Predictive Performance of the Get-With-The-Guidelines Heart Failure (GWTG-HF) Score for In-Hospital Mortality in Cameroonians Admitted in 2025 at Laquintinie Hospital Douala

Background: The Get With The Guidelines-Heart Failure (GWTG-HF) risk score predicts in-hospital mortality in heart failure patients, but its performance in Sub-Saharan African settings remains largely unevaluated. This study assessed the discriminative ability and calibration of the GWTG-HF score in a prospective cohort at a tertiary hospital in Cameroon. Methods: Adults (≥18 years) hospitalized primarily for acute decompensated heart failure (including both de novo presentations and exacerbations of chronic heart failure), confirmed by Framingham criteria plus echocardiography, at Laquintinie Hospital, Douala, Cameroon, between January and December 2025 were included. Exclusion criteria included incomplete data for GWTG-HF variables or alternative primary diagnoses (e.g., acute coronary syndrome as dominant presentation, primary pulmonary embolism, or sepsis without HF decompensation). The primary outcome was in-hospital mortality. As primary external validation, observed mortality was compared with original GWTG-HF predicted probabilities in predetermined risk groups (0 - 33: <1%; 34 - 50: 1% - 5%). Secondary analyses included logistic regression (continuous and quintile-based models). Results: Of 193 patients (median age 65 years [IQR 52 - 73], 50.8% male), in-hospital mortality was 16.6% (32 deaths). GWTG-HF score ranged from 6 to 50 (median 29, IQR 23 - 34). The score showed no discriminative ability (AUC 0.494, 95% CI 0.380 - 0.608) and poor calibration, with observed mortality far exceeding expected rates (16.8% in 0 - 33 group vs expected < 1%; 16.0% in 34 - 50 group vs expected 1% - 5%). Continuous logistic regression revealed a non-significant inverse association (OR 0.994 per point, p = 0.818). Quintile-based models showed no increasing mortality gradient (Q1: 25.6%, Q5: 18.4%). Conclusion: The GWTG-HF score exhibited limited predictive performance and no clear risk stratification in this Cameroonian heart failure cohort. These findings suggest the need for recalibration or development of alternative tools tailored to Sub-Saharan African populations to improve risk assessment in resource-limited settings.