Heart Failure in Younger Adults in Africa: Evidence from the Ibadan Heart Failure Project.

Abstract

Highlights: Younger patients were predominantly females and presented with advanced heart failure signs. They more frequently had dilated cardiomyopathy, peripartum cardiomyopathy, and rheumatic heart disease.Older patients had a higher prevalence of hypertension/hypertensive heart failure, diabetes mellitus, and cor pulmonale.One-year mortality, rehospitalization, and composite outcomes did not differ significantly between age groups.

Background: Heart failure (HF) is rising among younger adults in sub-Saharan Africa, yet data on their clinical profile and outcomes are limited. We compared clinical characteristics, etiology, and 1-year outcomes between younger and older HF patients in the Ibadan Heart Failure Project.

Methods: We included 1290 adults (≤50 y, n=430; >50 y, n=860) enrolled from 2016 through 2022. Baseline sociodemographic, clinical, laboratory, and echocardiographic data were collected. HF etiology was classified using ICD-10 codes. Medication use and 1-year outcomes, including rehospitalization, mortality, and a composite of rehospitalization and mortality, were assessed.

Results: Younger patients are predominantly females, more often single and employed, and presented with advanced HF signs, including paroxysmal nocturnal dyspnea, raised jugular venous pressure, S3 gallop, and cardiomegaly. Older patients had a higher prevalence of hypertension, diabetes mellitus, and peripheral edema. Hypertensive heart disease and cor pulmonale predominated in older patients (76% vs 44%), whereas younger patients more frequently had dilated cardiomyopathy (16% vs 7.4%), peripartum cardiomyopathy, and rheumatic heart disease (15% vs 6.2%). Guideline-directed therapy use was similar across ages. One-year mortality, rehospitalization, and composite outcomes did not differ significantly between age groups.

Conclusion: Younger HF patients in Nigeria present with severe nonischemic cardiomyopathies and advanced systolic dysfunction, whereas older patients have hypertensive and metabolic phenotypes. Despite these differences, 1-year outcomes were uniformly poor, reflecting the high burden of HF morbidity and mortality across all age groups in Nigeria.