Population-Based Epidemiology of Heart Failure in a Low-Income Country: The Haiti Cardiovascular Disease Cohort
Justin R. Kingery, Nicholas L S Roberts, Jean Lookens Pierre, Rodney Sufra, Eliezer Dade, Vanessa Rouzier, Rodolphe Malebranche, Michel Théard, Parag Goyal, Altaf Pirmohamed, Lily D. Yan, Myung Hee Lee, Denis Nash, Miranda Metz, Robert N. Peck, Monika M. Safford, Daniel W. Fitzgerald, Marie Deschamps, Jean W. Pape, Margaret L. McNairy
Abstract
Background: Cardiovascular disease disproportionately affects persons living in low- and middle-income countries and heart failure (HF) is thought to be a leading cause. Population-based studies characterizing the epidemiology of HF in these settings are lacking. We describe the age-standardized prevalence, survival, subtypes, risk factors, and 1-year mortality of HF in the population-based Haiti Cardiovascular Disease Cohort. Methods: Participants were recruited using multistage cluster-area random sampling in Port-au-Prince, Haiti. A total of 2981 completed standardized history and exam, laboratory measures, and cardiac imaging. Clinical HF was defined by Framingham criteria. Kaplan-Meier and Cox proportional hazard regression assessed mortality among participants with and without HF; logistic regression identified associated factors. Results: Among all participants, the median age was 40 years (interquartile range, 27–55), and 58.2% were female. Median follow-up was 15.4 months (interquartile range, 9–22). The age-standardized HF prevalence was 3.2% (93/2981 [95% CI, 2.6–3.9]). The average age of participants with HF was 57 years (interquartile range, 45–65), and 67.7% were female. The first significant increase in HF prevalence occurred between 30 to 39 and 40 to 49 years (1.1% versus 3.7%, P =0.003). HF with preserved ejection fraction was the most common HF subtype (71.0%). Age (adjusted odds ratio, 1.36 [1.12–1.66] per 10-year increase), hypertension (2.14 [1.26–3.66]), obesity (3.35 [95% CI, 1.99–5.62]), poverty (2.10 [1.18–3.72]), and renal dysfunction (5.42 [2.94–9.98]) were associated with HF. One-year HF mortality was 6.6% versus 0.8% (hazard ratio, 7.7 [95% CI, 2.9–20.6]; P <0.0001). Conclusions: The age-standardized prevalence of HF in this low-income setting was alarmingly high at 3.2%—5-fold higher than modeling estimates for low- and middle-income countries. Adults with HF were two decades younger and 7.7× more likely to die at 1 year compared with those in the community without HF. Further research characterizing the population burden of HF in low- and middle-income countries can guide resource allocation and development of pragmatic HF prevention and treatment interventions, ultimately reducing global cardiovascular disease health disparities. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03892265.