Heart failure in low-income and middle-income countries
Abstract
Heart failure (HF) is a complex syndrome which leads to significant morbidity and mortality, poor quality of life and extremely high costs to healthcare systems worldwide. Although progress in the management of HF in high-income countries is leading to an overall reduction in the incidence and mortality of HF, there is a starkly different scenario in low- and middle-income countries (LMICs). There is a substantial lack of data on HF in LMICs, as well as a scarcity of diagnostic tools, limited availability and affordability of healthcare and high burdens of cardiovascular risk factors and communicable diseases. Patients in this setting present with more advanced HF at much younger ages and are, more often, women. In this review, we aim to comprehensively describe the burden of HF from an LMIC perspective, based on the more recent available data. We summarise the major causes of HF that are endemic in these regions, including hypertension, cardiomyopathy, rheumatic heart disease, HIV-associated heart disease and endomyocardial fibrosis. Finally, we discuss the challenges faced by the least developed health systems and highlight interventions that may prove to be more efficient in changing the paradigm of HF of the more vulnerable populations.
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Recent global reviews have emphasized that the unmet need for AI-ECG screening may be greatest in LMICs, provided that implementation is accompanied by appropriate clinical pathways and treatment linkage.
“Recent global reviews of heart failure and digital cardiovascular tools have accordingly emphasized that the unmet need may be greatest in LMICs, provided that implementation is accompanied by appropriate clinical pathways and treatment linkage.”
From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [64]
In low- and middle-income settings, the appeal of AI-ECG lies not in an already mature external-validation literature, but in the possibility of adding a scalable, low-cost triage layer upstream of formal imaging.
“In such settings, the appeal of AI-ECG lies not in an already mature external-validation literature, but in the possibility of adding a scalable, low-cost triage layer upstream of formal imaging.”
From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [64]
The rationale for AI-ECG screening may be strongest in low- and middle-income settings, where heart failure and other echocardiography-detectable cardiac disorders are often recognized late and access to echocardiography remains constrained by cost, workforce, and infrastructure.
“The rationale for AI-ECG screening may be strongest in low- and middle-income settings, where heart failure and other echocardiography-detectable cardiac disorders are often recognized late and access to echocardiography remains constrained by cost, workforce, and infrastructure.”
From AI-ECG for Echocardiography Triage in Structural Heart Disease: Evidence, Implementation, and Future Directions (2026) · cites this paper as [64]
Cites
Bozkurt, B., Coats, A. J. S., Tsutsui, H., Abdelhamid, C. M., Adamopoulos, S., Albert, N., Anker, S. D., Atherton, J., Böhm, M., Butler, J., et al. (2021) · European Journal of Heart Failure · doi:10.1002/ejhf.2115 · Cited by 1,665 · see citing works
Mebazaa, A., Davison, B., Chioncel, O., Cohen-Solal, A., Diaz, R., Filippatos, G., Metra, M., Ponikowski, P., Sliwa, K., Voors, A. A., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)02076-1 · Cited by 1,123 · see citing works
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Tang, Q., Deng, K., Cui, Y., Liu, H., & Qian, B. (2026) · International Journal of General Medicine · doi:10.2147/ijgm.s610298
“64,65 At present, however, peer-reviewed evidence specifically validating stand-alone 12-lead AI-ECG for structural screening in resource-limited African practice remains sparse.”
- Authors
- Mbanze, I., Spracklen, T. F., Jessen, N., Damasceno, A., & Sliwa, K.
- Affiliations
- University of Cape Town (ZA)
- Eduardo Mondlane University (MZ)
- Corresponding author
- Sliwa, Karen
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2025-02-26
- Volume
- 111
- Issue
- 8
- Pages
- 341-351
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W4407953740
- Cited by
- 21
- References
- 2
- Citations by year
- 2026: 14 · 2025: 7
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- heart failure, low- and middle-income countries, hypertension, cardiomyopathy, rheumatic heart disease, endomyocardial fibrosis, cardiovascular risk factors, infectious diseases, health system challenges, women
- MeSH terms
- Developing Countries, Heart Failure, Humans, Risk Factors, Global Health, Cost of Illness
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