THe Sub-Saharan Africa Survey of Heart Failure (THESUS-HF II): Aetiology, 30- days and 6 months outcome

Background and aim Since the original Sub-Saharan Africa Survey of Heart Failure (THESUS-HF) study (2008–2010), the HF landscape in Africa has evolved. However, contemporary epidemiological data, particularly on treatment availability and outcomes remain limited. This study describes the epidemiology, clinical presentation, and in-hospital, 30-day, and 6-month outcomes of acute HF in a large, representative cohort of patients across Africa. Methods and results THESUS-HF II is a prospective, multicentre, observational cohort study coordinated by the Pan-African Society of Cardiology. Overall, 1578 patients were enrolled during seven 24-hour periods within an 8-week window. Standardised data were collected on clinical characteristics and outcomes to discharge, 30 days, and 6 months across 17 SSA countries. Mean age was 54.2 years, 50.5% were female. A prior HF diagnosis was recorded in 35.8% of patients. The leading aetiologies of HF were hypertensive heart disease (HHD, 37%), cardiomyopathy (23%) and ischaemic heart disease (IHD, 23%), followed by valvular/congenital heart disease (VHD/CHD, 11%). Common modifiable risk factors included hypertension (62.7%), diabetes (20.3%), dyslipidaemia (15.8%), and current/past smoking (16.1%). AF was identified on admission ECG in 19.6% of cases. Most presented in NYHA class III (29.6%) or IV (57.7%). Echocardiography showed a mean LVEDD of 56 mm and a mean LVEF of 40.9%; patients with cardiomyopathy had the lowest LVEF (34%) compared to other groups (p<0.001). Most (89.5%) were admitted to general wards (mean stay 8.1 days), while 10.2% required ICU care (mean 5 days). Among participating hospitals, 82.6% offered haemodialysis and 73.9% ventilatory support. However, advanced interventions were less accessible: valvular surgery (28.9%), PCI (23.9%), CABG (19.6%), ICDs (17.4%), and CRT (10.9%). At discharge, 87.8% of patients were prescribed loop diuretics, 76.9% beta-blockers, 42.3% ACEi, 30.8% ARBs, and 6.2% ARNIs. MRAs were used in 71.9%, SGLT2i in 54.7%, and digoxin in 26.7%. At discharge, 91.3% were alive. The 30-day mortality rate was 11.7%, with no significant variation by HF aetiology ( Kaplan-Meier, p=0.129, Figure 1) and a readmission rate of 2.7%. The 6-month overall mortality was 23.9% with substantial differences between the 5 groups, ranging from 16.5% for VHD/CHD, 18.4 % for IHD, 25.8 % for cardiomyopathy to 26.6% for HHD and 36.8% for other aetiologies (Kaplan-Meier, p= 0.006, Figure 1). The readmission rate was 12.2%. Conclusion THESUS-HF II (2024-2025) is the largest study of acute HF to date in SSA. It identifies HHD, cardiomyopathy and IHD as the leading contributors to acute HF presentations. Prescription of GDMT was better than expected but there are substantial gaps in access to advanced cardiac care. Acute HF was characterised by a high 30-day and 6-month mortality, underscoring the need to strengthen HF prevention and management across the continent.Graphical Abstract of THESUS-HF II StudyTHESUS-HF II Table