Improving heart failure outcomes in Africa: the PASCAR–Cardiff University Africa-HF programme

Heart failure (HF) remains one of the most pressing cardiovascular challenges in Sub-Saharan Africa, where patients often present younger and with more advanced disease than in high-income regions.1 Limited diagnostic capacity, shortages of specialized staff, and delayed health-seeking behaviour contribute to disproportionately high morbidity and mortality.2,3 Across the region, clinicians face the daily reality of overloaded clinics, fragmented care pathways, and a rising population of patients living with HF.4 In recent years, there has been growing emphasis on strengthening HF clinic services to enhance early diagnosis, optimize guideline-directed medical therapy (GDMT), and provide structured follow-up.5 ‘Heart failure patients in Africa often present late, but with the right structure and team-based approach, their outcomes can improve dramatically’. Recognizing these urgent needs, the Pan-African Society of Cardiology (PASCAR), in partnership with Cardiff University (CU), launched the Africa-HF Programme in 2018. This initiative provides targeted training to clinicians across Africa with the goal of establishing multidisciplinary HF teams (MDTs) capable of delivering coordinated, evidence-based care in resource-constrained settings. An initiative designed not merely to train clinicians, but to transform how heart failure care is delivered across Africa. Each year, 20 competitively selected delegates embark on a unique journey combining virtual learning on African-specific HF epidemiology and management, quality improvement to guide local service development, immersive clinical exposure at the multidisciplinary HF centre in Cardiff, Wales and long-term mentorship and networking across an Africa—wide community of practice (see Figure 1A and C). Showing (A) Faculty and delegates of the PASCAR–Cardiff University Africa-HF Programme. (B) Multidisciplinary team meeting at the UPTH Heart Failure Clinic, Nigeria. (C) Africa-HF cohort at Cardiff University Hospital. Wales. (D) Clinicians and nurses delivering heart failure education in UPTH The aim is simple but ambitious: to seed a network of skilled clinicians capable of building MDTs within their own hospitals. The programme is deeply grounded in African realities. Lectures focus on hypertensive and non-ischaemic cardiomyopathies, rural and urban disparities, workforce shortages, and how to deliver evidence-based care even when resources are limited. Delegates are supported to design and implement a quality improvement project tailored to their own clinical setting, putting new knowledge into practice rather than confining it to the classroom. ‘Africa-HF is more than a course; it is a movement to strengthen heart failure care across the continent’. A successful example of Africa-HF implementation is the multidisciplinary HF clinic established at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria which happens to be the first in the Southern, Nigeria. Inspired directly by programme participation, the clinic now brings together cardiologists, HF-trained nurses, pharmacists, and support staff, all united by a shared vision to deliver structured, team-based care and to improve patient outcomes (see Figure 1B). Today, each clinic session begins with a short educational video delivered in English and Nigerian Pidgin to ensure every patient hears consistent messages about HF management. Nurses take vital signs and anthropometric measurements, cardiologists perform focused assessments and echocardiography when necessary, and pharmacists review all prescribed medications to optimize therapy and reduce interactions. Patients are given dedicated HF support numbers, and those who miss appointments receive follow-up calls to encourage re-engagement (see Figure 1D). Over two years, the MDT clinic has cared for about 300 patients with chronic heart failure. The impact has been striking. A far greater proportion of patients now receive GDMT, with many on three or four evidence-based agents. Structured follow-up and education have contributed to a noticeable reduction in HF-related readmissions when compared with outcomes before the MDT clinic was established. For many patients and for the clinicians who care for them the shift has been transformative. The MDT approach has brought consistency, coordination, and renewed confidence in HF management. It has also created a sustainable framework for training young clinicians and embedding HF expertise within the hospital. This coordinated approach strengthens continuity of care and supports timely up-titration of GDMT. ‘Multidisciplinary teamwork has been a catalyst for improving guideline-directed care and reducing hospital readmissions’. The UPTH experience reflects the broader vision of PASCAR and CU: building a continent-wide network of clinicians capable of leading multidisciplinary HF services despite resource limitations. The Africa-HF programme has shown that when clinicians are empowered with training, mentorship, and a collaborative model of care, meaningful improvements in patient outcomes can be achieved even in the most challenging settings. As Nigeria and other SSA countries continue to confront the growing burden of heart failure, MDT-based HF clinics offer a promising path forward. Success at UPTH highlights not only what is possible, but what is urgently needed: coordinated, context-appropriate, and evidence-based heart failure care driven by teams, not individuals (see Figure 1). All authors declare no disclosure of interest for this contribution.