Key result
Evidence-based medical therapy at discharge was prescribed in only 8.1% of patients hospitalized for acute heart failure, though prescription rates significantly increased from 0% in 2022 to 17.5% in 2024.
Why the study?
Heart failure is a growing burden in sub-Saharan Africa, but data on adherence to evidence-based medical therapy following the 2021 ESC/ACC guidelines remain scarce.
Cohort (n=358)
No
Answers are grounded in this paper and cite their sources.
Despite an increasing trend over time, adherence to guideline-directed medical therapy for heart failure remains extremely low in this resource-limited setting, with only 8.1% of patients receiving evidence-based medical therapy at discharge.
Heart failure (HF) is a growing burden in sub-Saharan Africa, yet data on adherence to evidence-based medical therapy (EBMT) following the 2021 ESC/ACC guidelines remain scarce. This study explores patterns of EBMT prescriptions in a resource-limited African setting. We conducted a retrospective cohort study using medical records from patients hospitalised with acute HF at Laquintinie Hospital, Douala, Cameroon (2022–2024). The primary outcome was EBMT prescription at discharge, defined as at least Class IIa ESC/ACC recommendation irrespective of HF subtype and included medications like Renin-angiotensin aldosterone system (RAAS) inhibitors/Angiotensin Receptor–Neprilysin Inhibitors (ARNi), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Due to a limited sample size, analyses were primarily descriptive. Among 358 patients (median age 63 years, 50.6% female), hypertensive heart disease was the leading HF aetiology (33.0%) and HFrEF predominated (n = 192, 53.6%). EBMT at discharge was prescribed in patients. EBMT appeared to increase over the years (0% in 2022, 1.9% in 2023 and 17.5% in 2024; χ 2 = 28.23, p < 0.001) and vary by HF subtype: 5.7%, 14.3%, 11.8% and 0% in patients with HFrEF, HFmrEF, HFpEF and unclassified subtypes (χ 2 = 7.15, p = 0.067). Among patients with HFrEF, only 5.7% received quadruple therapy. Median hospital stay was 8 days (IQR 6–12) and mortality rate was 11.7%, with no apparent difference based on EBMT prescription ( p > 0.05). EBMT use appeared to increase over time, but approximately nine in ten HF patients may be discharged without recommended medical therapies. Improving access to affordable to SGLT2 inhibitors and clinician education on updated guidelines could help address care gaps in resource-limited settings. Further research is needed to confirm these observations.
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Siddikatou et al. (2025) conducted a cohort in Acute heart failure (n=358). Evidence-based medical therapy (EBMT) was evaluated on EBMT prescription at discharge (p=<0.001). Evidence-based medical therapy at discharge was prescribed in only 8.1% of patients hospitalized for acute heart failure, though prescription rates significantly increased from 0% in 2022 to 17.5% in 2024.
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