Sex differences in heart failure: an analytical cross-sectional study at Laquintinie Hospital, Douala, Cameroon, 2021-2024

Q: What are the key findings of this study?

Among hospitalized heart failure patients, female sex was associated with a 3.64-fold higher adjusted odds of atrial fibrillation compared to male sex, despite similar overall in-hospital mortality.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Heart failure (n=757). Intervention: Female sex vs. Male sex. Primary outcome: Atrial fibrillation (AOR 3.64, 95% CI 1.91-6.94, p=<0.001).

Q: What does this research mean for the field?

Female heart failure patients have a significantly higher risk of atrial fibrillation compared to males, while overall in-hospital mortality shows no significant sex difference. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Djibrilla Siddikatou; Marie Solange Ndom; Valérie Ndobo; Mandeng Ma Linwa Edgar; Sidick Mouliom; Hermann Tsague; Raissa Tchounja Kamgang; Ali Abas; Ba Hamadou; Seck M’Baye M’baye Salissou; Félicité Kamdem

doi:10.11604/pamj.2026.53.34.48976

January 27, 2026Pan African Medical JournalOpen Access

Sex differences in heart failure: an analytical cross-sectional study at Laquintinie Hospital, Douala, Cameroon, 2021-2024

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Key result

Female sex is linked to ~3.6-fold higher odds of AF among hospitalized heart failure patients.

AOR 3.64
95% CI 1.91-6.94
P<0.001
n=757

Why the study?

Heart failure is a major cause of mortality in sub-Saharan Africa, but limited data exist on sex-specific differences in HF presentation and outcomes.

Study Design

Type

Cross-Sectional (n=757)

Multicenter

No

Structured PICO

P

Population

757 patients hospitalized with acute heart failure at a single center in Cameroon between 2021 and 2024, evaluated for sex-based variations in clinical profiles and in-hospital outcomes.

O

Outcome

Sex-based variations in clinical profiles, aetiologies, and in-hospital outcomes including atrial fibrillation, ischemic cardiomyopathy, renin-angiotensin-aldosterone system (RAAS) inhibitor use at discharge, hypertension, and in-hospital mortality

Main Result

Odds Ratio: 3.64 (95% CI 1.91–6.94)

Absolute Event Rate: 34.1% vs 19.1%

p-value: p=<0.001

Significant sex differences exist in heart failure phenotypes in Cameroon, with females more frequently presenting with atrial fibrillation and hypertension, while males more often present with ischemic cardiomyopathy and renal dysfunction.

Limitations

Convenience sampling of only hospitalized cases introduces selection bias, likely representing more severe HF cases.
Omission of coronary angiography and high prevalence of idiopathic diagnoses potentially caused misclassification of ischemic heart disease.
High missing rate for ECG data (53.5%) affects the robustness of atrial fibrillation and ischemic cardiomyopathy models.
Inclusion of data from 2021 (during the COVID-19 pandemic) could have led to an underestimation of HF mortality.
Retrospective cross-sectional design limits causal inferences.
Retrospective cross-sectional design prevents causal insights
Single-center setting requires multicenter validation
High rate of missing diagnostic data (e.g., 53.5% missing ECG)
Lack of coronary angiography increases risk of misclassification of ischemic heart disease
Poor model fit for RAAS inhibitors outcome requiring cautious interpretation

Implication

Female HF patients may warrant closer AF monitoring; leaves open whether this improves prognosis in sub-Saharan cohorts.

Abstract

Introduction: heart failure (HF) is a major cause of mortality in sub-Saharan Africa. Limited data exist on sex-specific differences in HF presentation and outcomes. This study assessed sex-based variations in clinical profiles, aetiologies, and in-hospital outcomes among HF patients in Cameroon. Methods: we conducted an analytical cross-sectional study of patients admitted with clinical HF at Laquintinie Hospital, Douala (January 2021-December 2024). Patients without gender or outcome data were excluded. Sociodemographic, clinical, and treatment variables were compared by sex using appropriate statistical tests (p<0.05). Penalized logistic regression, validated via bootstrapping, modeled four outcomes: atrial fibrillation, ischemic cardiomyopathy, renin-angiotensin-aldosterone system (RAAS) inhibitor use, and hypertension. Missing data were imputed. Results: among 757 patients, 51.3% were female. Hypertension was present in 57.1%, more common in females (64.4% vs. 49.3%, p<0.001), with nearly equal known and new-onset cases. Females were older (median age 66 vs. 60 years, p<0.001) and had higher atrial fibrillation risk (AOR=3.64, 95% CI: 1.91-6.94). Males had more ischemic cardiomyopathy (AOR=0.48, p=0.035) and renal dysfunction (43.8% vs. 30.1%, p=0.003). Females more frequently received RAAS inhibitors/ARNI at discharge (33.5% vs. 26.3%, p=0.031). In-hospital mortality was 17.0%, with no sex difference (p=0.288). Conclusion: significant sex differences exist in HF presentation and treatment at Laquintinie. Strategies should include atrial fibrillation screening in females and renal monitoring in males. Findings support the need for sex-specific interventions and multicenter validation in similar settings. These cross-sectional associations highlight prevalence patterns but require prospective studies for causal insights.

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Published by Pan African Medical Journal · CC BY

Cite This Study

Siddikatou et al. (2026) conducted a cross-sectional in Heart failure (n=757). Female sex vs. Male sex was evaluated on Atrial fibrillation (AOR 3.64, 95% CI 1.91-6.94, p=<0.001). Among hospitalized heart failure patients, female sex was associated with a 3.64-fold higher adjusted odds of atrial fibrillation compared to male sex, despite similar overall in-hospital mortality.

synapsesocial.com/papers/6a1547cd37103a43379f7dc1 https://doi.org/10.11604/pamj.2026.53.34.48976