September 25, 2026The Lancet
Aetiology, management, and outcomes of acute heart failure in 17 African countries (THESUS-HF II): a prospective, multicentre, observational cohort study
Key result
Acute heart failure in relatively young African adults carries ~21% 180-day mortality.
- 95% CI 18.4-23.0
- n=1,578
Why the study?
Contemporary data on the aetiology, management, and outcomes of acute heart failure across Africa are scarce.
Population
1578 adults with acute heart failure in 50 hospitals across 17 African countries
Design
Prospective, multicentre, observational cohort study
Follow-up
180 days
Authors
Discussion
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
JHJulia HahnlePhD researcher, Cape Heart Institute, University of Cape Town
“THESUS-HF II demonstrates that while the heart failure landscape in Africa has evolved, it remains distinct. Although access to guideline-directed medical therapy appears better than anticipated, the outcome remained poor, underscoring the need for further advances, including the context-specific, African-centred strategies to improve care.”
“The study's strengths are the scale, geographical breadth, a pragmatic design suited to resource limited settings, and the first multi-country presentation-rate estimates for African acute heart failure. The project was a real team effort. I would thank all the investigators for the very time-consuming work, often in very difficult scenarios without any remuneration.”
“PASCAR, the Cape Heart Institute and all the investigators across Africa are to be warmly congratulated for completing the region's large”
Overview
Prospective cohort study observes aetiologies, clinical management, and mortality in acute heart failure across 17 African nations, highlighting crucial gaps in regional cardiovascular care.
Key Points
- To evaluate the underlying causes, management patterns, and clinical outcomes among patients hospitalized with acute heart failure across 17 African countries.
- Prospective, multicentre, observational registry (THESUS-HF II) conducted across hospital centers in 17 African nations.
- Enrolled patients presenting with acute heart failure to assess clinical characteristics, diagnostic assessments, and pharmacological therapies.
- Tracked hospital courses and post-discharge trajectories to evaluate inpatient mortality, readmission rates, and treatment compliance.
- Demonstrated that non-ischaemic aetiologies, particularly hypertensive heart disease, cardiomyopathies, and rheumatic heart disease, represent the leading causes of acute heart failure.
- Identified substantial cross-country disparities in the implementation of guideline-directed medical therapies and diagnostic investigations, influencing inpatient and post-discharge mortality.
Study Design
Type
Cohort (n=1,578)
Multicenter
Yes
PICO
P
Population
1,578 adults with acute heart failure across 17 African countries, followed for up to 180 days.
E
Exposure / Comparator
Acute heart failure
O
Primary Outcome
All-cause mortality at 180 days (18.4-23.0)
Limitations
- Differences in ascertainment and diagnostic capability might have contributed to the apparent aetiological shift
- 528 (33.7%) patients were lost to follow-up before 180 days
Cite This Study
Sliwa et al. (2026) conducted a cohort in Acute heart failure (n=1,578). Acute heart failure was evaluated on All-cause mortality at 180 days (95% CI 18.4-23.0). Among 1,578 adults with acute heart failure across 17 African countries, 180-day all-cause mortality was 20.6% (95% CI 18.4-23.0), highlighting high mortality in a relatively young cohort.