South Africa is facing a critical heart health crisis, with approximately 225 people dying from heart disease or stroke every day. According to the Heart and Stroke Foundation South Africa, these conditions account for almost one in six deaths in the country, with more than half of cardiovascular deaths occurring before the age of 65. Many of those who die are breadwinners, parents, or caregivers in midlife. This World Heart Day, the World Heart Federation is urging people to recognize the hidden signs, protect their hearts, and demand action.
High blood pressure is a significant contributor to this burden, driving one in two strokes and two in five heart attacks. However, it is often invisible until it strikes. An analysis of blood pressure screening campaigns across South Africa between 2017 and 2021 found that nearly 30% of the over 11,000 people screened had hypertension. However, only 54% of them knew they had the condition, 47% were on treatment, and about a quarter had their blood pressure under control. Awareness was particularly low among adults under 40, at just 24%.
Researchers are calling for a more integrated approach to addressing heart health, as hypertension often co-exists with other conditions such as diabetes, HIV, cancer, and depression. A study by PRICELESS SA found that hypertension was one of the most prevalent comorbid conditions among breast cancer patients. This highlights the need for routine blood pressure screening and integrated cardiovascular care throughout treatment. Furthermore, the study found a close link between breast cancer and cardiovascular health.
The relationship between heart health and mental health is also a significant concern. A systematic review of 11 studies found that better cardiovascular health was linked to lower odds of depression and anxiety, and that depression and anxiety were linked to poorer cardiovascular health. Caregivers, who are often relied upon to care for others, are also at risk, with 52% of caregivers of adolescents living with HIV in KwaZulu-Natal experiencing depressive symptoms.
The current healthcare system in South Africa is not equipped to effectively monitor and support patients living with heart-related and other conditions. The system is fragmented, and there is a lack of digital tools for comprehensive multimorbidity management and surveillance. Researchers are currently evaluating the cost and national scale-up of the Madiva dashboard, a digital platform that supports clinicians and nurses in managing patients with multiple chronic conditions.
To address the heart health crisis, researchers are calling for a range of policy and intervention changes. These include making blood pressure checks routine at clinics, workplaces, and pharmacies, especially for men and young adults. They also recommend closing the treatment gap by ensuring that hypertension medicines are affordable and accessible, and removing the hidden costs associated with healthcare. Additionally, they suggest investing in data and people, and raising and indexing the Health Promotion Levy.
The Health Promotion Levy, which is currently set at a lower rate than the World Health Organization's recommended 20%, could be used to strengthen primary and community-based healthcare services. Researchers also emphasize the importance of funding African evidence and local research on how heart-related and other chronic conditions interact. This, they argue, should guide national guidelines and inform policy decisions.
Key points
- High blood pressure is a significant contributor to South Africa's heart health crisis, with nearly 30% of people screened having hypertension.
- The current healthcare system in South Africa is not equipped to effectively monitor and support patients living with heart-related and other conditions.
- Researchers are calling for a range of policy and intervention changes, including routine blood pressure screening, integrated chronic care, and policies that make prevention affordable.
