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(Circulation. 2008;118:2360-2367.)
© 2008 American Heart Association, Inc.

Heart Failure

Predominance of Heart Failure in the Heart of Soweto Study Cohort

Emerging Challenges for Urban African Communities

Simon Stewart, PhD, FCSANZ; David Wilkinson, DSc, FRACGP; Craig Hansen, PhD; Vinesh Vaghela, MD; Robert Mvungi, MBBCh, FCP; John McMurray, MD, FESC; Karen Sliwa, MD, PhD, FESC

From the Soweto Cardiovascular Research Unit, Department of Cardiology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, Republic of South Africa (S.S., D.W., V.V., R.M., K.S.); Faculty of Health Sciences, University of Queensland, Brisbane, Australia (D.W., C.H.); Baker IDI Heart and Diabetes Institute, Melbourne, Australia (S.S.); and Department of Cardiology, University of Glasgow, Glasgow, United Kingdom (J.M.).

Correspondence to Karen Sliwa, MD, PhD, Soweto Cardiovascular Research Unit, Department of Cardiology, Chris Hani Baragwanath Hospital, Bertsham 2013, Johannesburg, South Africa. E-mail sliwa-hahnlek{at}mdh-africa.org

Received April 14, 2008; accepted September 2, 2008.

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.

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