The ‘Heart of Soweto Study’ (8000 patients), reporting on the prevalence, presentation and management of cardiac disease in an urban African population was published in the Lancet in 2008 (IF 44, CI 304). This seminal paper led to more than 25 publications describing the impact of HIV/AIDS on CVD (Sliwa. European Heart Journal, 2012), the prevalence of rheumatic heart disease diagnosed in adulthood (Sliwa. European Heart Journal, 2010) and the spectrum of conditions leading to heart failure (Stewart/Sliwa; Circulation 2008). The Heart of Soweto studies included cohort studies in tertiary, secondary and primary care facilities.
Those population studies were expanded (under the umbrella of the ‘Heart of Africa studies’) to other African countries, through the design of several innovative research programs and leveraging of funding. One such study was the THESUS study, which documented the factors contributing to acute heart failure management and outcome in a multi-centre cohort study. A large African team of researchers linked to the Hatter Institute for Cardiovascular Research in Africa continue to perform several other African clinical studies. A few examples are listed below:
Pan-African Nurse-led and Community-based care in Heart Failure (PANACEA-HF) Trial
A HF nurse-led, community-based management programme, specifically adapted to the African healthcare context, and with technological support, is likely to be more effective than standard management. This programme will assist in prolonging survival and reducing days in hospital (primary endpoint of days-alive and out-of-hospital) during the minimum 6-month follow-up of patients initially admitted to hospital with acute HF and discharged to home with a diagnosis of HF with reduced ejection fraction (HFrEF), who would require ongoing management. The PANACEA-HF Trial will be undertaken in a broad range of hospital settings to reflect the diversity of African communities and the health systems in which HF is typically managed. The study will commence in 2018 at the following African sites.
The Pan African Pulmonary Hypertension Cohort (PAPUCO) Study
The main objective of this research is to describe the epidemiology of pulmonary hypertension (PHT) in patients from a number of African countries. The study has recently be published. Thienemann et al. 2016.
Pulmonary hypertension (PH) is a condition of varying aetiologies that is primary characterised by narrowing of the pulmonary vasculature and consequential right heart failure (RHF). It is a devastating, progressive disease associated with increasingly debilitating symptoms and a poor prognosis. However, the majority of reports emanate from high-income countries. Based on the hypothesis that the underlying pathways to this deadly condition in Africa would be many and varied and produce a high burden of disease (relative to high-income countries), we initiated the Pan African Pulmonary Hypertension Cohort (PAPUCO) Registry Study; a unique study in the African context. The study provides prospective, standardised profiling and outcome data (including 6-month survival profiles) in a series of consecutive African patients newly diagnosed with PH from participating centres across the African continent. Our data provide new insights into PH from a developing world perspective; with clear opportunities to improve its prevention, treatment and outcomes taking into account the relative lack of health resources and the particular need to provide practical guidelines for its rapid detection and optimal management in the African context.
Recent research in cardiovascular disease in African populations (Heart of Soweto Study), specifically of heart failure (THESUS Study – Damasceno et al. The causes, treatment and outcome of acute heart failure in 1006 Africans from 9 countries. Arch Intern Med, 2012), has shown that heart failure is not treated optimally in Africa. Prof Sliwa has been the principal investigator of a prospective, placebo-controlled, double-blind, randomized study to compare treatment with Hydralazine-Isosorbide–Dinitrate (HYIS) versus placebo on top of standard care in African patients admitted with Acute Heart Failure (AHF) and left ventricular dysfunction - the BA-HEF study. This study commenced in January 2013 and the results were reported at the European Cardiac Society meeting in Florence, Italy in May 2016, and simultaneously published in the European Journal of Heart Failure. The use of different medications such as ACEi and hydralazine/nitrates, has never been examined in patients admitted with acute heart failure. The BA-HEF trial demonstrated challenges in recruiting the expected number of patients with acute heart failure in several African countries, thus highlighting the need for strategic logistic support.
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