title: Incidence and characteristics of newly diagnosed rheumatic heart disease in urban African adults: insights from the heart of Soweto study.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Soweto Cardiovascular Research Unit, Department of Cardiology, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Bertsham, 2013 Johannesburg, Republic of South Africa. sliwa-hahnlek@mdh-africa.org
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.forename: Melinda
authors.initials: M
authors.lastname: Carrington
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
authors.forename: Elias
authors.initials: E
authors.lastname: Zigiriadis
authors.forename: Robert
authors.initials: R
authors.lastname: Mvungi
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000401:mortality*; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012214:Rheumatic Heart Disease / Q000401:mortality*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014504:Urban Health; D055815:Young Adult