Epidemiological and Clinical Profile of Heart Failure at the Morafeno University Hospital of Toamasina, Madagascar: A Three-Year Retrospective Study.

Background Heart failure (HF) represents a major public health challenge worldwide, with particularly high morbidity and mortality in resource-limited settings. Despite its growing burden in sub-Saharan Africa, comprehensive epidemiological data from Madagascar remain scarce. This study aimed to describe the epidemiological, clinical, paraclinical, therapeutic, and prognostic profile of patients hospitalized for heart failure at the Centre Hospitalier Universitaire Morafeno Toamasina (University Hospital Center Morafeno Toamasina) (CHUMT), and to identify independent factors associated with prolonged hospitalization, rehospitalization, and in-hospital mortality. Methods We conducted a retrospective, cross-sectional, descriptive study in the cardiology department of CHUMT from January 1, 2021, to December 31, 2023. All patients hospitalized for echocardiographically confirmed heart failure were included. Data were collected from medical records using standardized forms. Binary logistic regression analyses (univariate followed by multivariate) were performed using Stata version 13 (StataCorp, College Station, USA) to identify independent factors associated with prolonged hospitalization (≥7 days), rehospitalization during the study period, and in-hospital mortality. Statistical significance was set at p<0.05. Results A total of 168 patients were included over the 36-month study period. The mean age was 54 ± 14 years (range: 18-89 years), with a sex ratio of 0.97 (50.6% female). The most prevalent cardiovascular risk factors were hypertension (n=86; 51.2%), overweight (n=46; 27.4%), and diabetes mellitus (n=37; 22.0%). Global heart failure was the predominant clinical form (n=127; 75.6%). Ischemic cardiomyopathy was the leading etiology (n=46; 27.4%), followed by hypertensive heart disease (n=39; 23.2%). Heart failure with reduced ejection fraction (HFrEF, left ventricular ejection fraction (LVEF) <40%) accounted for 53.6% (n=90) of cases. Clinical outcomes included favorable discharge in 81.5% (n=137) of cases, in-hospital mortality of 9.5% (n=16), and a 6-month rehospitalization rate of 41.7% (n=70). In multivariate analysis, right ventricular systolic dysfunction was the only independent factor associated with prolonged hospitalization (adjusted OR = 6.1; 95% CI: 1.5-23.5; p = 0.009). Atrial fibrillation (adjusted OR = 3.4; 95% CI: 1.3-29.3; p = 0.036) and intraventricular conduction disorders (adjusted OR = 2.3; 95% CI: 1.4-36.6; p = 0.013) were independently associated with rehospitalization. No factor reached statistical significance for in-hospital mortality in multivariate analysis. Conclusion Heart failure at CHUMT affects relatively young patients, predominantly presenting with global heart failure and primarily attributable to ischemic and hypertensive etiologies. Right ventricular systolic dysfunction, atrial fibrillation, and intraventricular conduction disorders are key independent prognostic factors. Strengthening cardiovascular prevention strategies, improving early diagnosis, and implementing structured therapeutic patient education programs are essential to reduce mortality, hospitalization duration, and readmission rates in this resource-limited setting.