Heart of Africa

Heart of Africa Projects

This includes collaborative projects that examine the emergence of heart disease in African communities in epidemiological transition.

In January 2006 a prospective registry of more than 9,000 men and women, with heart disease, from Soweto presenting to the Baragwanath Hospital, was initiated (The Heart of Soweto Study). So far information on 8000 patients has been collected and several intervention trials have been initiated and published. Details are available at www.socru.org. Prof. Sliwa is currently also the director of the Soweto Cardiovascular Research Unit (2006-2013). This project is now being extended to research the wider African community – The Heart of Africa Study.

The Pan African Pulmonary Hypertension Cohort (PAPUCO) Study

The main objective of this research is to describe the epidemiology of pulmonary hypertension (PHT) in 500 patients from 10 African countries, e.g. Mozambique, Sudan, Kenya, Nigeria, among patients attending referral units for cardiovascular and pulmonary diseases. This information will be crucial to the development of effective and resource-sensitive strategies to tackle PHT in Sub-Saharan Africa. The first step in this direction has been to build a registry of patients with PHT, attending a range of hospitals in several countries from this region.

The Pulmonary Vascular Institute Sub-Saharan Task Force, under the leadership of Dr Ana Olga Mocumbi (Mozambique) and Prof Karen Sliwa (HICRA), was established in January 2010 and they were later joined by Dr Friedrich Thienemann from the Institute of Infectious Disease and Molecular Medicine (IIDMM), University of Cape Town.  The primary aim of this Task Force was to establish a Sub-Saharan African Registry of Pulmonary Hypertension (PHT) and, subsequently, other research and educational awareness projects.

PHT is a devastating, progressive disease, with increasingly debilitating symptoms and, usually, shortened overall life expectancy. The epidemiology of PHT in Sub-Saharan Africa has not yet been determined, but limited reports suggest that the incidence is higher than that reported from developing countries, owing to the pattern of diseases prevalent in the region.  Many known factors for PHT are hyperendemic in this part of the world, including Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome, schistosomiasis, chronic hepatitis B and C and Sickle Cell Disease. On the other hand, a high prevalence of tuberculosis, poorly treated asthma, high levels of pollution in urban areas and exposure to mining, subsequently leads to various forms of pulmonary hypertension and, often, to right heart failure with premature death.

However, more detailed information is currently not available, thus leading to poor awareness of these devastating problems, not only in Sub-Saharan Africa, but worldwide. There is, therefore, an urgent need for research into the demographics, natural history and survival of patients with pulmonary hypertension.

This project receives funding from the Pulmonary Vascular Research Institute (PVRI) and via an unconditional research grant from Bayer, Germany.

B-A-HEF STUDY

Recent research in cardiovascular disease in African populations (Heart of Soweto Study), specifically of heart failure (THESUS Study – Damasceno A, Sliwa K, et al. The causes, treatment and outcome of acute heart failure n 1006 Africans from 9 countries. Arch Intern Med, 2012) has shown that heart failure is not treated optimally in Africa.

Prof Sliwa is the principle investigator of a the 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. The use of different medications, such as ACEi and hydralazine/nitrates, has never been examined in patients admitted with AHF. Performing a multicentre study in Africa could confirm data obtained in African Americans, create awareness for this promising combination treatment, and extend the use of the medication to patients with acute heart failure.

Participating sites: Principal Investigators at the various sites are: Prof. Karen Sliwa (South Africa); Dr Mahmoud Sani (Nigeria); Dr Okechukwu Ogah (Nigeria); Dr Dike Ojji (Nigeria); Prof. Elijah Ogola (Kenya); Prof. Gerald Yonga (Kenya); Dr Charles Mondo (Uganda); Dr Anastase Dzudie (Cameroon); Dr Charles Kouam Kouam (Cameroon); Prof. Albertino Damasceno (Mozambique); Prof. Sergine Abdou Ba (Senegal) and Dr Fikru Maru (Ethiopia).