How SA doctor’s research gives hope to those suffering from heart failure

South Africans suffering from heart failure could soon benefit from earlier diagnosis, tailored treatments and improved access to life-saving care after groundbreaking research by a Johannesburg clinician scientist.

Dr Nene Mboweni-Kondlo used her research to examine genetic, clinical and biological factors that may increase the progression of the condition, how it responds to treatment and patient outcomes.

Mboweni-Kondlo holds a PhD in cardiovascular physiology from Wits University which focused on the clinical and biochemical effects of atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF) among the sub-Saharan African population.

For Mboweni-Kondlo, producing evidence from South Africa and other African populations is more than only addressing an academic gap; it could greatly influence how the disease is identified and treated.

“If we can better characterise our patients, we can begin identifying which factors are most relevant to prognosis and treatment in our setting,” she said.

HFrEF occurs when the main pumping chamber of the heart (the left ventricle) weakens and cannot push blood around the body efficiently. Symptoms include breathlessness, fatigue, swelling in the legs and difficulty with daily activities. AF is a common abnormal heart rhythm where the upper chambers quiver irregularly rather than beat in an organised rhythm.

The broader aim is to understand whether HFrEF patients with AF represent a distinct, potentially higher-risk group, and whether we can identify characteristics that may help us recognise and manage these patients more effectively—  Dr Nene Mboweni-Kondlo

“Our findings suggest Southern African patients may develop HFrEF and AF at a younger age than typically reported in high-income countries, and patients with both conditions represent a particularly high-risk group, with more advanced disease, poor quality of life and worse outcomes,” she said.

Mboweni-Kondlo said she hoped her research would contribute to identifying high-risk individuals earlier, treating risk factors such as hypertension more aggressively and improving access to heart failure therapy.

The study, completed in 2025, revealed one in five patients with HFrEF also had AF.

Mboweni-Kondlo explained the relationship between the two conditions matters because they can worsen each other.

“A weak, enlarged heart is more likely to develop AF, while a persistently fast or irregular rhythm can further reduce the heart’s pumping efficiency,” she said.

Her research compared patients living with both conditions to those living without them across clinical characteristics, symptoms, quality of life, heart function, biomarkers, treatment and outcomes.

“The broader aim is to understand whether HFrEF patients with AF represent a distinct, potentially higher-risk group, and whether we can identify characteristics that may help us recognise and manage these patients more effectively,” she said.

The study further found patients with both HFrEF and AF had a poor quality of life and a history of stroke.

For Mboweni-Kondlo, the findings suggest AF should not be viewed as merely another abnormal rhythm happening alongside heart failure.

Issues such as hypertension, diabetes, obesity and access to health care are major contributors to cardiovascular disease and heart failure in South Africa.

“When hypertension or diabetes is diagnosed late or is uncontrolled, the eventual consequences can include significant damage to the heart, kidneys, brain and blood vessels,” Mboweni-Kondlo said.

“Addressing cardiovascular disease requires us to think far beyond what happens once someone reaches a tertiary medical or cardiac clinic. Prevention, primary health care, education, early detection and continuity of care are equally important,” she said.

Mboweni-Kondlo said the next step would be to translate the findings into earlier diagnosis, better risk assessment and more directed treatment for patients with heart failure and atrial fibrillation.

“This will require larger South African multi-centre studies, improved access to specialist cardiovascular care and greater investment in prevention and early intervention, and services such as catheter ablation. Ultimately, we need to ensure the evidence guiding how we treat our patients is generated from and relevant to the populations we serve,” she said.

She highlighted that the findings could improve access to specialised interventions such as catheter ablation for patients with HFrEF and AF. For Johannesburg patients, the procedure is offered at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital, but on a very limited basis.