Health-related quality of life and associated factors among patients with heart failure in Ethiopia: a systematic review and meta-analysis

Abstract Background Heart failure is a chronic and progressive cardiovascular condition that substantially impairs physical, emotional, and social functioning, resulting in reduced health-related quality of life (HRQoL). In Ethiopia, individual studies report a high burden of poor HRQoL among heart failure patients; however, there has been no comprehensive synthesis quantifying its overall magnitude or identifying consistent associated factors. Objective To estimate the pooled prevalence of poor HRQoL and identify associated factors among patients with heart failure in Ethiopia. Methods A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420261323503). Electronic databases including PubMed/MEDLINE, Scopus, Embase, Web of Science, African Journals Online, and Google Scholar were searched. Observational studies conducted in Ethiopia reporting HRQoL using validated tools were included. Data were analyzed using STATA version 17.0. A random-effects model was applied. Heterogeneity was assessed using Cochran’s Q and I² statistics. Publication bias was evaluated using funnel plot and Egger’s test. Results Seven studies involving 2,396 patients were included. The pooled prevalence of poor HRQoL was 47.82% (95% CI: 44.16–51.48). Moderate heterogeneity was observed (I² = 38.94%, p < 0.05). Sensitivity analysis showed stable results. Funnel plot inspection suggested slight asymmetry; however, Egger’s test indicated no statistically significant publication bias ( p = 0.21). Advanced NYHA class IV was significantly associated with poor HRQoL (AOR = 9.95, 95% CI: 2.49–17.41). Narrative synthesis identified additional factors including rural residence, NYHA Class II and III, age ≥ 50 years, comorbidities, occupational status, and severe LVEF. Conclusion Nearly half of Ethiopian heart failure patients experience poor HRQoL. Disease severity and multiple socioeconomic and clinical factors influence outcomes. Strengthening patient-centered care and early management is essential. Findings should be interpreted with caution due to limited number of studies.