With World Heart Day commemorated on 29 September, this month is Heart Awareness Month – but heart health is a global issue that should be an all-year-round concern. Heart failure affects millions of patients all over the world every year. It is a life-threatening condition, which culminates in poor quality of life, the burden of hospitalisations and often, premature death.[i],[ii] In fact, heart failure survival is often worse than some cancers.[iii]
Symptoms are not always cut and dried and are often difficult to interpret[iv],[v]. Up to 50% of patients can be misdiagnosed, resulting in issues like inappropriate care or treatment, costs to healthcare systems and, most importantly, an added burden for patients.[vi],[vii]
The African burden – Cardiovascular disease (CVD) or heart disease is the number-one cause of death in sub-Saharan Africa for people over 30 years of age.[viii] Cardiovascular disease includes conditions like high blood pressure, heart attacks, stroke, abnormal heart rhythms, congenital heart diseases, heart muscle disease and heart failure. And all over the world, at least three-quarters of the world’s deaths from CVDs occur in low-and middle-income countries. People living in low-and middle-income countries often do not have the benefit of primary healthcare programmes for early detection and treatment of people with risk factors for CVDs.[ix]
From a humanitarian perspective, the situation is dire. As is often the case, it is the poorest people in low-and middle-income countries that suffer the most.[x] In sub-Saharan Africa, the leading causes of heart failure are hypertensive heart disease (high blood pressure damaging the heart), cardiomyopathy (heart muscle disease) and rheumatic heart disease, with ischemic heart disease (narrowing of the arteries) accounting for more than 10% of cases compared to less than 50% in high-income countries.[xi]
In this instance, as with many non-communicable diseases (NCD), the importance of diagnosis cannot be stressed enough. Levels of high blood pressure diagnosis, treatment, and control are low at less than 40%, less than 35%, and 10–20%, respectively.And sub-Saharan Africa accounts for 23% of the world’s prevalent rheumatic heart disease cases. 9
The value of diagnostics – Physicians need a full clinical picture that includes the right objective information, so that they can make the best decisions in heart failure management to benefit patients.10 In South Africa, non-communicable diseases account for 43% of total adult deaths. CVDs account for almost a fifth (18%) of these deaths. 11
This number could potentially be dropped considerably through the PPP (Public/Private Partnership) approach.11 The burden of CVD diagnosis is simply too much for governments in sub-Saharan Africa to bear in our current reality.[xii]So, perhaps it is time that innovative business and funding models came to the rescue for the greater good. Businesses should remain competitive and healthy while promoting social inclusion and health security.12
Improved availability and access to diagnostic tests can be more cost effective in dealing with the burden of heart diseases. For example, research from The University of Sheffield showed that improved access to the high sensitive Troponin T diagnostic test for suspected heart attacks is more cost effective than admitting patients to hospital because the test can rule out heart attacks earlier.[xiii]
We as healthcare organisations need to open up dialogue with multiple stakeholders across the healthcare ecosystem. We cannot simply do this unilaterally. In South Africa, we are in a position to collaborate with national government – specifically the National Department of Health. Besides government, we can liaise with other stakeholders congruently, for example, medical aid schemes.
Together, we can engage with funders, policymakers and all concerned stakeholders on how the burden of non-communicable diseases like heart failure can be curbed through diagnosis. We have seen first-hand the impact that innovative diagnostics and treatments can have on people around the world, yet we know that there is significant unmet need for patients across Africa.[xiv]
We collaboratively have a responsibility to do something about it, and while the challenge may be greater than what we at Roche, as a single diagnostics organisation can address alone, we have a critical role to play in strengthening health systems so that innovative diagnostics, treatments and cures can be accessed by all Africans.
If we commit to co-creating solutions that are tailored to the specific needs of African countries and work with stakeholders across the healthcare ecosystem to correct unacceptable inequities in care, we can make a difference. And it all begins with an open dialogue.
In closing, with Heart Awareness Month in mind, here are some of the most common symptoms associated with cardiac conditions. Contact your healthcare professional if you find any of the following present: 8
- Pain or discomfort in the centre of the chest; and/or pain or discomfort in the arms, the left shoulder, elbows, jaw, or back;
- Shortness of breath; nausea or vomiting;
- Light-headedness or faintness;
- Cold sweats;
- Numbness of the face, arm or leg, especially on one side of the body;
- Confusion, difficulty speaking or understanding speech;
- Difficulty seeing with one or both eyes;
- Difficulty walking, dizziness and/or loss of balance or coordination;
- Severe headache with no known cause;
- fainting or unconsciousness;
- Fever, pain and swelling of the joints, nausea and stomach cramps.
References:
[i] Yancy, et al. (2013). 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation,128(16):1810-52, 11.
[ii] Ponikowski, P. et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 37(27): 2129-2200
[iii] Mamas A.M et,al Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. Heart Failure 2017, 9(9), 1095-1104
[iv] Hummel A. et al. (2015). De novo acute heart failure and acutely decompensated chronic heart failure. Dtsch Arztebl Int; 112: 298–310.
[v] Pang PS et al. (2015). The role of the emergency department in the management of acute heart failure: An international perspective on education and research. Eur Heart J Acute Cardiovasc Care. [Epub ahead of print]
[vi] Hobbs, F.D. et al (2002). Reliability of N-terminal pro-brain natriuretic peptide assay in diagnosis of heart failure: cohort study in representative and high risk community populations. BMJ., 324(7352), 1498
[vii] Gaziano T.A. Cardiovascular Disease in the Developing World and Its Cost-Effective Management. Circulation. 2005; 115(23): 3547-3553
[viii] https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) (last accessed 9/14/2021)
[ix] Yuyun F.M, et.al. Cardiovascular Diseases in Sub-Saharan Africa Compared to High-Income Countries: An Epidemiological Perspective. Global Heart. 2020; 15(1): 15. DOI: https://doi.org/10.5334/gh.403
[x]https://www.roche.com/research_and_development/what_we_are_working_on/cardiovascular_and_metabolism/biomarkers-heart-failure.htm (last accessed 9/14/2021)
[xi] https://world-heart-federation.org/wp-content/uploads/2017/05/Cardiovascular_diseases_in_South_Africa.pdf (last accessed 9/14/2021)
[xii]https://idl-bnc-idrc.dspacedirect.org/bitstream/handle/10625/59552/59734.pdf?sequence=1 (last accessed 9/14/2021)
[xiii] https://www.sheffield.ac.uk/research/features/reducing-hospital-admissions-heart-attacks (last accessed 9/14/2021)
[xiv]Petty C.A, et.al. Laboratory Medicine in Africa: A Barrier to Effective Health Care. Clinical Infectious Diseases, Volume 42, Issue 3, 1 February 2006, Pages 377–382,
Additional medical references sourced from:
https://www.roche.com/research_and_development/what_we_are_working_on/cardiovascular_and_metabolism/biomarkers-heart-failure.htm (last accessed 9/14/2021)
