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The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs.

A recent clinical practice guideline strongly supports cardiac rehabilitation for patients after acute myocardial infarction (AMI). 1 Cardiac rehabilitation programs are multifaceted outpatient interventions that include individualized exercise regimens, health education, and structured support focused on cardiovascular risk reduction and medication adherence. 2 Patients typically attend 2 to 3 sessions weekly for up to 36 sessions. Cardiac rehabilitation improves survival after AMI 3 and is associated with improvements in lifestyle, functional capacity, and quality of life for older adults. 4,5 Despite these benefits, rates of referral and participation have traditionally been low, especially among older adults. 6,7 Using a national quality improvement registry, we assessed rates of enrollment in cardiac rehabilitation, as well as completeness of participation (number of sessions attended), among older adults and compared characteristics between patients who did and did not participate after referral.

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