Download the full article from the Journal of Asian Pacific Society of Cardiology.
This piece argues that heart failure (HF) is an increasingly important but under-addressed health-system challenge in sub-Saharan Africa (SSA). Unlike in high-income countries, HF often affects younger adults in SSA, with hypertension, cardiomyopathy, and rheumatic heart disease among the leading causes. Patients frequently present late, contributing to substantially higher mortality and rehospitalization rates than global averages.
The authors (including Krishna Udayakumar, and G Titus Ngeno, of Duke Global Health Innovations Center), emphasize that the challenge extends beyond clinical capacity. Limited financing, high out-of-pocket costs, inadequate insurance coverage, shortages of trained health workers, limited diagnostic capacity, and concentration of services in tertiary hospitals all constrain access to effective HF care. Even when guideline-recommended medicines are available, their cost can make sustained treatment unaffordable.
The authors call for a system-wide, integrated approach spanning prevention, screening, diagnosis, treatment, referral, and long-term follow-up. Priorities include strengthening primary care, expanding financial protection, improving medicine availability and affordability, developing HF registries and health data systems, and strengthening the health workforce and referral networks. They also identify digital technologies and AI as opportunities to extend expertise and improve monitoring, while stressing that technology must complement—not replace—health-system investment.
Overall, the article argues that improving HF outcomes in SSA requires building systems of care capable of delivering sustained, affordable, patient-centered treatment, rather than focusing solely on individual products or specialist services. Duke GHIC authors were particularly instrumental in the development of core domains of integrated health systems for heart failure, as depicted in Figure 3 (see image selection).
Source: Wauye VM, Ahadzi D, Udayakumar K, Ngeno GT. Heart Failure in Sub-Saharan Africa: Current and Future Systems of Care. Journal of Asian Pacific Society of Cardiology. 2025;4:e16. DOI: 10.15420/japsc.2024.37.