Research

Abstract

Background

There is a paucity of data to describe the clinical characteristics of heart failure (HF) in urban African communities in epidemiologic transition.

Methods and Result

The Chris Hani Baragwanath Hospital services the 1.1 million black African community of Soweto in South Africa. We prospectively collected detailed demographic, clinical data from all de novo cases of HF and related cardiomyopathies (CMO) presenting to the hospital’s Cardiology Unit in 2006.

Results

Of 1960 patients presenting with HF in 2006, 844 (47%) with a mean age of 55 ± 16 years were identified as a de novo case. Women (478 [57%]) and black Africans (739 [88%]) predominated. Most patients (761 [90%]) had ≥ 1 cardiovascular risk factor. Mean left ventricular ejection fraction was 45 ± 18%: 180 (23%) patients had isolated diastolic dysfunction and 121 (14%) isolated right HF. The most common diagnoses were hypertensive HF (281 [33%]), idiopathic dilated CMO (237 [28%]), right HF (225 [27%]), ischemic CMO (77 [9%]) and HF due to primary valve disease (67 [8%]). On an adjusted basis, 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 137 (25%), 72 (10%) and 64 (8.5%) cases, respectively.

Conclusion

These contemporary data from Soweto highlight the multiple challenges of dealing with an increasing and complex burden of HF within an urban African community. The predominance of women and broad underlying causes contrast with high income countries.