Evidence to Support the Emergence of New Forms of Heart Failure in Africa: The Heart of Soweto Study
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ABSTRACTS S140 Abstracts Heart, Lung and Circulation 2008;17S:S1–S209 330 Evidence to Support the Emergence of New Forms of Heart Failure in Africa: The Heart of Soweto Study Simon Stewart 1,2,3,∗ , Vinesh Vaghela 1,2,3 , Robert Mvungi 1,2,3 , John McMurray 1,2,3 , Karen Sliwa 1,2,3 1 Baker Heart Research Institute, Melbourne, Australia; 2 University of the Witwatersrand, Johannesburg, South Africa; 3 University of Glasgow, Glasgow, United Kingdom Background: The Heart of Soweto Study is the largest study of emergent heart disease (HD) in Africa. Methods: Baragwanath Hospital in Soweto provides health care to a population of 1.1 million mainly black Africans. We registered detailed demographic, clinical and diagnostic data from all de novo presentations of heart disease (HD) in 2006. Results: In 2006, 844 patients presented with de novo heart failure HF. Women (57%) and black Africans (88%) pre- dominated: 90% had ≥1 risk factor, including hypertension and obesity (34%). Mean left ventricular ejection frac- tion was 45 ± 18%, 53% and 27%, respectively had systolic and diastolic dysfunction. The most common forms of HF were dilated CMO (35%), hypertensive HF (33%), right HF (27%), ischaemic CMO (9%) and valvular HF (8%). Adjust- ing for age, race and risk factor profile, women had less ischaemic CMO (OR 0.49, 95% CI 0.28–0.85: p = 0.011) but more right HF (OR 1.40, 95% CI 0.99–1.98: p = 0.051) com- pared to men. Similarly, black Africans had less ischaemic CMO (OR 0.12, 95% CI 0.07–0.20) but more idiopathic dilated CMO (OR 4.80, 95% CI 2.57–8.93). Concurrent renal dysfunction (25%), anaemia (10%), and atrial fibrillation (8.5%) were common with 15% having ECG-evidence of left ventricular hypertrophy. Summary: This study represents one of the largest and most comprehensive investigations of HF in Africa to date. We found a high burden of HF associated with a potentially large preventable component and a spectrum of aetiology not traditionally found on the continent. doi:10.1016/j.hlc.2008.05.331 331 Has Heart Failure Become Less Malignant Than Cancer? A Population-based Study of 770,485 Hospital Cases in Sweden Simon Stewart 1,2,3,∗ , Inger Ekman 1,2,3 , Annika Rosengren 1,2,3 1 Baker Heart Research Institute, Melbourne, Australia; 2 The Sahlgrenska Academy at G ¨ oteborg University, G ¨ oteborg, Swe- den; 3 Sahlgrenska University Hospital/ ¨ Ostra, G¨ oteborg, Sweden Background: We undertook a contemporary population study in Sweden to determine if heart failure (HF) is still more “malignant” than cancer. Methods: We studied 770,485 hospitalised patients during 1988–1999 (85% coverage of Swedish population): 159,230 men and 162,721 women with “first-ever” HF were iden- tified and 5-year survival rates to patients admitted with large bowel cancer (25,722 men and 25,992 women) and lung cancer (21,636 men and 12,945 women) were com- pared. Results: The ratio of patients with HF compared to the six most common forms of cancer (large bowel, lung, prostate, breast, bladder, and ovarian) was 1.5:1 (321,951 vs. 218,664 cases). For patients aged 60 years, the rate of 5- year survival was 70% and 75% in men and women with HF compared to 57% and 61%, respectively, in those with large bowel cancer and 18% and 20%, respectively for those with lung cancer. Odds ratios for a one-year increment of cal- endar year, showed that 5-year survival had significantly increased by 7.1% (95% CI 6.8–7.4%) and 6% (5.7–6.4%) per year for men and women with HF and 3.2% (2.4–3.9%) and 2.6% (1.8–3.3%), respectively, per year for large bowel cancer. Five-year survival in both men (odds ratio of 1.01: 0.99–1.02) and women (odds ratio of 1.00: 0.98–1.01) with a first-time diagnosis of lung cancer remained static. Conclusion: These preliminary data suggest that heart failure has become less malignant than many common forms of cancer in Sweden. doi:10.1016/j.hlc.2008.05.332 332 Evaluation of Clinical Utility of NT-ProBNP Testing in Hospital Patients with Possible Cardiac Failure Tanya Stewart ∗ , Lisa Koe, Geoff Tofler Royal North Shore Hospital, Sydney, NSW, Australia Introduction: It may be difficult to distinguish conges- tive cardiac failure (CCF) from other causes of dyspnoea. Although the diagnostic value of NT-ProBNP is well documented, few prospective, randomised studies have studied the utility of providing ProBNP results to physi- cians evaluating patients presenting to hospital with dyspnoea and suspected CCF. We evaluated the utility of this measurement in assessing patients in the emergency department. Methods: Emergency room clinicians completed a pre-test score (1–7) indicating their level of certainty as to whether or not the dyspnoea was due to heart failure. Patients were then randomly allocated into two groups where the clin- ician either did or did not receive a NT-ProBNP result. In those receiving the result, a post-test questionnaire determined the subsequent level of certainty of diagno- sis. The results were then compared to determine if the NT-ProBNP result aided the determination of the cause of dyspnoea. Results: Among the 46 patients who received a NT ProBNP level, 30 results were above the rule-in value for CCF, 13 were below rule-out, and 3 were intermediate. A high NT ProBNP level increased the clinician’s certainty of diagno- sis of CCF in 26 of 30 (87%) patients while a normal level increased certainty of excluding CCF in 9 of 13 (69%). Conclusions: Knowledge of the NT-ProBNP level increased the diagnostic certainty of the cause of dys- pnoea in 75% of patients presenting to hospital with possible CCF. The study suggests that this test has clinical
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Transcript of Evidence to Support the Emergence of New Forms of Heart Failure in Africa: The Heart of Soweto Study
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S140 Abstracts Heart, Lung and Circulation2008;17S:S1–S209
330Evidence to Support the Emergence of New Forms of HeartFailure in Africa: The Heart of Soweto Study
Simon Stewart 1,2,3,∗, Vinesh Vaghela 1,2,3, RobertMvungi 1,2,3, John McMurray 1,2,3, Karen Sliwa 1,2,3
1 Baker Heart Research Institute, Melbourne, Australia;2 University of the Witwatersrand, Johannesburg, South Africa;3 University of Glasgow, Glasgow, United Kingdom
Background: The Heart of Soweto Study is the largeststudy of emergent heart disease (HD) in Africa.Methods: Baragwanath Hospital in Soweto provideshealth care to a population of 1.1 million mainly blackAfricans. We registered detailed demographic, clinicaland diagnostic data from all de novo presentations of heartdisease (HD) in 2006.Results: In 2006, 844 patients presented with de novo heartfailure HF. Women (57%) and black Africans (88%) pre-dominated: 90% had≥1 risk factor, including hypertensionand obesity (34%). Mean left ventricular ejection frac-tion was 45 ± 18%, 53% and 27%, respectively had systolicand diastolic dysfunction. The most common forms of HFwere dilated CMO (35%), hypertensive HF (33%), right HF(27%), ischaemic CMO (9%) and valvular HF (8%). Adjust-ing for age, race and risk factor profile, women had lessischaemic CMO (OR 0.49, 95% CI 0.28–0.85: p = 0.011) butmore right HF (OR 1.40, 95% CI 0.99–1.98: p = 0.051) com-
large bowel cancer (25,722 men and 25,992 women) andlung cancer (21,636 men and 12,945 women) were com-pared.Results: The ratio of patients with HF compared to thesix most common forms of cancer (large bowel, lung,prostate, breast, bladder, and ovarian) was 1.5:1 (321,951vs. 218,664 cases). For patients aged 60 years, the rate of 5-year survival was 70% and 75% in men and women with HFcompared to 57% and 61%, respectively, in those with largebowel cancer and 18% and 20%, respectively for those withlung cancer. Odds ratios for a one-year increment of cal-endar year, showed that 5-year survival had significantlyincreased by 7.1% (95% CI 6.8–7.4%) and 6% (5.7–6.4%)per year for men and women with HF and 3.2% (2.4–3.9%)and 2.6% (1.8–3.3%), respectively, per year for large bowelcancer. Five-year survival in both men (odds ratio of 1.01:0.99–1.02) and women (odds ratio of 1.00: 0.98–1.01) with afirst-time diagnosis of lung cancer remained static.Conclusion: These preliminary data suggest that heartfailure has become less malignant than many commonforms of cancer in Sweden.
doi:10.1016/j.hlc.2008.05.332
332Evaluation of Clinical Utility of NT-ProBNP Testing inHospital Patients with Possible Cardiac Failure
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pared to men. Similarly, black Africans had less ischaemicCMO (OR 0.12, 95% CI 0.07–0.20) but more idiopathicdilated CMO (OR 4.80, 95% CI 2.57–8.93). Concurrent renaldysfunction (25%), anaemia (10%), and atrial fibrillation(8.5%) were common with 15% having ECG-evidence ofleft ventricular hypertrophy.Summary: This study represents one of the largest andmost comprehensive investigations of HF in Africa to date.We found a high burden of HF associated with a potentiallylarge preventable component and a spectrum of aetiologynot traditionally found on the continent.doi:10.1016/j.hlc.2008.05.331
331Has Heart Failure Become Less Malignant Than Cancer?A Population-based Study of 770,485 Hospital Cases inSweden
Simon Stewart 1,2,3,∗, Inger Ekman 1,2,3, AnnikaRosengren 1,2,3
1 Baker Heart Research Institute, Melbourne, Australia; 2 TheSahlgrenska Academy at Goteborg University, Goteborg, Swe-den; 3 Sahlgrenska University Hospital/Ostra, Goteborg,Sweden
Background: We undertook a contemporary populationstudy in Sweden to determine if heart failure (HF) is stillmore “malignant” than cancer.Methods: We studied 770,485 hospitalised patients during1988–1999 (85% coverage of Swedish population): 159,230men and 162,721 women with “first-ever” HF were iden-tified and 5-year survival rates to patients admitted with
Tanya Stewart , Lisa Koe, Geoff Tofler
Royal North Shore Hospital, Sydney, NSW, Australia
Introduction: It may be difficult to distinguish conges-tive cardiac failure (CCF) from other causes of dyspnoea.Although the diagnostic value of NT-ProBNP is welldocumented, few prospective, randomised studies havestudied the utility of providing ProBNP results to physi-cians evaluating patients presenting to hospital withdyspnoea and suspected CCF. We evaluated the utility ofthis measurement in assessing patients in the emergencydepartment.Methods: Emergency room clinicians completed a pre-testscore (1–7) indicating their level of certainty as to whetheror not the dyspnoea was due to heart failure. Patients werethen randomly allocated into two groups where the clin-ician either did or did not receive a NT-ProBNP result.In those receiving the result, a post-test questionnairedetermined the subsequent level of certainty of diagno-sis. The results were then compared to determine if theNT-ProBNP result aided the determination of the cause ofdyspnoea.Results: Among the 46 patients who received a NT ProBNPlevel, 30 results were above the rule-in value for CCF, 13were below rule-out, and 3 were intermediate. A high NTProBNP level increased the clinician’s certainty of diagno-sis of CCF in 26 of 30 (87%) patients while a normal levelincreased certainty of excluding CCF in 9 of 13 (69%).Conclusions: Knowledge of the NT-ProBNP levelincreased the diagnostic certainty of the cause of dys-pnoea in 75% of patients presenting to hospital withpossible CCF. The study suggests that this test has clinical
