Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 21 2 2026 04 26 116 125 Okechukwu Ogah Department of Medicine, University of Ibadan Chukwuemeka Anyikwa Cardiomyopathies, Heart Failure and Atrial Fibrillation Research, Cardiology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria Endurance Evbayekha Division of Cardiovascular Health, University of Massachusetts School of Medicine, Worcester, MA, USA Olanike Orimolade Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. Ayodipupo Oguntade Advanced Cardiac Imaging, Division of Cardiology, Montefiore-Einstein Center for Heart & Vascular Care, Montefiore Medical Center, Bronx, NY, USA Franklin Obiekwe Cardiomyopathies, Heart Failure and Atrial Fibrillation Research, Cardiology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria Chidinma Ogah Cardiomyopathies, Heart Failure and Atrial Fibrillation Research, Cardiology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria Ibukun Ishola Cardiomyopathies, Heart Failure and Atrial Fibrillation Research, Cardiology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria Innocent Chukwuonye Nephrology Unit, Department of Medicine, Federal Medical Center, Umuahia, Abia State , Nigeria Oladimeji Adebayo Institute of Cardiovascular Diseases, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Nigeria Akinyemi Aje Cardiology Unit, Department of Medicine, University College Hospital , Ibadan, Oyo State, Nigeria. Abiodun Adeoye Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. Adewole Adebiyi Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. Olulola Oladapo Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. 2026 01 05 2026 04 19 Background: Heart failure (HF) is rising among younger adults in sub-Saharan Africa, yet data on their clinical profile and outcomes are limited. We compared clinical characteristics, etiology, and 1-year outcomes between younger and older HF patients in the Ibadan Heart Failure Project. Methods: We included 1290 adults (≤50 y, n=430; >50 y, n=860) enrolled from 2016 through 2022. Baseline sociodemographic, clinical, laboratory, and echocardiographic data were collected. HF etiology was classified using ICD-10 codes. Medication use and 1-year outcomes, including rehospitalization, mortality, and a composite of rehospitalization and mortality, were assessed. Results: Younger patients are predominantly females, more often single and employed, and presented with advanced HF signs, including paroxysmal nocturnal dyspnea, raised jugular venous pressure, S3 gallop, and cardiomegaly. Older patients had a higher prevalence of hypertension, diabetes mellitus, and peripheral edema. Hypertensive heart disease and cor pulmonale predominated in older patients (76% vs 44%), whereas younger patients more frequently had dilated cardiomyopathy (16% vs 7.4%), peripartum cardiomyopathy, and rheumatic heart disease (15% vs 6.2%). Guideline-directed therapy use was similar across ages. One-year mortality, rehospitalization, and composite outcomes did not differ significantly between age groups. Conclusion: Younger HF patients in Nigeria present with severe nonischemic cardiomyopathies and advanced systolic dysfunction, whereas older patients have hypertensive and metabolic phenotypes. Despite these differences, 1-year outcomes were uniformly poor, reflecting the high burden of HF morbidity and mortality across all age groups in Nigeria. https://jthc.tums.ac.ir/index.php/jthc/article/view/2415 https://jthc.tums.ac.ir/index.php/jthc/article/download/2415/1256