What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=168). Primary outcome: Prolonged hospitalization (≥7 days) (OR 6.1, 95% CI 1.5-23.5, p=0.009).

May 24, 2026Cureus0 citationsOpen Access

Epidemiological and Clinical Profile of Heart Failure at the Morafeno University Hospital of Toamasina, Madagascar: A Three-Year Retrospective Study

Q: What does this research mean for the field?

In a resource-limited setting in Madagascar, heart failure predominantly affects relatively young patients with ischemic and hypertensive etiologies, and right ventricular systolic dysfunction, atrial fibrillation, and intraventricular conduction disorders are key independent prognostic factors for prolonged hospitalization and rehospitalization. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

RSRado Olivier Rakoto SedsonUniversity of Toamasina JBJean Christian BezaraUniversity of Toamasina HRHoly Mihanta Sabrina RanaivosonUniversité de Fianarantsoa

Key Result

Right ventricular systolic dysfunction was independently associated with prolonged hospitalization (adjusted OR 6.1), while atrial fibrillation and intraventricular conduction disorders predicted rehospitalization.

Study Design

Type

Observational (n=168)

Multicenter

Structured PICO

Population

168 patients hospitalized for echocardiographically confirmed heart failure at a single center in Madagascar. Mean age 54 ± 14 years, 50.6% female.

Outcome

Prolonged hospitalization (≥7 days), rehospitalization during the study period, and in-hospital mortalityhard clinical

In a resource-limited setting in Madagascar, heart failure affects relatively young patients and is primarily driven by ischemic and hypertensive etiologies, with right ventricular dysfunction and atrial fibrillation serving as key prognostic markers.

Main Result

Effect estimate: OR 6.1 (95% CI 1.5-23.5)

p-value: p=0.009

Limitations

Retrospective design relies on medical record documentation, which may be incomplete or inconsistent
Single-center study at a tertiary referral hospital, limiting generalizability and introducing referral bias
Data on natriuretic peptides (BNP/NT-proBNP) were available for only a small subset of patients
Information on medication adherence, quality of life, and functional capacity at follow-up was not systematically collected
Relatively small number of mortality events limited statistical power for identifying independent predictors of in-hospital mortality

Abstract

Background Heart failure (HF) represents a major public health challenge worldwide, with particularly high morbidity and mortality in resource-limited settings. Despite its growing burden in sub-Saharan Africa, comprehensive epidemiological data from Madagascar remain scarce. This study aimed to describe the epidemiological, clinical, paraclinical, therapeutic, and prognostic profile of patients hospitalized for heart failure at the Centre Hospitalier Universitaire Morafeno Toamasina (University Hospital Center Morafeno Toamasina) (CHUMT), and to identify independent factors associated with prolonged hospitalization, rehospitalization, and in-hospital mortality. Methods We conducted a retrospective, cross-sectional, descriptive study in the cardiology department of CHUMT from January 1, 2021, to December 31, 2023. All patients hospitalized for echocardiographically confirmed heart failure were included. Data were collected from medical records using standardized forms. Binary logistic regression analyses (univariate followed by multivariate) were performed using Stata version 13 (StataCorp, College Station, USA) to identify independent factors associated with prolonged hospitalization (≥7 days), rehospitalization during the study period, and in-hospital mortality. Statistical significance was set at p<0.05. Results A total of 168 patients were included over the 36-month study period. The mean age was 54 ± 14 years (range: 18-89 years), with a sex ratio of 0.97 (50.6% female). The most prevalent cardiovascular risk factors were hypertension (n=86; 51.2%), overweight (n=46; 27.4%), and diabetes mellitus (n=37; 22.0%). Global heart failure was the predominant clinical form (n=127; 75.6%). Ischemic cardiomyopathy was the leading etiology (n=46; 27.4%), followed by hypertensive heart disease (n=39; 23.2%). Heart failure with reduced ejection fraction (HFrEF, left ventricular ejection fraction (LVEF) <40%) accounted for 53.6% (n=90) of cases. Clinical outcomes included favorable discharge in 81.5% (n=137) of cases, in-hospital mortality of 9.5% (n=16), and a 6-month rehospitalization rate of 41.7% (n=70). In multivariate analysis, right ventricular systolic dysfunction was the only independent factor associated with prolonged hospitalization (adjusted OR = 6.1; 95% CI: 1.5-23.5; p = 0.009). Atrial fibrillation (adjusted OR = 3.4; 95% CI: 1.3-29.3; p = 0.036) and intraventricular conduction disorders (adjusted OR = 2.3; 95% CI: 1.4-36.6; p = 0.013) were independently associated with rehospitalization. No factor reached statistical significance for in-hospital mortality in multivariate analysis. Conclusion Heart failure at CHUMT affects relatively young patients, predominantly presenting with global heart failure and primarily attributable to ischemic and hypertensive etiologies. Right ventricular systolic dysfunction, atrial fibrillation, and intraventricular conduction disorders are key independent prognostic factors. Strengthening cardiovascular prevention strategies, improving early diagnosis, and implementing structured therapeutic patient education programs are essential to reduce mortality, hospitalization duration, and readmission rates in this resource-limited setting.

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