Liesl Zühlke1, Mark E Engel2, Ganesan Karthikeyan3, Sumathy Rangarajan4, Pam Mackie4, Blanche Cupido2, Katya Mauff5, Shofiqul Islam4, Alexia Joachim2, Rezeen Daniels2, Veronica Francis2, Stephen Ogendo6, Bernard Gitura7, Charles Mondo8, Emmy Okello9, Peter Lwabi9, Mohammed M Al-Kebsi10, Christopher Hugo-Hamman11, Sahar S Sheta12, Abraham Haileamlak13, Wandimu Daniel13, Dejuma Y Goshu14, Senbeta G Abdissa14, Araya G Desta14, Bekele A Shasho14, Dufera M Begna14, Ahmed ElSayed15, Ahmed S Ibrahim15, John Musuku16, Fidelia Bode-Thomas17, Basil N Okeahialam17, Olukemi Ige17, Christopher Sutton18, Rajeev Misra19, Azza Abul Fadl20, Neil Kennedy21, Albertino Damasceno22, Mahmoud Sani23, Okechukwu S Ogah24, Taiwo Olunuga25, Huda H M Elhassan26, Ana Olga Mocumbi27, Abiodun M Adeoye28, Phindile Mntla29, Dike Ojji30, Joseph Mucumbitsi31, Koon Teo4, Salim Yusuf4, Bongani M Mayosi32. 1. The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. 2. The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa. 3. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. 4. Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada. 5. Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa. 6. Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya. 7. Cardiology Unit, Department of Medicine, Kenyatta National Teaching and Referral Hospital, Nairobi, Kenya. 8. Cardiology Unit, Department of Medicine, Mulago Hospital, Kampala, Uganda. 9. Uganda Heart Institute, Kampala, Uganda. 10. Faculty of Medicine and Surgery, University of Sana'a, Al-Thawrah Cardiac Center, Sana'a, Yemen. 11. Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa Paediatric Cardiology Service, Windhoek Central Hospital, Windhoek, Namibia. 12. Department of Paediatrics, Division of Paediatric Cardiology, Faculty of Medicine, Cairo University Children's Hospital, Cairo, Egypt. 13. Department of Paediatrics and Child Health, Jimma University Hospital, Jimma, Ethiopia. 14. Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia. 15. Department of Cardiothoracic Surgery, Al Shaab Teaching Hospital, Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan. 16. Department of Paediatrics and Child Health, University Teaching Hospital, University of Zambia, Lusaka, Zambia. 17. Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria. 18. Department of Paediatrics and Child Health, University of Limpopo, Polokwane, South Africa. 19. Department of Internal Medicine, University of Limpopo, Polokwane, South Africa. 20. Faculty of Medicine, Benha University, Cairo, Egypt. 21. Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi. 22. Department of Cardiology, Eduardo Mondlane University, Maputo, Mozambique. 23. Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria. 24. Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria Nigeria Ministry of Health, Umuahia, Abia State, Nigeria Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria. 25. Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria. 26. Ahmed Gasim Teaching Hospital, Khartoum, Sudan. 27. Instituto Nacional de Saúde and Eduardo Mondlane University, Maputo, Mozambique. 28. Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria. 29. Department of Cardiology, Dr. George Mukhari Hospital and University of Limpopo (MEDUNSA Campus), Tshwane, South Africa. 30. Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria. 31. Paediatric Cardiology Unit, Department of Paediatrics, King Faisal Hospital, Kigali, Rwanda. 32. The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa bongani.mayosi@uct.ac.za.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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 diseasepatients 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. Published on behalf of the European Society of Cardiology. All rights reserved.
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Authors: Chris T Longenecker; Stephen R Morris; Twalib O Aliku; Andrea Beaton; Marco A Costa; Moses R Kamya; Cissy Kityo; Peter Lwabi; Grace Mirembe; Dorah Nampijja; Joselyn Rwebembera; Craig Sable; Robert A Salata; Amy Scheel; Daniel I Simon; Isaac Ssinabulya; Emmy Okello Journal: Circ Cardiovasc Qual Outcomes Date: 2017-11