Patterns of Rheumatic Heart Disease and Treatment Practices at Tertiary Care Center in Nepal: A Descriptive Cross-sectional Study.

Abstract

Rheumatic heart disease is a sequel of rheumatic fever which causes heart valve damage. This study was conducted to look at the pattern of valve lesions and treatment practices in patients with rheumatic heart disease. A cross-sectional study conducted at the tertiary care center with a diagnosis of rheumatic heart disease from July 2018 to January 2020 by convenient sampling. Ethical clearance was obtained from the Institutional Review Committee (ref no. 55/2018). Data were analyzed by using Statistical package for social sciences version 20. Out of 600 patients, 428 (71.3%) were female. The mean age was 44.24±14.24 years. The isolated mitral valve was affected in 280 (46.6%). Dual involvement of mitral and aortic valve was present in 294 (49%). Only 14 (2.3%) had involvement of isolated aortic valve involvement. Overall, mitral stenosis was the most common abnormality 508 (84.6%) followed by mitral regurgitation 418 (69.6%), aortic regurgitation 320 (53.3%), and aortic stenosis 63 (10.5%). Assessment of the severity of lesions showed that 247 (41.2%) patients had severe mitral stenosis, 119 (19.8%) severe mitral regurgitation, 14 (2.3%) severe aortic stenosis, and 11 (1.8%) severe aortic regurgitation. Majority 493 (82.2%) were treated with medical therapies. Surgical procedures were performed in 51 (8.5%). The use of anticoagulation was in 212 (35.3%) of eligible patients. Mitral valve was affected commonly both in isolation and combination. The majority of patients who were eligible for cardiac interventions were treated medically with suboptimal use of anticoagulation and secondary prophylaxis.