Therapeutic Optimization in Acute Heart Failure with Reduced Ejection Fraction: Experience from the Strong HF Study Adapted to the Cameroonian Hospital Setting
Introduction: Nearly half of patients with acute heart failure (AHF) and reduced ejection fraction (HFrEF) are readmitted within 6 months [1]. Rapid therapeutic optimization is vital [2][3], yet many patients never receive the doses recommended by clinical guidelines [4][5]. Our study aimed to evaluate therapeutic optimization in patients hospitalized for a first episode of HFrEF in Yaoundé, using a model adapted from the STRONG-HF study. Methods: A prospective longitudinal study was conducted over 9 months (November 2024-August 2025) in three cardiology departments in Yaoundé. Clinical, echocardiographic, and therapeutic evaluations were performed at inclusion (M0, six weeks post-treatment initiation) and at three months (M3 ± 2 weeks). Results: Ninety-eight patients were included (mean age 64.5 ± 10.4 years; sex ratio 1.2). Hypertension and hypertensive cardiomyopathy were the predominant factors. At M0, the mean LVEF was 29.9 ± 6.2%. Four-pillar therapy (quadritherapy) was absent in 65.3% of patients, primarily due to undocumented reasons (59.7%) or hypotension (33.3%). The median delay for initiating full four-pillar therapy was 65 days. Its implementation at M0 was associated with age (45 - 55 years, p = 0.042) and health insurance coverage (p = 0.033). By M3, the mean LVEF increased to 34.1 ± 6.9%, and the proportion of patients on four-pillar therapy rose to 54.1%. LVEF improvement was significantly associated with a sequential initiation duration of < 42 days (p = 0.041) and its maintenance at M3 (OR = 2.6 [1.1 - 6.9], p = 0.041 and OR = 4.2 [1.7 - 11], p = 0.02, respectively). Conclusion: There is a significant delay and a lack of optimization in initiating four-pillar therapy in Yaoundé. Despite improvement during follow-up, practices remain below recommended standards, highlighting the need for dedicated heart failure centers.
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