Socru presents at European Heart Failure meeting, Nice, France

The poster below formed part of the presentation. It is entitled "Vitamin C but not thiamine deficiency in black African patients with heart failure in South Africa: Identifying the need for nutritional intervention in the urban African setting".

Poster

Management of heart failure with limited resources

In the last 10-15 years, heart failure (HF) has emerged as a major health problem worldwide.

Since 2006, the Soweto Cardiovascular Research Unit, in conjunction with the Baker Cardiovascular Research Institute and the University of Queensland, has been involved in creating a large registry – the Heart of Soweto Study Registry.

In our study, very late presentation of more than 50% of the cases meant that the patients presented in heart failure. We found antecedents common to high-income countries and factors unique to South Africa that no doubt contributed to the unexpectedly large (and inherently preventable) volume of cases from this large urban region.

Numerous studies done by the unit described the characteristics of heart failure due to idiopathic and dilated cardiomyopathy and came up with suggestions for managing it.

We then identified a need to address the ‘epidemic of heart failure’ and started to prepare for a study to investigate the outcome with a multi-disciplinary heart failure management programme in 2008.

For the planning of this study we needed data from pilot studies. We examined the pattern of treatment adherence using a simple questionnaire in a cohort of HF patients from Soweto.

As in many other regions of the world, non-adherence to complex HF treatment was identified as a problem in Soweto and confirmed the need for a dedicated programme to optimise HF management and outcomes. Sandra Pretorius, dietician at the Soweto Cardiovascular Research Unit, presented those findings at the South African Heart Association meeting at Sun City in November 2007.

Consistent with data from Western developed countries, 20% of hospitalised patients with chronic forms of heart failure (CHF) at Chris Hani Baragwanath Hospital die within one year and 60% of survivors are readmitted to hospital within 18 months (unpublished data).

In developed countries, interest has been growing in dedicated CHF management programmes that provide individualised education, care and support to patients and families affected by this deadly and disabling syndrome. Such programmes have now become part of the gold-standard management of the syndrome, but there is no data to support their use in the developing world.

Hypothesis

A culturally specific, community-based management programme will improve health outcomes in patients with CHF living in Africa.

In order to examine the potential value of the type of CHF management that has successfully been developed and implemented in high-income countries, we decided to undertake a randomised controlled study of a multidisciplinary, community-based CHF management programme in Soweto, compared with the usual methods of care.

Core components of the study: The study will incorporate the key components of successful programmes of care in high-income countries:

  1. Establish a comprehensive clinical and socio-demographic profile of the patient to determine the factors that are likely to increase or decrease the probability of future morbid or fatal events (as part of the Heart of Soweto Registry).
  2. Prof Sliwa will give a lecture about heart failure and importance of compliance to the patient and family. Afterwards a ‘Living with Heart Failure in Soweto’ booklet will be given to the patient.
  3. Sandra Pretorius will give a lecture about diet.
  4. The patient or family can register for a cooking class with Sandra Pretorius.
  5. The patient will be given a management diary (to document changes in weight and medication, for example).