The Ibadan Chronic Heart Failure Project: Baseline Clinical Profile, Management, and Six-Month Outcomes of the First 1,290 Participants.

Abstract

BACKGROUND: Chronic heart failure is an increasing cause of morbidity and mortality across sub-Saharan Africa, yet contemporary data from large African cohorts remain limited. OBJECTIVES: To characterise the clinical profile, management, and short-term outcomes of patients with chronic HF enrolled in the Ibadan Heart Failure Project. METHODS: The Ibadan Heart Failure Project is a real-life, pragmatic, prospective, hospital-based cohort of adults with chronic heart failure being conducted at University College Hospital, Ibadan, Nigeria. The present report is based on participants recruited between September 1, 2016, and December 31, 2022. Baseline sociodemographic, clinical, and echocardiographic data were obtained, and participants were followed for six months. The primary outcomes were all-cause mortality and hospital readmission. RESULTS: Among 1,290 patients (mean age 56.7 ± 15.4 years; 55.8% men), hypertensive heart disease was the leading cause, followed by dilated cardiomyopathy and rheumatic heart disease. Women were younger and more likely to have preserved or mildly reduced ejection fraction. The use of sodium-glucose cotransporter-2 inhibitors (3.3%) was low. The cumulative incidence of readmission, death, and a composite of these events at six months was 4.9%, 12.9%, and 17.8%, respectively. The use of beta blockers was associated with 43% reduction in the risk of readmission (HR-0.57, 95%CI-0.33-0.97), while the use of renin -angiotensin-aldosterone axis inhibitors was associated with 62% and 46% reduction in the risk of death and composite of readmission and death, respectively. A unit increase in serum creatinine is associated with 11% and 32% increase in readmission and death, respectively (HR-1.11, 95%CI-1.00-1.23 and HR-1.32, 95% CI-1.21-1.45, respectively) In addition, a unit increase in tricuspid annular plane systolic excursion is associated 64% and 53% lower risk of death and composite of readmission and death, respectively. (HR-0.36, 95%CI-0.22-0.60, HR-0.47, 95%CI-0.30-0.73 respectively). No significant sex or age-related differences were observed in adjusted risks of hospitalization or death. CONCLUSIONS: Hypertensive heart disease remains the predominant cause of chronic heart failure in Nigeria. Despite similar short-term outcomes across sexes, suboptimal use of newer evidence-based therapies underscores the need for system-level interventions to improve HF care in sub-Saharan Africa.