Characteristics, Complications, and Gaps in Rheumatic Heart Disease Interventions | Journal Scan

Study Questions:

What are the characteristics of rheumatic heart disease (RHD) presentation, complications, and treatment?

Methods:

This prospective registry 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. Characteristics of presentation, complications, and treatment were recorded.

Results:

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%). One-quarter 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. Fifty-five percent (n = 1,761) 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.

Conclusions:

RHD patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anticoagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.

Perspective:

As much as RHD has become a rarity in developed countries, it remains the cause of tremendous morbidity and mortality in the developing world. 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. RHD remains a huge health burden in developing countries, responsible for over a million premature deaths each year.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Pulmonary Hypertension

Keywords: Rheumatic Heart Disease, Antibiotic Prophylaxis, Anticoagulants, Atrial Fibrillation, Contraception, Endocarditis, Bacterial, Heart Failure, Hypertension, Pulmonary, Mitral Valve Stenosis, Stroke, Mortality, Premature, Prospective Studies, Registries


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