Trends and Predictors of In-Hospital Mortality among Heart Failure Patients in a Cameroonian Tertiary Care Center, 2021-2024<br>—Mortality Predictors in Acute Heart Failure in Cameroon

Background: Heart failure (HF) mortality is a critical challenge in low-resource settings like Cameroon, where predictors and trends are poorly understood. This study evaluated in-hospital mortality rates, trends, and predictors among HF patients at a Cameroonian tertiary cardiology unit. Methods: This retrospective cohort study analysed 757 HF admissions at Laquintinie Hospital, Douala (2021-2024). Multivariable logistic regression identified mortality predictors (p Results: Among 757 HF patients (median age 63 years, 51.3% female), hypertensive heart disease (28.5%) was prevalent, with an in-hospital mortality rate of 17.0% (n = 129). Multivariable analysis identified elevated Blood Urea Nitrogen (BUN) (aOR = 1.01, 95% CI: 1.01 - 1.02, p Conclusions: In-hospital HF mortality was high, driven by elevated BUN, dobutamine use, and later admission years, potentially reflecting increased patient acuity or resource constraints. Hypertensive heart disease and higher systolic blood pressure were protective. Interventions to enhance diagnostic access (e.g., echocardiography, ECG), and address systemic healthcare barriers are critical. Prospective studies are needed to investigate rising mortality trends and optimize HF management in Cameroon.