Heart failure in Kenya: epidemiology, management patterns, and outcomes from a national multicenter registry.

INTRODUCTION: Heart failure (HF) poses a significant and growing public health challenge in Kenya, largely driven by the increasing prevalence of hypertension, diabetes mellitus, and obesity. The condition disproportionately affects younger adults and is primarily linked to non-ischemic causes. Despite the existence of evidence-based treatment options, major barriers remain-particularly in timely diagnosis, access to care, and long-term management-leading to high rates of hospital readmission and mortality. Additionally, the absence of robust national data limits the development of effective policies and optimized HF care strategies. This study aimed to describe the clinical and demographic characteristics, underlying etiologies, management practices, and short-term outcomes-including in-hospital and six-month mortality-of HF patients in Kenya, utilizing data from the National Research Fund (NRF) Registry on Cardiovascular Diseases. METHODS: This was a prospective observational study, conducted at three tertiary hospitals in Kenya-Kenyatta National Hospital, Moi Teaching and Referral Hospital, and Aga Khan University Hospital-representing public and private sectors from December 2021 to December 2022. Adults (≥ 18 years) with clinically and objectively confirmed heart failure were enrolled from both inpatient and outpatient settings. Data were managed via REDCap and analyzed using Stata 17.0. Descriptive statistics were used to describe the population. Logistic regression was used to assess survival and predictors of mortality. Statistical significance was set a P value < 0.05. RESULTS: A total of 795 HF patients were enrolled across three tertiary hospitals in Kenya. The mean age was 52.3 years (SD 18.4), 51.7% were female. The majority were of African descent (n = 763, [97.2%]) who presented with new-onset HF (n = 704, [88.6%]). Hypertension was the most common comorbidity (39%). On ECG, 6.3% had left bundle branch block (LBBB). Echocardiographic findings showed that majority (n = 598, [76%]) had a LVEF of < 40%. Most patients (n = 534, [83.3%]) were symptomatic, classified as NYHA class II or higher. In-hospital mortality was 6.6%, and the median length of stay was 8 days. Independent predictors of in-hospital mortality included age > 50 years [OR 2.65 (1.25-5.61)] and NYHA class III/IV symptoms [OR 7.74 (1.02-58.5)]. CONCLUSION: HF patients in Kenya are predominantly middle-aged and commonly present with new-onset symptoms and reduced LVEF. In-hospital mortality was 6.6% and was independently associated with age over 50 years and advanced symptoms (NYHA class III/IV). These findings highlight the need for earlier detection and more aggressive initial management in this population.