Predominance of heart failure in the heart of Soweto study cohort: Emerging challenges for urban African communities

Stewart, Simon, Wilkinson, David, Craig Hansen, Vaghela, Vinesh, Mvungi, Robert, McMurray, John and Sliwa, Karen (2008) Predominance of heart failure in the heart of Soweto study cohort: Emerging challenges for urban African communities. Circulation, 118 23: 2360-2367. doi:10.1161/CIRCULATIONAHA.108.786244


Author Stewart, Simon
Wilkinson, David
Craig Hansen
Vaghela, Vinesh
Mvungi, Robert
McMurray, John
Sliwa, Karen
Title Predominance of heart failure in the heart of Soweto study cohort: Emerging challenges for urban African communities
Journal name Circulation   Check publisher's open access policy
ISSN 0009-7322
Publication date 2008-12-02
Year available 2008
Sub-type Article (original research)
DOI 10.1161/CIRCULATIONAHA.108.786244
Open Access Status
Volume 118
Issue 23
Start page 2360
End page 2367
Total pages 8
Editor J. Loscalzo
Place of publication Philadelphia PA
Publisher Lippincott Williams & Wilkins
Language eng
Subject C1
110201 Cardiology (incl. Cardiovascular Diseases)
920103 Cardiovascular System and Diseases
Formatted abstract
Background— 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.
Keyword Africa
Epidemiological Transition
Epidemiology
Heart Failure
Population
Q-Index Code C1
Q-Index Status Confirmed Code
Additional Notes Published online before print November 24, 2008.

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Wed, 25 Mar 2009, 01:53:54 EST by Helen Spindler on behalf of School of Medicine