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*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

257 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
DOIs
Publication statusPublished - 7 May 2015
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Congestive heart failure
  • Infective endocarditis
  • Rheumatic heart disease
  • Stroke
  • Valve surgery
  • Valvuloplasty

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