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Characteristics and Problems of Rheumatic Heart Disease in Indonesia: The Ina-RHD Multicenter Study
Amiliana Mardiani Soesanto1, Prima Almazini2, Rina Ariani1
1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Insights
This study highlights the significant burden of Rheumatic Heart Disease (RHD) in Indonesia, predominantly affecting women with mitral stenosis and advanced disease. Management challenges include underutilization of anticoagulation and secondary prophylaxis.
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.
Background:
Rheumatic heart disease (RHD) presents a significant public health challenge. Unfortunately, there is a lack of national data regarding the incidence and prevalence of RHD in Indonesia.
Objectives:
The purpose of this study was to evaluate the characteristics, burdens, and problems of RHD in Indonesia.
Methods:
We collected medical reports of RHD patients over 18 years of age from 21 hospitals. Secondary data about clinical and echocardiography was collected to describe the characteristics, disease conditions, and complications of the disease.
Results:
We recruited 3,431 patients, average age was 44 years, and 64.4% (2,209 of 3,431) were women. Dyspnea was found in 85.7% (2,939 of 3,431), and 25% (862 of 3,431) of patients with NYHA functional class III to IV. Isolated mitral stenosis was the most prevalent valve lesion in 1,357 of 3,431 patients (39.6%). A total of 62.5 % (2,146 of 3,431) of patients had atrial fibrillation (AF), with the highest prevalence being in MV lesions. Vitamin K antagonist was prescribed in 2,411 of 3,431 (70.3%) of patients. A history of stroke was reported in 227 of 3,431 (6.6%) of patients and most frequently happened in isolated mitral stenosis patients 128 of 1,357 (9.4%). Finally, secondary prophylaxis was only administered in 1,279 of 3,431 (37.3%) of patients, and only 23.2% (796 of 3,431) had it regularly.
Conclusions:
Our patients were predominantly women and had isolated mitral stenosis. Many patients came at a later stage of the disease, with older average age, a high prevalence of AF, pulmonary hypertension, and right heart involvement. The challenges were suboptimal use of anticoagulation despite the high prevalence of AF and underused secondary prophylaxis.
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