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Background Cardiovascular disease (CVD) is a major cause of death worldwide. At least two-third of CVD death occurs in low- (LIC) and middle-income (MIC) countries. An estimated 1 million deaths were attributable to CVD in sub-Saharan Africa (SSA) alone. Scarce data are available about the admission for CVD and outcome in cardiology department in SSA. Purpose To describe admission for CVD and outcome of hospitalization in 17 in SSA countries. Methods We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo, Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The February study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016.Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10)) Results Overall, 4360 patients were included in the February study. Men represented 56.4%. Mean of age was 56.7±16.8 years. The main cause of admission was heart failure (41.5%) followed by acute coronary syndrome (11.9%) and stroke (11%). Cause of admission varied significantly across countries (p Conclusion Heart failure, acute coronary syndrome and stroke represent the two-third of causes of admission. Overall, mortality rate in cardiology departments in SSA reached 11%. Funding Acknowledgement Type of funding sources: None.

Background/Introduction Most studies on the association between sleep habits and cardiovascular disease (CVD) have focused on one single sleep dimension, essentially sleep duration and sleep apnea. Purpose To examine the joint effect of several dimensions of sleep habits with incident CVD in a community-based prospective cohort. Methods Between 2008 and 2011, 10,157 men and women aged 50 to 75 years were recruited in a preventive medical center. They underwent a standard physical examination coupled with standard biological tests, and provided information related to lifestyle, personal and family medical history, current health status, and medication use on questionnaires. Sleep habits were self-reported on validated questionnaires that assess sleep duration and insomnia complaints (Pittsburg questionnaire), early chronotype, sleep apnea (Berlin questionnaire) and subjective daytime sleepiness (Epworth questionnaire). Each sleep dimension was assigned 1 point if optimal and 0 point otherwise. A healthy sleep score ranging from 0 to 5 (the higher the better) and reflecting the number of optimal sleep dimensions was computed: early chronotype, sleep duration of 7–8 h/day, never/rarely insomnia, no sleep apnea, and no frequent excessive daytime sleepiness. The occurrence of incident CVD events including coronary heart disease and stroke was followed every two years up to September 2020, and events were validated after review of the medical records. The multivariable association between higher healthy sleep score and CVD events was examined in proportional hazard Cox regression analysis. Population-attributable fractions were calculated to estimate the proportion of CVD cases that could be prevented by healthier sleep habits. Results This study included 7203 participants (62% of men, mean age: 59.7 years±6.2) who were free of CVD at baseline and had complete data on sleep habits and covariates. Among them, 6.9% had a poor sleep score (healthy sleep score of 0 or 1), and 10.4% had an optimal sleep score (score= 5). After a median follow-up of 8 years, 275 participants had incident CVD events. After adjustment for age, sex, total alcohol consumption, socioprofessional categories, smoking status, body mass index, physical activity, family history of heart diseases, LDL and HDL cholesterol, and diabetes status, the risk of CVD decreased by 22% (HR=0.78 [95% CI: 0.71–0.86]) per 1 point increment in the healthy sleep score, and there was a 74% risk reduction in CVD risk (HR=0.26 [0.13–0.51]) between participants with the highest (score of 5) and those with the lowest (score of 0–1) healthy sleep score (Table 1). Under the hypothesis that all the participants would achieve an optimal sleep score of 5, 70.8% of incident CVD could be potentially avoided each year. Conclusion(s) In this community-based prospective cohort, a higher healthy sleep score combining 5 sleep dimensions was associated with a lower risk of CHD or stroke. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): The National Research Agency (ANR), The Region Ile de France (Domaine d'Intérêt Majeur)

Background Cardiac troponin I (cTnI) as measured by high-sensitive assays has been related to incident cardiovascular disease events (CVD) in the community. With the advent of ultra-sensitive assays, it is now possible to detect troponin I at very low concentration, far below the classical threshold of 1.9 pg/mL. However, the clinical relevance of these low concentrations for predicting CVD is largely unknown. Purpose To examine the association of cTnI as low as 0.013 pg/mL with incident cardiovascular disease events (CVDs) in the primary prevention setting. Methods cTnI was analyzed in the baseline plasma (2008–2012) of CVD free volunteers from the Paris Prospective Study III using for the first time a novel ultra-sensitive immunoassay (Simoa Troponin-I 2.0 Kit, Quanterix, Lexington) with a limit of detection (LOD) of 0.013 pg/mL. Incident CVD hospitalizations for coronary heart disease, stroke, arrhythmias, venous thromboembolism, arterial aneurysms and heart failure were validated by critical review of the hospital records. Hazard ratios were estimated per log-transformed standard deviation (SD) increase of cTnI in Cox models using age as the time scale. The added value (gain in discriminatory capacity) of cTnI for CVD risk prediction was examined by calculating the Harell's C-index boostraped difference of the SCORE 2 risk model with and without cTnI. Results There were 9503 CVD free participants (40% women) aged 59.6 (6.3) years at baseline. cTnI was detected in 99.6% of the participants (median value = 0.63 pg/mL, interquartile range [IQR] 0.39–1.09). After a median follow-up of 8.34 years (IQR, 8.0–10.07), 516 participants suffered 612 events. In fully-adjusted analysis, higher cTnI (per 1 SD increase of log cTnI) was significantly associated with CVD events combined (n=516, HR= 1.21; 1.06; 1.39). In univariate Cox analysis and compared to each single established risk factor, cTnI had the highest discrimination capacity for incident CVD events (C-index=0.6349) (Figure 1). Adding log cTnI to the SCORE 2 algorithm increased significantly albeit moderately discriminatory capacity (C-index 0.698 vs. 0.685; boostraped C index difference: 0.0135 (95% CI: 0.0131; 0.0138)). Conclusion cTnI concentrations as measured by a novel ultra-sensitive immunoassay is associated with a significant increased risk of incident CVD events in the primary prevention setting. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): ANR: French National Research AgencyEurope: Horizon 2020

Background Stroke is one of the leading causes of morbidity and mortality worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability would occur in low- and middle-income countries. Between 2002 and 2020, estimation stroke mortality in Sub-Saharan Africa (SSA) was tripled. There is scarce data on management of stroke in SSA. Purpose To describe stroke care in cardiology departments in 17 SSA countries Methods We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo (DCR), Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The FEBRUARY study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10)). Results Overall, 4360 patients were admitted to hospital over the 6 years of the study. Stroke was the third cause of hospitalization with 477 (11%) patients admitted. Proportions of patients admitted for stroke varied across countries from 0% in Ethiopia to 52% in DRC (p Conclusion Stroke was the third cause of admission with more than 1/10 patients and the second cause of mortality with almost 1/5 patients in cardiology departments in SSA. Funding Acknowledgement Type of funding sources: None.

Background High blood pressure (BP) is a major risk factor for several common cardiovascular (CV) disease such as stroke, heart failure or chronic kidney disease. The Sub-Saharan Africa (SSA) should face the highest rate of hypertension worldwide with an overall prevalence estimation of 46%. Due to scarce resources and inadequate healthcare provision, SSA have scarce hard data on treatment and control of high BP. Purpose To assess the detection and characteristics of hypertension patients admitted in hospitalizations 17 SSA countries Methods We conducted a transversal and longitudinal study in CV department of 37 hospitals from 23 cities in 17 SSA countries (10 low income: Niger, Guinea, Benin, Mali, Democratic Republic of the Congo, Tchad, Burkina Faso, Togo, Burundi, Ethiopia and 7 middle income: Cote d'Ivoire, Senegal, Cameroon, Congo, Soudan, Mauritania, Gabon). The February study was designed by a multidisciplinary collaborative team of epidemiologists, pharmacists and cardiologists from Africa and France. This ongoing observatory included all inpatients in February from each year since 2016. Data including socio-demographic and clinical characteristics, causes of admission, clinical, biological, complementary examinations, treatments, length of stay and discharge diagnosis were collected by the investigating physicians. Hypertension and severity of hypertension were defined according to 2018 ESC/ESH guidelines and BP was measured twice using standardized method. All analyses were performed through scripts developed in the R software (4.0.3 (2020-10-10)) Results The study involved 4360 patients. Hypertension was measured on 1906 (43.7%) patients at admission. Proportion of patients with high BP in hospital increased from 42.2% in 2016 to 52.2% in 2021 (p Conclusion In patients admitted in cardiology departments, hypertension is a huge burden in SSA. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Camille Lassale is supported by a fellowship from “La Caixa” Foundation (ID 100010434). The fellowship code is LCF/BQ/PR21/11840003 Background Use of traditional medicine (TM), is widespread in Sub-Saharan Africa as treatment option for a wide range of disease. We aimed to describe the profile of TM users and estimate the association with blood pressure (BP) and control of hypertension among hypertensive patients in a pan-African study. Methods We included 2128 participants in the cross-sectional EIGHT study, who attended an outpatient consultation in the cardiology departments of 12 Sub-Saharan African countries (Benin, Cameroon, Congo, Democratic Republic of the Congo, Gabon, Guinea, Côte d’Ivoire, Mauritania, Mozambique, Niger, Senegal, Togo). We describe patients’ characteristics according to TM use. We modelled the odds of uncontrolled hypertension, severe hypertension, and complications of hypertension by multivariable mixed logistic regression, and the linear association with systolic and diastolic BP by linear regression, all adjusted for age, sex, individual wealth index, adherence to hypertension conventional treatment, and country. Results A total of 512 (24%) of participants reported using TM, and this percentage varied drastically across countries from 10% in the Congo to 48% in Guinea. TM users were more likely to be male, with poor treatment adherence, reporting missing treatment because it is too expensive, and presenting any complication of hypertension. TM use was associated with greater odds of hypertension (OR=1.30; 95% confidence interval: 0.99, 1.70), severe hypertension (OR=1.34; 1.04, 1.74) and of any complication of hypertension (OR=1.27; 1.01, 1.60), driven by renal complication (OR=1.57; 1.07, 2.29). Use of TM was associated with a 3.87 mmHg higher systolic BP and 1.75 mm Hg higher diastolic BP compared to no use. Conclusions In this cross-sectional study of patients with hypertension in 12 Sub-Saharan African countries, we identified that the use of traditional medicine was associated with a poorer control of hypertension and more complications.

Objectives This study sought to assess the relationship between an immediate invasive strategy and survival after an out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause, according to prognosis evaluated on hospital arrival. Background An immediate coronary angiogram (CAG) may be associated with better outcome after OHCA in neurologically preserved patients but could be futile in other cases. Methods From May 2011 to May 2015, we collected data for all patients admitted in hospital after OHCA in Paris and its suburbs (France). Risk of in-hospital death was retrospectively calculated using the validated Cardiac Arrest Hospital Prognosis score, which includes age, setting, initial rhythm, durations from collapse to basic life support and from basic life support to return of spontaneous circulation, pH, and epinephrine dose. Independent predictors of survival at discharge (including immediate CAG) were assessed in multivariate logistic regression in each of the 3 pre-defined subgroups of Cardiac Arrest Hospital Prognosis score: low risk ( 200 points) for in-hospital death. Results A total of 1,410 patients were included and overall survival rate at hospital discharge was 32%. Distribution in the low-, medium-, and high-risk Cardiac Arrest Hospital Prognosis subgroups was 667 (47%), 469 (33%), and 274 patients (20%), respectively. The rate of early CAG was 86%, 66%, and 47% in the low-, medium-, and high-risk subgroups, respectively (p Conclusions In cardiac arrest patients, our results suggest that investigations regarding early CAG after OHCA should focus on patients with preserved neurological status.

Background: QT abnormalities have been reported in left ventricular hypertrophy and hypertrophic cardiomyopathy. Objective: To determine the relation between left ventricular hypertrophy and increased QT interval in familial hypertrophic cardiomyopathy. Methods: The QT interval was measured in 206 genotyped adult subjects with familial hypertrophic cardiomyopathy from 15 unrelated families carrying mutations in the β myosin heavy chain (β-MHC) gene (five families, n = 68) or the cardiac myosin binding protein C (MyBPC) gene (10 families, n = 138). Subjects were classified as genetically unaffected (controls, n = 112), affected with left ventricular hypertrophy (penetrants, n = 58), or affected without left ventricular hypertrophy (non-penetrants, n = 36). Results: There was a significant increase in QTmax and QTmin from controls to non-penetrants and penetrants for both the MyBPC group (p ≤ 0.001 and p ≤ 0.001, respectively) and the β-MHC group (p ≤ 0.001 and p ≤ 0.001, respectively). In the MyBPC group, the increase in the QT interval could be explained by increased left ventricular hypertrophy. In the β-MHC group, non-penetrants had a significantly longer QTmax than controls despite the absence of left ventricular hypertrophy, and a similar QT interval to penetrants despite a lesser degree of left ventricular hypertrophy. Conclusions: In familial hypertrophic cardiomyopathy, genetically affected subjects without left ventricular hypertrophy may have a prolonged QT duration, which depends not only on the degree of left ventricular hypertrophy, when present, but also on the causative mutation.