期刊
EUROPEAN HEART JOURNAL
卷 36, 期 18, 页码 1115-U29出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehu449
关键词
Rheumatic heart disease; Atrial fibrillation; Congestive heart failure; Stroke; Infective endocarditis; Valvuloplasty; Valve surgery
资金
- Canadian Network and Centre for Trials Internationally (CANNeCTIN)
- South African Medical Research Council
- Lily and Ernst Hausmann Trust
- Else Kroner Frasenius Foundation
- University of Cape Town
- National Research Foundation of South Africa
- World Heart Federation
- Jos University Teaching Hospital
- Heart Aid Trust Inc.
- FaithAlive Foundation
- Sheikan Insurance Company
- Discovery Foundation
- US National Institutes of Health Fogarty International Clinical Research Fellowship
- Thrasher Research Fund Early Career Award
- Wellcome Trust Clinical Infectious Disease Research Initiative (CIDRI) Research Officer Award
- Hamilton Naki Clinical Scholarship
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.
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