Heart Failure with Reduced Ejection Fraction in North Africa: Clinical Characteristics and Paraclinical Findings Compared to International Registries

Abstract

Introduction: Heart failure with reduced ejection fraction (HFrEF), defined as LVEF ≤ 40%, is a major public health problem due to its high morbidity and mortality, affecting approximately 64.3 million individuals worldwide, of whom nearly 50% present with reduced ejection fraction. Objectives: To analyze the clinical and paraclinical profile of HFrEF patients hospitalized in the Cardiology Department of the Avicenne Military Hospital in Marrakech, and to compare our findings with international registry data. Patients and Methods: Retrospective descriptive study of 173 patients hospitalized between December 2021 and December 2023 with a confirmed diagnosis of HFrEF (LVEF ≤ 40%). Results: Mean age was 67.9 ± 8.7 years with male predominance (80%). Main cardiovascular risk factors were physical inactivity (85%), smoking (53%), diabetes mellitus (45%), hypertension (33%), and dyslipidemia (33%). Dyspnea was the predominant symptom (98.2%), with 45% in NYHA class II. Electrocardiography revealed intraventricular conduction abnormalities in 58% of patients, predominantly left bundle branch block (LBBB, 32.3%). Mean LVEF was 32%. Anemia was present in 45% of patients and BNP was elevated in all patients (mean 427 ± 87 pg/mL). Coronary angiography demonstrated significant lesions in 56.6 % of explored patients. Conclusion: This study highlights the epidemiological, clinical, and paraclinical features of HFrEF in our context, broadly comparable to international data, and underscores the need for optimized multidisciplinary diagnostic and therapeutic management. The main limitation of this work is its retrospective single-center design, which may limit generalizability.