Burden of Heart Failure in Soweto
The Heart of Soweto Study
Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto, South Africa. Of 1960 cases of HF and related cardiomyopathies (CMO) in 2006, we prospectively collected detailed demographic and clinical data from all 844 de novo presentations (43%). Mean age was 55 ± 16 years while 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 (23%) patients 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 CMO (237 [28%]) and, surprisingly, right HF (225 [27%]). Black Africans had less ischemic CMO (adjusted OR 0.12, 95% CI 0.07 to 0.20) but more idiopathic and other causes of CMO (adjusted OR 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.
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. [Download PDF]
Stewart S, Wilkinson D, Hansen C, Vaghela J, Mvungi R, McMurray J Sliwa K Predominance of Heart Failure in the Heart of Soweto Study Cohort: Challenges for Urban African Communities. Circulation 2008;118, 4 Dec.