Heart failure outcomes in Sub-Saharan Africa: a scoping review of recent studies conducted after the 2022 AHA/ACC/HFSA guideline release

Abstract

BACKGROUND: Heart failure (HF) in Sub-Saharan Africa (SSA) presents unique challenges, with high prevalence and distinct epidemiological features compared to high-income settings. Despite its burden, recent comprehensive data are lacking, especially amidst recent 2022 AHA/ACC/HFSA guideline release. This scoping review aims to map the literature on HF in SSA, focusing on aetiologies, structural abnormalities, management practices, and outcomes to identify research gaps and inform clinical practice. METHODS: Studies from 2022-2024 published in English or French were included, covering adult patients > 18 years, all study designs except case reports. Studies not reporting any outcomes or focusing solely on one HF subtype were excluded. Literature from all SSA countries was searched using a FACET approach in databases including PubMed, Google Scholar, Cochrane and Scopus. RESULTS: Ten studies, evaluating 2039 patients, were analysed. Dilated cardiomyopathy (DCM), and Hypertensive cardiomyopathy (HCM) emerged as prominent aetiologies. Rheumatic heart disease was reported in only four studies. Common issues included high rates of electrolyte disturbances and anemia, which influenced patient outcomes. Guideline adherence exhibited significant deficiencies, notably with a suboptimal prescription rate of SGLT2 inhibitors (8.3-24.7%). Mortality rates ranged from 3.7% to 19%, linked to factors like low blood pressure and electrolyte imbalances. Hospital stays were variable but significant rehospitalization were common within 8-15 days post discharge and associated with non-compliance and lifestyle factors. CONCLUSION: HCM and DCM are prevalent heart failure aetiologies in SSA. Longitudinal studies are recommended to contextualise aetiological diagnosis and validate prognostic tools amidst limited resources. Enhanced guideline adherence, hypertension control and efficient post-discharge care are essential to reduce morbidity and mortality.