Healing hearts is top priority for Mayosi protégé

Healing hearts is the number one priority for University of Cape Town (UCT) Associate Professor Liesl Zühlke. She credits the late Professor Bongani Mayosi for developing her into an award-winning scientist who uses her passion and expertise to fight the scourge of rheumatic heart disease (RHD), a preventable condition that nevertheless takes the lives of hundreds of thousands of people annually.

Speaking out to mark Rheumatic Fever (RF) and Rheumatic Heart Disease Week this week, the leading National Research Foundation (NRF) rated clinical scientist and academic unpacked this medical challenge that is considered the most important form of acquired heart disease in children and young adults living in developing countries.

Zühlke, who became a student of Mayosi’s in 2008, is today based in UCT’s Division of Cardiology and is an affiliate member of the university’s Institute of Infectious Disease and Molecular Medicine (IDM). She is committed to raising the profile internationally of what she describes as a “largely neglected” disease that is a social barometer for inequality and poor access to healthcare.

She explained that the real challenge lies in the fact that RHD is preventable only at one stage – the sore throat, or more specifically, streptococcal or strep throat.

“This is what can go on to develop [into] acute rheumatic fever (ARF). Within two or three weeks the clinical features occur.”

These include rheumatic carditis (30% to 80% of cases) and arthritis (35% to 66%), but thanks to less than optimal healthcare, they often go unnoticed – and so untreated.

Preventable disease

Put simply, attacks of ARF cause permanent scarring and damage to the heart valves which regulate blood flow into the heart chambers. Because they can’t open and close normally, the blood moves in the wrong direction, resulting in heart failure.

In effect, this preventable disease is responsible for an estimated global burden of 33.4 million cases, and an annual death toll of 319 400, according to a 2015 study.

 Awareness strategies around early diagnosis and treatment are critical, argues Zühlke, who worked with Mayosi on the Global Rheumatic Heart Disease Registry (REMEDY study) which identified that the RHD patients studied in low- and lower- to middle-income countries were at increased risk for high mortality and morbidity, despite their young age.

“This initiative gained such traction that it has spread to multiple countries, encouraging support groups that have resulted in more patient champions.”

Under Mayosi’s guidance, she said, these findings from 12 African countries were first presented affected communities before being shared with the scientific community in Europe, prompting the creation of a community advisory group.

This in turn spurred the Listen to My Heart Rheumatic Heart Disease events in South Africa, at which patients listened to their own hearts and those of others, asked questions about medication and learnt more about the disease.

“This initiative gained such traction that it has spread to multiple countries, encouraging support groups that have resulted in more patient champions,” she said.

African Research Leader Award

Zühlke recently received the SA Medical Research Council/United Kingdom Department for International Development (MRC/DFID) African Research Leader Award for her work in the field, which she said would allow for cross-country collaborations with Namibia, Malawi, Egypt, Zambia and Ghana.

She called children with heart disease “a lost generation”, and said that while awareness has improved thanks to interventions by global agencies such as the African Union and the World Heart Federation, and policies like the World Health Organization’s (WHO) Global Resolution which put the issue front and centre, “it’s never enough”.

“Lack of awareness, advocacy and availability of penicillin [to treat strep throat] are a global crisis.”

It is a disease of contradictions: While accounting for approximately 15% of all patients with heart failure in endemic areas such as Africa, South America and Asia, it has virtually disappeared in industrialised countries since the mid-20th century.

“Lack of awareness, advocacy and availability of penicillin [to treat strep throat] are a global crisis,” Zühlke said.

The situation is compounded by the fact that 40% to 50% of RHD patients need cardiac surgery. This involves mechanical valve replacement that can cost upwards of R50 000 for consumables alone, and requires a specially skilled surgeon.

“Funding is a critical issue at every stage of the disease. And that’s besides the costs to do research.”

Zühlke said the news of her African Research Leader Award came days after Mayosi’s death, “making the two events, celebration and loss, closely intertwined”.

“He irrevocably and indelibly changed my life. Not only did he alter my career trajectory, he grew me into an academic and clinical scientist. My relationship with him was the foremost in my academic life and [grew] an award-winning scientist [who uses] her passion and expertise to heal hearts.”