Identification and reporting of heart failure with preserved ejection fraction in Sub-Saharan Africa: a scoping review of diagnostic approaches, echocardiographic assessment, and evidence gaps.

backgroundHeart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a major heart failure phenotype globally; however, its diagnosis is complex and is recommended to require integrated assessment of clinical features, echocardiographic abnormalities, and biomarkers. In Sub-Saharan Africa (SSA), where diagnostic resources are limited, HFpEF identification may rely on simplified approaches, potentially leading to under-recognition and heterogeneity in reporting. This review evaluates how HFpEF is identified and reported in SSA, with emphasis on diagnostic approaches, echocardiographic characterization, and biomarker use.

methodsA scoping review of observational studies reporting heart failure with left ventricular ejection fraction (LVEF) data in Sub-Saharan Africa (SSA) was conducted using predefined eligibility criteria and reported in accordance with PRISMA-ScR. PubMed, Google Scholar, Web of Science, and African Journals Online (AJOL) were searched for relevant studies published in English from database inception to May 2026. Data were extracted on HFpEF definitions, echocardiographic parameters, biomarker use, and diagnostic approaches and frameworks used during the respective study periods. Contemporary HFpEF diagnostic frameworks, including HFA-PEFF and H₂FPEF, were considered separately when interpreting the compatibility of reported phenotyping approaches with current diagnostic concepts.

results10 observational studies involving 3,821 patients with heart failure, published between 2009 and 2024, were included. Studies were conducted in South Africa, Nigeria, Senegal, Côte d'Ivoire, Cameroon, and Tanzania, with two multicountry Sub-Saharan African registries also represented. HFpEF definitions were inconsistent, with most studies relying primarily on LVEF ≥ 50% without application of structured diagnostic algorithms. Only two studies reported dedicated HFpEF cohorts, while the remainder identified HFpEF as a subgroup within broader heart failure populations. Echocardiographic reporting was highly variable; left ventricular hypertrophy and left atrial enlargement were the most frequently reported structural abnormalities, but diastolic function parameters were inconsistently assessed, and formal grading was rare. Natriuretic peptides were infrequently measured and seldom integrated into diagnostic classification. No study applied contemporary multiparametric diagnostic frameworks such as HFA-PEFF or H₂FPEF scoring systems.

conclusionHFpEF in SSA is predominantly identified using simplified ejection fraction-based criteria, with limited integration of echocardiographic diastolic assessment and biomarker data. This results in heterogeneous and potentially non-standardized phenotyping across studies, limiting comparability and accurate disease estimation. Strengthening diagnostic standardization through structured echocardiographic reporting, improved access to natriuretic peptide testing, and consideration of adapted multiparametric HFpEF algorithms may help improve diagnostic consistency and research quality in the region. These findings should be interpreted in the context of the heterogeneous and predominantly hospital-based evidence currently available from SSA.