Heart failure in Africa: putting Africa on the map

The “Correct the Map” campaign is a global initiative calling for the replacement of the Mercator projection with the Equal Earth projection to accurately represent Africa’s true size and significance (Figure 1A)1. Launched by advocacy groups Africa No Filter and Speak Up Africa, and officially endorsed by the African Union in August 2025, the campaign highlights how centuries-old distortions have shaped perceptions of the continent. Just as the Mercator projection minimizes Africa on the world map, the continent has long been underrepresented in global research—including in critical areas such as heart failure. Heart failure (HF) remains a major global health burden, with varying aetiologies and outcomes in Africa compared with Western countries. While the Sub-Saharan Africa Survey of Heart Failure (THESUS-HF) had taken strides forward in understanding the aetiology of HF in nine African countries,2 much of the epidemiological landscape has shifted over the past decade. Rapid urbanization and the adoption of Western lifestyles in many low- and middle-income countries (LMICs) in Africa have increased the prevalence of non-communicable risk factors, resulting in a dual burden of communicable diseases and conditions associated with an occidental lifestyle. Although HF management guidelines have been adapted for African settings, limited information exists on healthcare infrastructure, clinical expertise, and diagnostic capacity for HF on the continent. In addition, little is known about whether patients can access, and afford, guideline-recommended therapies and interventional treatments. This is particularly important in Africa as HF imposes substantial economic strain on individuals, families, and health systems. In Africa the disease primarily affects individuals in their most economically productive years, compounding the financial burden. To address these important gaps, the ongoing multicentre observational study, Incidence, Management, and Outcome of Acute Heart Failure in Africa: The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF II) (Figure 1B), was launched under the umbrella of the Pan African Cardiac Society (PASCAR), and under the leadership of Prof. Karen Sliwa, Cape Heart Institute (CHI), University of Cape Town. This study aims to characterize the incidence, epidemiology, clinical presentation, and in-hospital, 30 day and 6 months outcomes of acute heart failure (AHF) across the continent. THESUS-HF II is a prospective observational study enrolling patients with AHF from 50 health centres spanning 17 African countries. Participants undergo clinical assessments, laboratory investigations, and echocardiography. Each centre reports data on patient demographics, comorbidities, treatments, and outcomes, as well as on its catchment population, workforce capacity, and access to advanced diagnostics and therapies. The study further aims to gather insights on real-world diagnostic and treatment strategies for AHF, assessing how well clinical practices align with established guidelines and recommendations. The methodology of the study has been published recently.3 Early results of the 1500 patients recruited have been presented as a Late Breaking Science Session on 31 August at the European Cardiac Society & World Heart Federation Congress, Madrid 2025. PASCAR was established 1981 and unites 27 African national cardiac societies on the continent. However, many African countries have too few cardiologists to form a national society such as Namibia, Malawi, Mozambique, and Sierra Leone, to name a few. PASCAR has been instrumental in coordinating the study, ensuring broad participation and true representation across the continent. An integrated Capacity Development Programme accompanies the study, providing training in research methodology, data collection, and analysis. Prior to enrolment, investigators enthusiastically attended hybrid workshops focused on the study protocol, methodology, and database management, with continued support from the combined PASCAR–CHI coordination team. (A) Africa’s true scale: large enough to fit the USA, China, India, Japan, and much of Europe (Kai Krause). (B) The diverse regions and nations contributing to the THESUS-HF II study Building on the study’s findings and in collaboration with investigators across the continent, a Heart Failure Advocacy Program will be developed to train nurses and healthcare workers in HF-specific patient advocacy, tailored to their local healthcare contexts. Through this programme, early detection and resource-specific management can improve patient outcomes. THESUS-HF II marks a pivotal step in defining the evolving HF landscape in Africa. Despite being the world’s second-largest continent with over a billion people, Africa has long been underrepresented in HF research, with most treatment guidelines based on data from the Global North. This multicentre study now puts Africa on the research map, revealing its unique HF epidemiology, risk factors, and outcomes. By identifying challenges and opportunities in HF care, the study will inform tailored interventions to improve patient management and outcomes in Africa. Supported by PASCAR and dedicated investigators, it has the potential to significantly impact the lives of millions affected by HF across the continent. Nothing to declare.