TY - JOUR
T1 - Predominance of heart failure in the heart of Soweto study cohort
T2 - Emerging challenges for urban African communities
AU - Stewart, Simon
AU - Wilkinson, David
AU - Hansen, Craig
AU - Vaghela, Vinesh
AU - Mvungi, Robert
AU - McMurray, John
AU - Sliwa, Karen
PY - 2008/12/2
Y1 - 2008/12/2
N2 - There is a paucity of data to describe the clinical characteristics of heart failure (HF) in urban African communities in epidemiological transition. Methods and Results - Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto. South Africa. Of 1960 cases of HF and related cardiomyopathies in 2006, we prospectively collected detailed demographic and clinical data from all 844 de novo presentations (43%). Mean age was 55 ± 16 years, and women (479 [57%]) and black Africans (739 [88%]) predominated. Most (761 [90%]) had ≥1 cardiovascular risk. Mean left ventricular ejection fraction was 45 ± 18%. Overall, 180 patients (23%) had isolated diastolic dysfunction, 234 (28%) tricuspid regurgitation, 121 (14%) isolated right HF, and 100 (12%) mitral regurgitation. The most common diagnoses were hypertensive HF (281 [33%]), idiopathic dilated cardiomyopathy (237 [28%]), and, surprisingly, right HF (225 [27%]). Black Africans had less ischemic cardiomyopathy (adjusted odds ratio, 0.12; 95% CI, 0.07 to 0.20) but more idiopathic and other causes of cardiomyopathy (adjusted odds ratio, 4.80; 95% CI, 2.57 to 8.93). Concurrent renal dysfunction, anemia, and atrial fibrillation were found in 172 (25%), 72 (10%), and 53 (6.3%) cases, respectively. Conclusions - These contemporary data highlight the multiple challenges of preventing and managing an increasing and complex burden of HF in urban Africa. In addition to tackling antecedent hypertension, a predominance of young women and a large component of right HF predicate the development of tailored therapeutic strategies.
AB - There is a paucity of data to describe the clinical characteristics of heart failure (HF) in urban African communities in epidemiological transition. Methods and Results - Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto. South Africa. Of 1960 cases of HF and related cardiomyopathies in 2006, we prospectively collected detailed demographic and clinical data from all 844 de novo presentations (43%). Mean age was 55 ± 16 years, and women (479 [57%]) and black Africans (739 [88%]) predominated. Most (761 [90%]) had ≥1 cardiovascular risk. Mean left ventricular ejection fraction was 45 ± 18%. Overall, 180 patients (23%) had isolated diastolic dysfunction, 234 (28%) tricuspid regurgitation, 121 (14%) isolated right HF, and 100 (12%) mitral regurgitation. The most common diagnoses were hypertensive HF (281 [33%]), idiopathic dilated cardiomyopathy (237 [28%]), and, surprisingly, right HF (225 [27%]). Black Africans had less ischemic cardiomyopathy (adjusted odds ratio, 0.12; 95% CI, 0.07 to 0.20) but more idiopathic and other causes of cardiomyopathy (adjusted odds ratio, 4.80; 95% CI, 2.57 to 8.93). Concurrent renal dysfunction, anemia, and atrial fibrillation were found in 172 (25%), 72 (10%), and 53 (6.3%) cases, respectively. Conclusions - These contemporary data highlight the multiple challenges of preventing and managing an increasing and complex burden of HF in urban Africa. In addition to tackling antecedent hypertension, a predominance of young women and a large component of right HF predicate the development of tailored therapeutic strategies.
KW - Africa
KW - Epidemiological transition
KW - Epidemiology
KW - Heart failure
KW - Population
UR - http://www.scopus.com/inward/record.url?scp=58149105364&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.108.786244
DO - 10.1161/CIRCULATIONAHA.108.786244
M3 - Article
C2 - 19029467
AN - SCOPUS:58149105364
SN - 0009-7322
VL - 118
SP - 2360
EP - 2367
JO - Circulation
JF - Circulation
IS - 23
ER -