Characteristics and Problems of Rheumatic Heart Disease in Indonesia: The Ina-RHD Multicenter Study

Area of Science:

• Cardiology
• Public Health
• Epidemiology

Background:

• Rheumatic Heart Disease (RHD) poses a significant public health challenge globally.
• Indonesia lacks comprehensive national data on RHD incidence and prevalence.

Purpose of the Study:

• To characterize the demographics, clinical presentation, and management of RHD patients in Indonesia.
• To identify the burdens and challenges associated with RHD care in the Indonesian context.

Main Methods:

• Retrospective analysis of medical records from 3,431 RHD patients aged over 18 across 21 Indonesian hospitals.
• Collection of clinical and echocardiography data to assess disease characteristics, severity, and complications.

Main Results:

• The study population (average age 44) was predominantly female (64.4%). Isolated mitral stenosis was the most common valve lesion (39.6%). High rates of dyspnea (85.7%), atrial fibrillation (62.5%), and stroke history (6.6%) were observed.
• Pulmonary hypertension and right heart involvement were common, with many patients presenting at advanced NYHA functional class (III-IV) in 25% of cases.
• Suboptimal anticoagulation use (70.3% prescribed Vitamin K antagonist) and underuse of secondary prophylaxis (37.3% administered, 23.2% regularly) were identified.

Conclusions:

• RHD in Indonesia disproportionately affects women and is often diagnosed at later stages.
• High prevalence of atrial fibrillation and valve lesions like mitral stenosis necessitate improved anticoagulation strategies.
• Underutilization of secondary prophylaxis represents a critical gap in RHD management, increasing the risk of recurrent rheumatic fever and complications.