3%); Ischaemic heart disease (7.7%); Peripartum cardiomyopathy (7.7%); Pericardial tamponade (6.8%); HIV cardiomyopathy (2.6%); Endomyocardial fibrosis (1.3%). | 12-lead ECG; echocardiography; stress test | Moderate |
| Kwan, 2013 [12] | Rwanda | Eastern | Rural | Cross-sectional | Hospital-based | Retrospective | Heart failure patients treated between November 2006 and march 2011 | No | 30.0 | NR | NR | 138 | NR | Dilated cardiomyopathy (54%), Rheumatic heart disease (25%), hypertensive heart disease (8%) and ischaemic heart disease (0%) | NR | Moderate |
| Massouré, 2013 [13] | Djibouti | Eastern | NR | Cohort | Hospital-based | Prospective | Adults hospitalized for heart failure | No | 84.0 | 55.8 | 27–75 | 45 | Framingham criteria | Coronary artery disease (62%); hypertensive heart disease (18%); rheumatic valvular disease (13%) and primary dilated cardiomyopathy (7%) | 12-lead ECG; echocardiography; stress test | Moderate |
| Ojji, 2013 [14] | Nigeria | Western | Urban | Cross-sectional | Hospital-based | Prospective | Patients with novo presentations of heart disease | No | 49.3 | 49.0 | NR | 1515 | European Society of Cardiology (ESC) guidelines on HF | Hypertensive heart disease (60.6%); Idiopathic dilated cardiomyopathy (12.0%); Valvular rheumatic heart disease (8.6%); peripartum cardiomyopathy (5.3%); Alcoholic cardiomyopathy (4.2%); Thyrotoxic heart disease (2.9%); right heart failure (2.5%); Ischaemic heart disease (0.4%) | ECG; Cardiac enzymes; Echocardiography | High |
| Makubi, 2014 [16] | Tanzania | Eastern | Urban | Cohort | Hospital-based | Prospective | Patients ≥18 years of age with heart failure defined by the Framingham criteria | No | 49.0 | 55.0 | ≥18 | 427 | Framingham criteria | Hypertensive heart disease (45%); Cardiomyopathy (28%); Rheumatic heart disease (12%); Ischaemic heart disease (9%); Othersa (6%) | 12-lead ECG; echocardiography; angiography | High |
| Ogah, 2014 [17] | Nigeria | Western | Urban | Cross-sectional | Hospital-based | Prospective | Patients presenting with acute heart failure | No | 54.9 | 56.4 | NR | 452 | Framingham criteria and ESC | Hypertensive heart disease (78.5%); Dilated cardiomyopathy (7.5%); Cor pulmonale (4.4%); Pericardial disease (3.3%); Rheumatic heart disease (2.4%); Ischaemic heart disease (0.4%) | 12-lead ECG and Echocardiography | High |
| Pio, 2014 [18] | Togo | Western | Urban | Cross-sectional | Hospital-based | Prospective | Hospitalized patients with heart failure | No | 48.2 | 52.2 | 18–106 | 297 | European Society of Cardiology (ESC) guidelines on HF | Hypertensive heart disease (43.1%); Ischaemic heart disease (19.2%); Peripartum cardiomyopathy (11.8%); valvulopathies (11.8%); HIV-related cardiopathy (3.4%); Thyrotoxic heart disease (3%); Cor pulmonale (2.7%); congenital cardiopathies (2.7%); Chronic alcoholism (2%) and idiopathic (5.9%). | ECG; Cardiac enzymes; Echocardiography | High |
| Pio, 2014 [19] | Togo | Western | Urban | Cross-sectional | Hospital-based | Retrospective | Files of patients hospitalized with heart failure | No | NR | 36.5 | 18–45 | 376 | NR | Hypertensive heart disease (42.8%); Valvulopathies (18.1%); Peripartum cardiomyopathy (15.4%); Idiopathic dilated cardiomyopathy (5.8%); Alcoholic cardiomyopathy (3.2%); IHD (2.7%); Congenital cardiopathy (2.7%); Cor pulmonale (2.1%); thyrotoxic heart failure (1.8%); Pericardial tamponade (1.1%) and HIV-associated myocarditis (1.1%) | ECG; Cardiac enzymes; Echocardiography | Low |
| Dokainish, 2015 [22] | The INTER-CHF registry | SSA | – | Cohort | Hospital-based | Prospective, international, multicenter | Ambulatory and hospitalized adult patients with heart failure | Yes | 51.8 | 53.4 | ≥18 | 1294 | Boston criteria of HF | Hypertensive heart disease (35%); Ischaemic cardiomyopathy (20%); Idiopathic dilated cardiomyopathy (14.5%); Valvular rheumatic heart disease (7.2%); Endocrine/metabolic heart disease (5.3%); Vavlular non-rheumatic heart disease (2.3%); Alcohol/drug induced cardiopathy (0.7%); HIV cardiomyopathy (0.7%). | 12-lead ECG; echocardiography | Moderate |
| Ansa, 2016 [24] | Nigeria | Western | NR | Cross-sectional | Hospital-based | Retrospective medical record review | All cardiovascular admissions to the medical wards | No | NR | NR | ≥18 | 144 | NR | Hypertensive heart disease (48.6%); dilated cardiomyopathy (35.4%); Anaemia (14.6%) and Rheumatic heart disease (1.4%) | NR | Low |
| Abebe 2016 [25] | Ethiopia | Eastern | Urban | Chart review | Hospital-based | Retrospective | Medical records of patients admitted for heart failure | NR | 30.2 | 53.6 | NR | 311 | NR | Valvular heart disease (40.8%); Hypertensive heart disease (16.1%); Ischaemic heart disease (15.8%); Dilated cardiomyopathy (12.5%), Cor pulmonale (4.5%); Others (10.3%) | NR | Moderate |
| Kingery, 2017 [27] | Tanzania | Eastern | Urban | Cohort | Hospital-based | Prospective | Medical inpatients admitted for heart failure | No | 44.1 | 52.0 | ≥18 | 145 | Framingham criteria of HF | Hypertensive heart disease (42.8%); dilated cardiomyopathy (19.3%); Valvular heart disease (16.6%); cor pulmonale (7.6%); ischaemic heart disease (6.2%); Other causes (7.6%) | 12-lead ECG; echocardiography | High |
| Boombhi, 2017 [28] | Cameroon | Central | Urban | Cross-sectional | Hospital-based | Retrospective | Patients hospitalized for acute heart failure, diagnosed on clinical and/or ultrasound evidence | No | 42.7 | 61,5 | 16–95 | 148 | NR | Hypertensive heart disease (30.16%); Dilated cardiomyopathy (28.57%); Valvular heart disease (11.90%); Chronic cor pulmonale (8.73%); Ischemic heart disease (6.35%); Pericardial diseases (3.96%); Peripartum cardiomyopathy (3.18%) | 12-lead ECG; echocardiography | Low |
| Traore, 2017 [29] | Ivory Coast | Western | Urban | Cross-sectional | Hospital-based | Retrospective | Patients hospitalized for heart failure | No | 51.0 | NR | NR | 257 | NR | Hypertensive heart disease (22.9%); Dilated cardiomyopathy (55.57%); Valvular heart disease (6.76%); Ischemic heart disease (11.23%); Other (9.9%) | Echocardiography ± coronarography | Low |
Othersa=Tuberculosis; HIV-related cardiomyopathy; endomyocardial fibrosis; obstructive pulmonary disease; IHD=Ischaemic heart disease; ECG=Electrocardiography; HF=Heart failure; THESUS-HF=sub-Saharan Africa Survey for Heart Failure; INTER-CHF=INTERnational Congestive Heart Failure; ESC=European Society of Cardiology; NR=not reported.