The Burden of Heart Failure in Africa

This editorial refers to ‘A predominance of hypertensive heart failure in the Abuja Heart Study cohort of urban Nigerians: a prospective clinical registry of 1515 de novo cases’, by D. Ojji et al., published in this issue on pages 835–842. Over the last few years, the focus of the international health community has shifted from communicable diseases as the main cause of morbidity and mortality in Africa (and indeed in the world in general) to non-communicable diseases.1,2 Relatively scant recent research suggests that in Africa cardiovascular (CV) diseases are a leading cause of morbidity and mortality, where up to 25% of admissions to hospitals are for CV disease, including hypertension (HTN).3-14 Heart failure (HF) is the most common CV disorder and the main driver of CV adverse morbidity and mortality.3-15 In this respect, the study by Ojji et al. in this month’s issue of the journal16 is a welcomed addition. In this hospital-based study, the authors report on the current spectrum of (CV) diseases in Abuja—the new and modern capital of the Federal Republic of Nigeria. The data from Abuja were compared with the findings in Soweto, a predominantly Black community in South Africa. The findings suggest that CV diseases in Abuja, Nigeria are mainly non-ischaemic in origin and occur mainly in a younger and productive age group. Hypertension was found to be the most common cause, followed by dilated cardiomyopathies and rheumatic heart disease. The authors noted some subtle differences in the heart disease pattern in Abuja and Soweto. While there are higher rates of HTN and hypertensive HF in Abuja, ischaemic heart disease and right HF were more common in the Soweto study. As noted by the authors, this may be related to a higher burden of CAD and lung disease risk factors such as cigarette smoking, obesity, dyslipidaemia, and diabetes in Soweto compared with Abuja. Furthermore, peripartum cardiomyopathy is not as common a cause of CV disease and HF as expected.