Liesl J Zühlke1, Mark E Engel2, David Watkins3, Bongani M Mayosi1. 1. Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. 2. Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. Electronic address: mark.engel@uct.ac.za. 3. Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa; Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Abstract
BACKGROUND: Twenty years after its first democratic election, South Africa is experiencing a health transition. The impact of change on the incidence, prevalence and outcome of rheumatic heart disease (RHD) is unknown. METHODS: We conducted a systematic overview of the incidence, prevalence and outcomes of RHD in South Africa over the past two decades according to a published protocol. RESULTS: The overall crude incidence of symptomatic RHD was 24.7 per 100,000 (95% confidence interval (CI) 22.1 to 27.4) population per annum among adults (>13years) in Soweto, while the prevalence of asymptomatic echocardiographic RHD in schoolchildren was 20.2 cases per 1000 children (95% CI 15.3 to 26.2) in Cape Town. The 60-day mortality after admission with acute heart failure due to RHD was 24.8% (95% CI 13.6% to 42.5%) and 180-day mortality was 35.4% (95% CI 21.6% to 54.4%). Postoperative mortality at 30days was 2% (95% CI 0.0% to 4%). Post-surgical survival was over 75% at 5years, and over 70% at 10years. Cause-specific mortality rate per 100,000 population decreased from 1.27 (95% CI 1.17 to 1.39) in 1997 to 0.7 (95% CI 0.63 to 0.78) in 2012. CONCLUSIONS: The incidence of symptomatic RHD in adults and prevalence of asymptomatic RHD in schoolchildren are high in South Africa. Mortality was high in patients with RHD-related heart failure, although post-surgical morbidity and mortality were low. Mortality attributed to RHD may be falling at a population level.
BACKGROUND: Twenty years after its first democratic election, South Africa is experiencing a health transition. The impact of change on the incidence, prevalence and outcome of rheumatic heart disease (RHD) is unknown. METHODS: We conducted a systematic overview of the incidence, prevalence and outcomes of RHD in South Africa over the past two decades according to a published protocol. RESULTS: The overall crude incidence of symptomatic RHD was 24.7 per 100,000 (95% confidence interval (CI) 22.1 to 27.4) population per annum among adults (>13years) in Soweto, while the prevalence of asymptomatic echocardiographic RHD in schoolchildren was 20.2 cases per 1000 children (95% CI 15.3 to 26.2) in Cape Town. The 60-day mortality after admission with acute heart failure due to RHD was 24.8% (95% CI 13.6% to 42.5%) and 180-day mortality was 35.4% (95% CI 21.6% to 54.4%). Postoperative mortality at 30days was 2% (95% CI 0.0% to 4%). Post-surgical survival was over 75% at 5years, and over 70% at 10years. Cause-specific mortality rate per 100,000 population decreased from 1.27 (95% CI 1.17 to 1.39) in 1997 to 0.7 (95% CI 0.63 to 0.78) in 2012. CONCLUSIONS: The incidence of symptomatic RHD in adults and prevalence of asymptomatic RHD in schoolchildren are high in South Africa. Mortality was high in patients with RHD-related heart failure, although post-surgical morbidity and mortality were low. Mortality attributed to RHD may be falling at a population level.
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Authors: Liesl J Zühlke; Andrea Beaton; Mark E Engel; Christopher T Hugo-Hamman; Ganesan Karthikeyan; Judith M Katzenellenbogen; Ntobeko Ntusi; Anna P Ralph; Anita Saxena; Pierre R Smeesters; David Watkins; Peter Zilla; Jonathan Carapetis Journal: Curr Treat Options Cardiovasc Med Date: 2017-02