Heart Failure Care and Post-Hospital Outcomes in Northwestern Tanzania

Introduction: In Africa, heart failure (HF) mortality is the highest in the world; approximately 50% of patients die within one year of HF hospitalization. Little is known about the quality of inpatient and post-discharge care and its association with patient outcomes. The purpose of this study is to describe HF outcomes for patients admitted in Northwestern Tanzania and evaluate associations between gaps in quality care and post-hospital survival. Methods: We conducted a retrospective chart review of all adult patients admitted with HF at Bugando Medical Centre in 2023. We abstracted data from the index hospitalization and subsequent encounters until August 31, 2025. Vital status was ascertained by telephone. We characterized post-discharge outcomes and adherence to guideline recommendations for HF care. Cox proportional hazards models assessed associations between gaps in quality measures and mortality. Results: Among 177 patients admitted with HF, 23 (13%) died during the index hospitalization. Of the 154 patients alive at discharge, 63 (40.9%) died within six months and 86 (56%) within a year. Among patients alive at discharge, 79% received indicated testing, 50% were on guideline-directed medical therapy (GDMT) at discharge, 68% attended the first post-discharge appointment, 53% received ongoing care three months post-discharge, and 39% were on GDMT three months post-discharge. Attending the first post-discharge visit (aHR 0.32 [95% CI: 0.17, 0.63]) and remaining in care three months after discharge (aHR 0.36 [95% CI: 0.16, 0.81]) were both independently associated with improved survival. GDMT use was low across outpatient visits (47%), with frequent medication changes and de-escalation over time. Conclusions: Mortality following HF admission in Northwestern Tanzania remains high. Factors associated with post-hospital mortality may include poor linkage to post-discharge care and low sustained care engagement. Implementation research is needed to develop strategies to improve post-discharge HF outcomes in East Africa, focusing on optimizing GDMT before discharge and improving early post-hospital linkage to care. Lay Summary Heart failure (HF) mortality in sub-Saharan Africa is the highest in the world, yet little is known about the quality of HF care provided during and after HF hospitalization and its relationship to post-hospital outcomes. This study seeks to understand the quality of care provided to patients admitted with HF in Northwestern Tanzania and its association with post-hospital outcomes. This study took place at Bugando Medical Centre, a large academic regional referral hospital in Mwanza, Tanzania that serves a catchment population of ~22 million people. Among 177 patients admitted with HF in 2023, there was a trend of high, early mortality following hospital discharge. Among the 154 patients who survived and were discharged, we found significant gaps in linkage to care after hospitalization, sustained retention in care, and utilization of guideline-directed medical therapy at discharge and in the outpatient setting. Linkage to care and retention in care were each independently associated with significant improvements in survival. There is a pressing need for future studies focused on understanding and addressing factors associated with post-hospital care engagement and utilization of guideline-directed medical therapy after HF hospitalization in East Africa.