Objective: Heart failure (HF) continues to be a global health problem. Due to limited epidemiological data in Africa, there is need to explore and better understand its aetiology and outcome to improve its management.

Design and Method: We analysed clinical and echocardiographic data of patients with acute HF at the cardiology units of Douala General Hospital and Douala Cardiovascular Center, among which 290 retrospective and 122 prospective cases during a period of 5 years (2009–2013). Chi square and student t-tests (where appropriate) were used for group comparisons while logistic regression models were used to investigate the predictors of mortality in HF and survival estimated using Kaplan Meier curves.

Results: In all, 412 patients (214 men (mean age 58.1 ± 14.8 years) and 198 women (mean age 62.7 ± 17.4 years)) were included. The aetiologies of HF were predominantly non-ischemic: hypertensive cardiomyopathy (HTCM) (54.5%), dilated cardiomyopathy (20.5%), valvular heart disease (VHD) (11.7%) and ischemic heart disease (4.9%). The trend in incidence of HTCM and IHD was constant over 5 years while VHD had a declining trend (p < 0.01). A low use of beta-blockers was noticeable. Mortality rates were 14.3% for in hospital, 29.6% at 6 months to 38.2% at one year.

Conclusions: Contemporary aetiologies of HF in Cameroon are similar to previous reports from other African registries; with dominance of HTCM and declining but persisting VHD. Mortality rates of HF are high, huge efforts are needed to improve management of HF in low-resourced settings.