Prognostic factors in childhood rheumatic disease

Forty-eight Nigerian children (M = 22, F = 26; mean age = 6 years) With rheumatic heart disease (RHD) were studied prospectively. Three years after the initial presentation 12 of them (25%) had improved, 14 (29%) remained about the same while 22 (46%) had either deteriorated or died. A poor socio-economic background, delay in seeking medical treatment, and recurrence of acute rheumatic fever (ARF) all adversely affected the prognosis. Similarly mitral stenosis, multiple valve lesions, pulmonary hypertension, and subacute bacterial endocarditis (SBE) were associated with a poor prognosis. However the short-term prognosis was uninfluenced by the patient's age, sex, P-R interval, or cardiac functional class at first presentation. It is concluded that prompt institution of appropriate therapeutic measures, SBE prophylaxis, prevention of recurrent ARF, and health education would significantly improve the prognosis in childhood RHD.