Сердечная недостаточность в Африке остается смертельной: данные масштабного исследования

A University of Cape Town (UCT) led study, the Sub-Saharan Africa Survey of Heart Failure (THESUS II), has found that the conditions of those most affected by heart failure in Africa haven’t changed much. Africans presenting with heart failure are still 10-20 years younger than other cases worldwide, are of working age and include a large proportion of women. However, the study covering more than 1 500 acute cases of heart failure across Africa also found that “heart failure in Africa remains deadly”, with one in 10 of those affected dying during their hospital presentation and one in five dying within six months of their presentation. The large research project, led by a team at the UCT’s Cape Heart Institute (CHI), under the umbrella of the Pan African Cardiac Society (PASCAR) has been published in The Lancet. While untreated high blood pressure and the historical disease affecting the African population are still important factors, there is evidence that factors like coronary artery disease due to changing diets rich in fat are becoming more important. Professor Karen Sliwa, principal investigator of the study and director of the CHI, says: “The study’s strengths are the scale, geographical breadth, a pragmatic design suited to resource-limited settings, and the first multi-country presentation-rate estimates for African acute heart failure. The project was a real team effort. I would thank all the investigators for the very time-consuming work, often in very difficult scenarios without any remuneration.” The successful completion of THESUS-HF II reflects the strength of collaboration between African clinicians and researchers and demonstrates the importance of generating high-quality evidence that addresses the realities of cardiovascular disease on the continent. The study was conducted across 17 African countries. Importantly, THESUS-HF II extends beyond generating new evidence. The project also contributes to developing the next generation of African cardiovascular researchers by supporting two PhD students, Dr Julia Hahnle and Dr Shaazia Allie, whose research is part of the project. Hahnle presented the main findings, “The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF II): Aetiology, 30- days and 6 months outcome”, on behalf of the study investigators at the world’s largest and most influential cardiac meeting, the European Society of Cardiology’s Annual Congress in Munich, Germany. The study is a testament to what can be achieved through African-led collaboration and investment in research capacity. It marks an important milestone for PASCAR and reinforces the society’s commitment to advancing cardiovascular research, education and care across Africa. Study background Original findings from the THESUS-HF study, conducted more than 15 years ago, revealed that heart failure – a condition that affects the heart’s ability to provide the body with the blood supply it needs – is very different in sub-Saharan Africa compared to the rest of the world. In sub-Saharan Africa, many younger people of working age present to hospital with acute heart failure, more women than men are affected, death rates are high, and the underlying causes (including high blood pressure but not heart attacks) are varied. Despite the important insights it provided, the original THESUS-HF included a limited number of countries and regions in sub-Saharan Africa and many things have changed over time – including population growth and ageing, urbanisation and risk factor profiles linked to life-style changes across the continent. PASCAR’s ability, with the critical support of UCT’s CHI, to engage with more sentinel sites and investigators across the continent has continued to grow. What the researchers expected to find? Applying the enhanced capacity of engaging clinicians and researchers from 50 hospitals across 17 African countries, the researchers first expected to gather a “more complete picture of heart failure in Africa than ever before”. At the same time, they expected to see a “changing profile of those presenting with heart failure in terms of why they developed their condition and how it affected them”. The way forward PASCAR and the CHI, along with the network of THESUS-HF II contributors across the continent, plan to publish a series of reports that further illuminate the impact and consequences of heart failure from a uniquely African perspective. They will also be working to increase the number of sites and countries across the region that can contribute to future studies to better understand and respond to the challenges of heart failure and other deadly forms of heart disease in Africa. Professor Simon Stewart, co-investigator, says: “PASCAR, the Cape Heart Institute and all the investigators across Africa are to be warmly congratulated for completing the region’s largest and most detailed study of heart failure to date. The findings are incredibly important; they reveal what has and hasn’t changed over time. Sadly, heart failure in Africa is still deadly and affects many young people of working age. More encouragingly, access to life-saving medicines is improving. The THESUS-HF II provides an incredibly important platform to support and promote life-saving heart failure detection and care across Africa.”