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Prognostic factors in childhood rheumatic disease
Insights
Prognosis for Nigerian children with rheumatic heart disease (RHD) is often poor, with nearly half deteriorating or dying within three years. Factors like delayed treatment and recurrent acute rheumatic fever (ARF) worsen outcomes, highlighting the need for early intervention and prophylaxis.
Area of Science:
- Cardiology
- Pediatrics
- Public Health
Background:
- Rheumatic heart disease (RHD) remains a significant health concern in childhood, particularly in low-resource settings.
- Understanding prognostic factors is crucial for effective management and improving outcomes in pediatric RHD patients.
Purpose of the Study:
- To prospectively evaluate the short-term and medium-term prognosis of childhood rheumatic heart disease in Nigerian children.
- To identify clinical, socio-economic, and echocardiographic factors associated with poor prognosis in pediatric RHD.
Main Methods:
- Prospective study of 48 Nigerian children diagnosed with RHD.
- Follow-up assessment over three years to evaluate disease progression, improvement, or mortality.
- Analysis of socio-economic status, treatment delays, acute rheumatic fever recurrence, and specific cardiac manifestations.
Main Results:
- After three years, 46% of children experienced disease deterioration or died, while 25% improved and 29% remained stable.
- Poor socio-economic background, delayed medical attention, and recurrent acute rheumatic fever (ARF) were linked to adverse outcomes.
- Mitral stenosis, multiple valve lesions, pulmonary hypertension, and subacute bacterial endocarditis (SBE) were associated with a poor prognosis. Short-term prognosis was not influenced by age, sex, P-R interval, or functional class.
Conclusions:
- Childhood RHD in this cohort has a significant mortality and morbidity rate.
- Interventions focusing on early treatment, SBE prophylaxis, ARF prevention, and health education are vital for improving RHD prognosis.
- Targeted interventions are necessary to mitigate the impact of socio-economic factors and disease recurrence on pediatric RHD outcomes.
Abstract:
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.