Purpose of Review Heart failure is a complex cardiovascular syndrome with diverse etiologies. It is prevalent and has a substantial adverse global health impact. This review focuses on the peculiarities of HF in sub-Saharan Africa. Findings Heart failure poses a significant challenge in sub-Saharan Africa, primarily affecting young adults aged 36.5 to 61.5 years. Patients often present with advanced symptoms, exacerbated by socioeconomic factors and other complications. Key risk factors include hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease, with new challenges arising from obesity, air pollution, and infectious diseases, further complicating treatment approaches. Diagnostic capabilities in sub-Saharan Africa remain limited. Non-adherence to prescribed medications ranges between 23.7% and 74.7%, worsening disease progression and leading to increased rehospitalizations and mortality rates. Moreover, the high costs of guideline-recommended medications, including sodium-glucose cotransporter-2 inhibitors and angiotensin receptor-neprilysin inhibitors, restrict their availability. Additionally, advanced device therapies like implantable cardioverter-defibrillators and cardiac resynchronization therapy are often inaccessible due to their high costs, the scarcity of invasive cardiac laboratories, and a limited number of trained healthcare professionals. Summary Heart failure poses a significant challenge in sub-Saharan Africa, especially among younger adults. Late clinical presentations, compounded by socioeconomic barriers, underscore the urgent need for improved healthcare access and education. Addressing key risk factors, enhancing diagnostics, and ensuring treatment adherence are vital for better management. Additionally, the high costs of advanced medications highlight the necessity for more affordable healthcare solutions to alleviate the burden of heart failure in the region.

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