Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries Academic Article uri icon

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abstract

  • BACKGROUND: There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia. METHODS: Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis. RESULTS: Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18-40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80-3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70-2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32-2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10-1.78), and older age (HR, 1.02; 95% CI, 1.01-1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54-0.85) and female sex (HR, 0.65; 95% CI, 0.52-0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle-income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle-income countries. Valve surgery was significantly more common in upper-middle-income than in lower-middle- or low-income countries. CONCLUSIONS: Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle-income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes.

authors

  • Zühlke, Liesl
  • Karthikeyan, Ganesan
  • Engel, Mark E
  • Rangarajan, Sumathy
  • Mackie, Pam
  • Cupido-Katya Mauff, Blanche
  • Islam, Shofiqul
  • Daniels, Rezeen
  • Francis, Veronica
  • Ogendo, Stephen
  • Gitura, Bernard
  • Mondo, Charles
  • Okello, Emmy
  • Lwabi, Peter
  • Al-Kebsi, Mohammed M
  • Hugo-Hamman, Christopher
  • Sheta, Sahar S
  • Haileamlak, Abraham
  • Daniel, Wandimu
  • Goshu, Dejuma Yadeta
  • Abdissa, Senbeta G
  • Desta, Araya G
  • Shasho, Bekele A
  • Begna, Dufera M
  • ElSayed, Ahmed
  • Ibrahim, Ahmed S
  • Musuku, John
  • Bode-Thomas, Fidelia
  • Yilgwan, Christopher C
  • Amusa, Ganiyu A
  • Ige, Olukemi
  • Okeahialam, Basil
  • Sutton, Christopher
  • Misra, Rajeev
  • Abul Fadl, Azza
  • Kennedy, Neil
  • Damasceno, Albertino
  • Sani, Mahmoud U
  • Ogah, Okechukwu S
  • Elhassan, Taiwo OlunugaHuda HM
  • Mocumbi, Ana Olga
  • Adeoye, Abiodun M
  • Mntla, Phindile
  • Ojji, Dike
  • Mucumbitsi, Joseph
  • Teo, Koon
  • Yusuf, Salim
  • Mayosi, Bongani M

publication date

  • November 8, 2016