Sex differences in heart failure: an analytical cross-sectional study at Laquintinie Hospital, Douala, Cameroon, 2021-2024

Abstract

Introduction: heart failure (HF) is a major cause of mortality in sub-Saharan Africa. Limited data exist on sex-specific differences in HF presentation and outcomes. This study assessed sex-based variations in clinical profiles, aetiologies, and in-hospital outcomes among HF patients in Cameroon. Methods: we conducted an analytical cross-sectional study of patients admitted with clinical HF at Laquintinie Hospital, Douala (January 2021-December 2024). Patients without gender or outcome data were excluded. Sociodemographic, clinical, and treatment variables were compared by sex using appropriate statistical tests (p<0.05). Penalized logistic regression, validated via bootstrapping, modeled four outcomes: atrial fibrillation, ischemic cardiomyopathy, renin-angiotensin-aldosterone system (RAAS) inhibitor use, and hypertension. Missing data were imputed. Results: among 757 patients, 51.3% were female. Hypertension was present in 57.1%, more common in females (64.4% vs. 49.3%, p<0.001), with nearly equal known and new-onset cases. Females were older (median age 66 vs. 60 years, p<0.001) and had higher atrial fibrillation risk (AOR=3.64, 95% CI: 1.91-6.94). Males had more ischemic cardiomyopathy (AOR=0.48, p=0.035) and renal dysfunction (43.8% vs. 30.1%, p=0.003). Females more frequently received RAAS inhibitors/ARNI at discharge (33.5% vs. 26.3%, p=0.031). In-hospital mortality was 17.0%, with no sex difference (p=0.288). Conclusion: significant sex differences exist in HF presentation and treatment at Laquintinie. Strategies should include atrial fibrillation screening in females and renal monitoring in males. Findings support the need for sex-specific interventions and multicenter validation in similar settings. These cross-sectional associations highlight prevalence patterns but require prospective studies for causal insights.