THe Sub-Saharan Africa Survey of Heart Failure (THESUS-HF II): access to care

Abstract Background Heart failure (HF) affects approximately 64.3 million people worldwide. In Africa, substantial advancements have been made over the past two decades in understanding HF. However, several challenges persist, including outdated data on access to care and a lack of information regarding the availability and affordability of HF medications. These issues hinder effective patient care and healthcare planning, particularly as the continent faces an evolving burden of cardiovascular disease. Methods THe Sub-Saharan Africa Survey of Heart Failure (THESUS-HF II) is an ongoing, prospective, multi-country and multi-centre observational study comprehensively characterizing acute heart failure and access to care from a Pan-African perspective. Data on human resources, drug availability, cardiac implantable electronic devices and costs were sought from all member countries of the Pan African Society of Cardiology. The study commenced mid-2024 and was designed to provide comprehensive, up-to-date information on acute HF in Africa. Results Among the 37 hospitals surveyed across 16 countries (Figure) until February 2025, 91.9% operate in the public sector. Of these hospitals, 22.2% serve regions with populations exceeding 10 million. A medical intensive care unit (ICU) is available in 94.4% of hospitals, while 27.8% offer diagnostic cardiac catheterization. Electrocardiography and echocardiography are universally available. Cardiac computed tomography (CT) is accessible in 52.8% of hospitals, whereas cardiac magnetic resonance imaging (MRI) is available in 25%. High-sensitivity troponin testing is offered in 72.2% of hospitals, and 69.4% provide access to biomarkers such as NT-proBNP/BNP. All hospitals supply ACE inhibitors and beta-blockers, with 72% of these medications provided directly by the hospital. Mineralocorticoid receptor antagonists (MRAs) are universally available, with 70.8% supplied by the hospital. Sodium-glucose cotransporter-2 (SGLT2) inhibitors are accessible in 82.8% of hospitals, but 81% of patients obtain them privately. Sacubitril-valsartan is available in 64.3% of hospitals, though 93.8% of patients acquire it privately, often paying fully out of pocket. Regarding advanced therapies, coronary artery bypass grafting (CABG) is available in 14.8% of hospitals. Implantable cardioverter-defibrillators (ICDs) are accessible in 7.4% of hospitals, while cardiac resynchronization therapy (CRT) is offered in only 3.7%. None of the hospitals surveyed provide heart transplantation services. Conclusion Access to diagnostic work up and means for managing ischaemic causes of heart failure remains limited in most part of Africa. Access to medical care improved substantially over the past decade with most guideline directed medical therapy such as beta-blocker, ACE-inhibitors and MRA are currently largely supplied by the hospital but other medications having to be purchased privately.