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Mortality and Morbidity in Adults With Rheumatic Heart Disease.

Ganesan Karthikeyan1,2, Mpiko Ntsekhe3, Shofiqul Islam4

  • 1Department of Cardiology, All India Institute of Medical Sciences, New Delhi.

JAMA
|June 5, 2024
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This summary is machine-generated.

Mortality in rheumatic heart disease (RHD) is high, particularly in lower-income countries. Valve surgery and valvuloplasty significantly reduce RHD mortality, highlighting the need for improved access to these interventions.

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Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Rheumatic heart disease (RHD) is a significant public health concern in low- and middle-income countries (LMICs).
  • Large-scale studies involving multiple endemic countries are scarce.

Purpose of the Study:

  • To determine the risk and predictors of major clinical outcomes in patients with RHD.
  • To analyze event rates across different World Bank country income groups.

Main Methods:

  • A multicenter, prospective observational study involving 138 sites in 24 RHD-endemic LMICs.
  • Enrollment of 13,696 patients between August 2016 and May 2022.
  • Analysis of all-cause mortality, cause-specific mortality, heart failure hospitalizations, stroke, recurrent rheumatic fever, and infective endocarditis.

Main Results:

  • Overall mortality was 15% over a median follow-up of 3.2 years, with vascular causes, mainly heart failure, being the leading cause of death.
  • Markers of severe valve disease like heart failure and pulmonary hypertension increased mortality, while valve surgery and valvuloplasty were associated with significantly lower mortality.
  • Higher country income levels correlated with lower mortality after adjusting for patient-level factors.

Conclusions:

  • High mortality in RHD is linked to valve disease severity.
  • Access to valve surgery and valvuloplasty is crucial for reducing RHD-related mortality.
  • Findings emphasize the need to enhance access to surgical and interventional care alongside existing prophylactic measures.