Spectrum of heart failure in 16 sub-saharan countries: drugs strategies and 8-year trends (the february study 2016-2023)
Authors: N'guetta R , Ali Toure I , Cavagna P , Diop I B , Limbole E , Kouam Kouam C , Ikama M S , Menta I , Mipinda J B , Balde D , Suliman A , Perier M C , Traore A , Antignac M , Jouven X 
Published: October 2024

Abstract

Background
Heart failure (HF) is a growing public health concern in Sub-Saharan Africa (SSA). The hospital prevalence studies estimate that in SSA, HF is responsible for 9.4% to 42.5% of all medical admission. However, little is known about the management of HF in hospitalization in SSA.

Purpose
To describe in hospital drugs strategies and 8-year trends in Africa.

Methods
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, causes of admission, 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&lt;40%), mildly reduced(LVEF[41-49%] or preserved(LVEF&gt;50%). All analyses were performed with random effect on countries through scripts developed in the R software(4.0.3(2020-10-10)).

Results
Overall, 2351 patients(57±17.5 years; 54% men) were admitted for HF in the February study. HF representing 44.6% of all patients admitted. Proportions of patients included for HF varied across countries from 28% Democratic Republic of the Congo to 75% in Guinea. 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 betablockers(BB)(30%VS46% and 46%) and angiotensin-converting enzyme inhibitors(ACEI)(50%vs77% 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. Proportions of drugs strategies differed significantly across countries adjusted for LVEF. Drugs 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, drugs 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.

Conclusion
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.