Key result
High RHD incidence in adult urban Africans supports making first episodes notifiable for secondary prophylaxis.
Observational (n=344)
No
The study highlights a high incidence of newly diagnosed rheumatic heart disease in an urban African adult population, emphasizing the need for register-based secondary prophylaxis programs.
May support notifiability of first RHD episodes in urban African adults to enable secondary prophylaxis; leaves open impact on disease control pending validation.
AIMS: Little is known on the incidence and clinical characteristics of newly diagnosed rheumatic heart disease (RHD) in adulthood from urban African communities in epidemiologic transition. METHODS AND RESULTS: Chris Hani Baragwanath Hospital services the black African community of 1.1 million people in Soweto, South Africa. A prospective, clinical registry captured data from all de novo cases of structural and functional valvular heart disease (VHD) presenting to the Cardiology Unit during 2006/07. We describe in detail all cases with newly diagnosed RHD. There were 4005 de novo presentations in 2006/07 and 960 (24%) had a valvular abnormality. Of these, 344 cases (36%) were diagnosed with RHD. Estimated incidence of new cases of RHD for those aged >14 years in the region was 23.5 cases/100 000 per annum. Most were black African females (n = 234-68%) with a similar age profile to males [median 41 (interquartile range 30-55) years vs. 42 (interquartile range 31-55) years]. The predominant valvular lesion (n = 204, 59%) was mitral regurgitation (MR), with 48 (14%) and 43 (13%) cases, respectively, having combination lesions of aortic plus MR and mixed mitral VHD. Impaired systolic function was found in 28/204 cases (14%) of predominant MR and in 23/126 cases (18%) with predominant aortic regurgitation. Elevated right ventricular systolic pressure >35 mmHg (62 cases), atrial fibrillation (34 cases), and anaemia (27 cases) were found in 18, 10, and 8% of 344 RHD cases, respectively. Subsequent valve replacement/repair was performed in 75 patients (22%). A total of 90 cases (26%) were admitted within 30 months of initial diagnosis for suspected bacterial endocarditis. CONCLUSION: These data reveal a high incidence of newly diagnosed RHD within an adult urban African community. These data argue strongly for the first episode of RHD to be made a notifiable condition in high burden countries in order to ensure control of the disease through register-based secondary prophylaxis programmes.
No takes yet. Share an insight, caveat, or question.
Sliwa et al. (2009) conducted an observational in Rheumatic heart disease (n=344). Rheumatic heart disease was evaluated on Incidence of new cases of RHD for those aged >14 years. The estimated incidence of newly diagnosed rheumatic heart disease in adults >14 years in Soweto, South Africa was 23.5 cases/100,000 per annum, predominantly affecting females (68%).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: