Defining Characteristics of Rheumatic Heart Disease
Journal Wrap | Rheumatic heart disease (RHD) accounts for more than one million premature deaths annually around the world, yet there is little contemporary information on presentation, complications, and treatment. A new study published in the European Heart Journal attempts to rectify this situation.
This prospective registry study enrolled 3,343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen, between January 2010 and November 2012. Overall results found that the majority (63.9%) of patients had moderate-to-severe multivalve disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%).
The study also found that 25% of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had a dilated LV. In addition, 55% of patients were on secondary antibiotic prophylaxis. Oral anticoagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1,825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries.
The findings suggest that RHD patients are young, predominantly female, and have high prevalence of major cardiovascular complications. The study investigators suggest opportunities to optimize the use of secondary antibiotic prophylaxis, oral anticoagulation, and contraception, and variations in the use of percutaneous and surgical interventions, particularly in less developed countries.
"As much as RHD has become a rarity in developed countries, it remains the cause of tremendous morbidity and mortality in the developing world," says David S. Bach, MD, in a recent ACC Journal Scan. "Medical resources are scarce, often including access to what in developed countries is considered the most basic medical care; and access to intervention can be rare or nonexistent."
- Zühlke L, Engel ME, Karthikeyan G, et al. Eur Heart J. 2015;doi:10.193/eurheartj/ehu449.
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