Clinical Profile, Aetiology, and Temporal Trends of Hospitalized Heart Failure Patients in a Private Tertiary Hospital in Sierra Leone (2021 – 2025)
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Background
Heart Failure (HF) is a complex clinical syndrome of growing public health concern in sub-Saharan Africa, yet data from Sierra Leone are absent. The aim of the study is to characterize the clinical profile, etiological and temporal trends of hospitalized HF patients at Choithrams Memorial Hospital (CMH), in Freetown, Sierra Leone, to inform specific management strategies.
Methods
This single-centre, retrospective observational cohort study analysed data on HF patients (≥ 18years) admitted at the CMH between January 2021 to 31 December 2025. The clinical definition of HF was based on the Framingham criteria and the European Society of Cardiology (ESC) guidelines, including standard echocardiographic parameters. All variables, including patients’ demographics, HF phenotype, aetiology, medical history, and hospital outcomes, were extracted from the digital record. Non-parametric tests, multivariable logistic regression to identify variables associated with aetiology, Wilcoxon rank-sum test to compare groups, and Kruskal-Wallis test to analyse trends over time were utilised.
Result
A total of 765 patients were included in the study, with a median age of 53 years (IQR 42-61) and male predominance of 55.3%. Patients with recurrent HF (60.9%) were more common than those with de novo HF (39.1%), were older (54 years vs 53 years), had a higher comorbidity burden (34% vs 4%, p < 0.001), and presented with a cold-wet hemodynamic profile (18.4% vs 8.4%, p < 0.001). HFrEF (61.3%) was the most predominant phenotype, though HFpEF increased with age. Dilated Cardiomyopathy (37.0%), Hypertensive Heart Disease (31.2%) and Valvular Heart Failure (17.1%) were the leading etiologies, while ischemic heart disease (6.3%) was relatively uncommon. A majority of the patients were referred (77.9%), and 50.8% presented with NYHA IV. The strongest independent predictor for HF was hypertensive heart disease [AOR = 17.81; C.I 95%: (3.13-48.76), p <0.001]. An analysis of the trends in etiologies and demographics over the five-year period demonstrated no significant changes (all p-values > 0.05 for age, sex, aetiology, and most comorbidities).
Conclusion
HF affects the younger adult population in Sierra Leone and is mainly caused by DCM and HHD. The late case presentations, the high prevalence of recurrent HF, and the associated high burden of comorbidities emphasize an urgent need to develop and implement improved strategies for the prevention, early detection, and long-term management of HF within Sierra Leone’s healthcare system.
