6ER-027 Management of heart failure in 16 Sub-Saharan African countries: drug strategies and 8-year trends (the February study 2016–2023)

Abstract

<h3>Background and Importance</h3> Heart failure (HF) is a growing cause of hospitalisation in Sub-Saharan Africa (SSA). However, scarce data are available about drug management of HF in SSA. <h3>Aim and Objectives</h3> To describe in hospital drugs management of HF and 8-year trends in Africa. <h3>Material and Methods</h3> We conducted a transversal and longitudinal study in cardiology departments of 37 hospitals (public and private) in 16 SSA countries. The February study is an ongoing observatory included all inpatients in February from each year since 2016. Collected data included socio-demographic and clinical characteristics, clinical, biological, complementary examinations, medicines, length of stay were collected by the investigating physicians. HF severity was defined according to proportion of left ventricular ejection fraction (LVEF): reduced (LVEF£40%), mildly reduced (LVEF(41–49%) or preserved (LVEF³50%). All analyses were performed with random effect on countries through scripts developed in the R software (4.0.3(2020–10–10)). <h3>Results</h3> Overall, 2351 patients (57±17.5 years; 54% men) were admitted for HF in the February study. At admission, 56% of patients had reduced LVEF; 12.5% had mildly reduced and 31.5% had preserved LVEF. Proportions of drug classes varied significantly according to LVEF: diuretics were significantly less prescribed in patients with preserved LVEF (65%) compared to patients with mildly reduced (77%) or reduced (73%) LVEF (p&gt;0.01). The same result was observed for beta blockers (BB) (30% vs 46% and 46%) and angiotensin-converting enzyme inhibitors (50% vs 77% and 71%) (p&lt;0.01). Mineralocorticoid receptor antagonists were significantly more prescribed in patients with preserved LVEF(p&lt;0.01). The proportion of treated with BB increased significantly over the years (p&lt;0.05) from 17% in 2016 to 62% in 2023. Drug strategies differed significantly according to LVEF (p&lt;0.01). The more reduced the LVEF, the more the drugs strategy increased. In patients with preserved LVEF, the proportion of monotherapy was 20%; this decreased to 9% in patients with reduced LVEF. Combinations of three drugs increased from 35% in patients with preserved LVEF to 46% in patients with reduced LVEF. Overall, drug strategies differed across years (p&lt;0.05): three-drug strategies increased from 35% in 2016 to 51% in 2023 and two-drug strategies decreased from 38% in 2016 to 23% in 2023. <h3>Conclusion and Relevance</h3> Up-titrated strategies were prescribed according to severity of HF and access to BB increased across years according to international guidelines. However, novel drugs classes remain unavailable in SSA. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest