A new regional Rheumatic Heart Disease Registry: results of the first 2595 patients

Abstract

Abstract Background Rheumatic Heart Disease (RHD) remains a major cause of morbidity and mortality in low- and middle-income countries. However, specific disease characteristics and progression varies in different regions. Purpose We here present preliminary results of a new regional RHD registry. Methods A total of 2595 consecutive patients with clinical and echocardiographic RHD were registered from March 2009 and February 2023, and their baseline clinical and echo characteristics, demographics, comorbidities, the pattern and severity of valvular involvement, intervention history and treatment practices were recorded. Follow-up ranged from 1 to 168 months (47±38.8) and was complete in 90.4% of the patients. Results The age of the patients ranged from 3-86 years (40.18±13.83). The majority was female (n=1765, 68%). At enrolment only 26 (1%) patients were on secondary penicillin prophylaxis. Symptoms were present in 73.8% (n=1916) of the patients (NYHA III: n=984, 37.9%). 2226 (85.8%) patients had moderate-to-severe multivalvular disease complicated by pulmonary hypertension (n=877, 33.8%), atrial fibrillation (AF) (n=750, 28.9%), cerebrovascular events (n=158, 6%), infective endocarditis (n=17, 0.66%) and thrombosis of valve prosthesis (n=14, 0.54%). Previous cardiac intervention was reported by 492 patients (19%). Regular 6 monthly follow-up at our centre for periods ranging from 1 to 168 months (47±38.8). During this period a total of 1309 (50.4%) patients underwent cardiac procedures. Balloon Mitral Valvuloplasty was performed in 289 patients (11.1%). Cerebrovascular events (n=92, 3.5%), LA thrombus (n=22, 0.85%), infective endocarditis (n=13, 0.5%) and thrombosis of valve prosthesis (n=19, 0.73%) occurred during follow-up. Patient mortality was 12.6% (n=328) during the study period (47±38.8 months). Penicillin prophylaxis rate was 63.3% (n=1742), however, only 15% of these patients followed the penicillin prophylaxis schedule. Conclusions In spite of continued cardiac care in this study, young patients with rheumatic heart disease have high morbidity and mortality. Further efforts to determine the exact causes involved and improve prognosis are warranted.