Survival rate and predictors of 36-month mortality in patients with heart failure in Sub Saharan Africa: insights from the Douala Heart Failure Registry (Do-HF)

Abstract

Background: Heart failure (HF) is a growing public health concern with a high mortality rate in sub-Saharan Africa. However, few studies have reported the long-term predictors of mortality in this region. This study sought to determine the 3-year mortality rate and the predictors of mortality amongst HF patients in Douala, Cameroon. Methods: We conducted a prospective analysis on patients recruited in the Douala Heart Failure (DoHF) registry, an ongoing prospective data collection on patients with HF at four cardiology units in Douala, Cameroon. Patients included were followed for 36 months from the index date of inclusion, with all-cause mortality as the primary outcome. Cox proportional hazard regression models were used to determine predictors of mortality. Results: Out of the 347 participants included, 318 (91.6%) completed follow-up. The mean age was 64±14 years, 172 (49.6%) were men. Hypertensive cardiomyopathy and dilated cardiomyopathy were the most frequent causes of heart failure. The median follow-up was 33 months, and 150 (47.2%) patients died. Independent predictors of mortality included New York Heart Association functional class III & IV (aHR 2.23; 95% CI: 1.49–3.33; P<0.001), presence of pulmonary rales (aHR 1.87; 95% CI: 1.30–2.68; P=0.005), chronic kidney disease (aHR 2.92; 95% CI: 1.79–4.78; P<0.001), enrolment as inpatient (aHR1.96; 95% CI: 1.17–2.54; P=0.005), no formal education (aHR 2.06; 95% CI: 1.28–3.33; P=0.003), and a monthly income of at most three minimum wage (aHR 2.06; 95% CI: 1.28–3.33; P=0.003). Conclusions: This study shows that almost half of HF patients die after 36 months of follow-up. Also, late presentation and poverty-related conditions were associated with poor outcomes. These findings suggest prioritizing preventive strategies that target early diagnosis and socioeconomic status to improve the prognosis of HF.