The Sub-Saharan Africa Survey of Heart Failure (THESUS–HF) was a prospective, multicenter, observational survey of patients with acute heart failure (HF) admitted to 12 university hospitals in 9 countries. Patients with acute HF were evaluated for HF etiology, treatment, and outcomes over 6 months. Acute HF affects patients in sub-Saharan Africa at an extremely early age and is mostly due to hypertension and primary cardiomyopathies. The disease leads to a high burden of readmission and death, similar to that observed in other countries, affecting younger patients in the prime of their life. These data challenge us to recognize and respond to HF in Africa by responding to the common precursors, such as hypertension, and the urgent need for culturally sensitive interventions.