Cardiovascular Journal of Africa: Vol 28 No 4 (July/August 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 4, July/August 2017 250 AFRICA
median age was four years (range 1.9–4.9 years). This emphasises
that even though ARF/RHD commonly presents at between five
and 15 years of age, there are cases that present early (under five
years) who meet the criteria for the diagnosis of ARF.
Regarding clinical presentation, the majority (n = 52; 93%)
of our patients presented for the first time with RHD. Only four
patients presented with ARF as their first presentation. This
may have be due to cases of ARF being missed at the primary
healthcare level or patients not presenting early at the clinic with
a sore throat.
In the Soweto study, Sliwa et al.15 reported on adult cases who
presented for the first time with RHD. No patients presented
with ARF. This suggests that patients who are not diagnosed
early with ARF may present later with established RHD. As a
result, they made the suggestion that new cases of RHD should
be notified in order to ensure registration and follow up of these
patients. Lack of notification of ARF/RHD may result in under-
reporting. Nkgudi et al. mentioned under-reporting of ARF in
their study16 and concluded it was due to poor administration of
the ARF notification system.
The majority of patients who underwent valvular surgery in
our study had mitral and aortic valve surgery. Cilliers reported
this as the commonest surgery for RHD.2 Timeous surgery for
RHD has very good outcomes.17
A limitation of this study is that it was a retrospective chart
audit of patients seen and admitted to one hospital. The fact that
these patients were mostly referred from other hospitals made
it very challenging to estimate the incidence of ARF/RHD, as
there was no primary screening of subjects suspected to have
ARF/RHD.
Despite the limitations, the findings have important
implications. RHD should be notifiable, as the majority of our
patients presented with RHD. Prospective studies are required in
the Eastern Cape to determine the true prevalence of ARF/RHD.
Conclusion
The true burden of ARF/RHD in the Eastern Cape Province
is unknown and therefore prospective studies are needed to
determine the prevalence or incidence of ARF and RHD in this
province.
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