Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)

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

Research output: Contribution to journalArticlepeer-review

211 Citations (Scopus)

Abstract

AIMS: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment.

METHODS AND RESULTS: This prospective registry enrolled 3343 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. The majority (63.9%) had moderate-to-severe multivalvular 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 dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants 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 1825 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.

CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.

Original languageEnglish
Pages (from-to)1115-1122
Number of pages8
JournalEuropean Heart Journal
Volume36
Issue number18
Early online date25 Nov 2014
DOIs
Publication statusPublished - 07 May 2015

Keywords

  • Administration, Oral
  • Adult
  • Age Distribution
  • Anti-Bacterial Agents
  • Antibiotic Prophylaxis
  • Anticoagulants
  • Cross-Sectional Studies
  • Developing Countries
  • Evidence-Based Medicine
  • Female
  • Global Health
  • Heart Valve Diseases
  • Humans
  • Male
  • Penicillins
  • Pilot Projects
  • Prospective Studies
  • Rheumatic Heart Disease
  • Sex Distribution

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