Related Experiment Video
Updated: Aug 21, 2025
Rat Model of Right-Sided Cardiac Remodeling and Arrhythmia Using Pulmonary Artery Banding
Published on: August 30, 2024
Survival of Rheumatic Heart Disease in Indonesian Children
Nadya Arafuri1, Indah Kartika Murni1, Madarina Julia1
1Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Dr Sardjito Hospital, Yogyakarta, ID.
Insights
Long-term survival for children with Rheumatic Heart Disease (RHD) is poor, with only 60% surviving 8 years. Poor adherence to penicillin and congestive heart failure predict mortality in pediatric RHD patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Epidemiology
- Global Health
Background:
- Rheumatic heart disease (RHD) is a preventable cause of childhood cardiovascular death in low- and middle-income countries.
- Indonesia lacks long-term outcome data for children diagnosed with RHD.
Purpose of the Study:
- To investigate the long-term outcomes, survival rates, and predictors of mortality in pediatric patients with RHD in Indonesia.
Main Methods:
- A retrospective cohort study of 155 children (<18 years) with RHD from 2011-2021.
- Survival analysis using Kaplan-Meier curves, log-rank test, and Cox-regression.
- Identified predictors of mortality including adherence and clinical factors.
Main Results:
- 9.0% of RHD patients died during the study period (mean age 11.9 years).
- 8-year survival rate was 60%, lower in those with severe valve lesions or NYHA class III-IV.
- Poor penicillin adherence (HR 12.7) and congestive heart failure (HR 18.6) were significant mortality predictors.
Conclusions:
- Pediatric RHD survival remains a critical issue, with approximately 6 in 10 children surviving 8 years post-diagnosis.
- Improving penicillin adherence and early detection of subclinical carditis are crucial for better outcomes in pediatric RHD.
- Congestive heart failure and poor medication adherence are key predictors of mortality in children with RHD.
Background:
Rheumatic heart disease (RHD) remains a preventable cause of cardiovascular deaths in children in low- and middle-income countries. However, long-term outcome data of children with RHD is still lacking in Indonesia.
Objective:
To investigate the long-term outcomes of RHD, particularly the survival rates and the predictors.
Methods:
A retrospective cohort study was done in children aged less than 18 years old admitted with RHD at a tertiary hospital (Dr. Sardjito Hospital, Indonesia) from 2011-2021. Survival time was estimated from the date of first diagnosis of RHD to the survival endpoint (date of mortality or censoring). Kaplan-Meier curves, log-rank test and Cox-regression analysis were used for survival analysis and the predictors.
Results:
A total of 155 patients admitted with RHD during the study period. Of these, 14 (9.0%) deaths were reported as RHD related mortality with the mean age ± standard deviation of 11.9 ± 2.9 years. Median follow up period was 16 months. The survival rate at 1, 4, and 8 years were 93%, 86.1% and 60%, respectively. Survival was lower in patients with severe valve lesions and NYHA functional class III-IV at the time of diagnosis. Multivariate Cox-regression analysis showed the significant predictors for mortality were poor adherence to penicillin and congestive heart failure, HR 12.7 (95%CI 1.4-113.5) and 18.6 (95%CI 1.8-185.0) respectively.
Conclusion:
Approximately, only six in 10 children are able to survive at eight years after diagnosis. Poor adherence to penicillin and congestive heart failure were predictors for death. This study emphasizes the needs to improve the adherence of children with RHD and early detection of subclinical carditis in children.
Related Concept Videos
01:23Rheumatic Heart Disease I: Introduction
01:21Rheumatic Heart Disease III: Medical Management
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:20Rheumatic Heart Disease IV: Nursing Management
01:26Mitral Stenosis III: Medical Management
01:18Endocarditis III: Medical Management