Valvular Interventions in Rheumatic Heart Disease in Rural and Remote Indigenous Communities: An Update of Indigenous Cardiac Outreach Program Cohort

Abstract

Background: Rheumatic Heart Disease (RHD) is highly prevalent in remote and rural Indigenous communities with a significant rate of valvular intervention. Contemporary data regarding valvular interventions is lacking. Design: A retrospective review of medical records and echocardiography from multiple sources from 2007 to 2018. Results: Out of 3005 patients, 152 patients were identified to have rheumatic heart disease. Mean age 38 (range 12 to 85) years. Median follow up period was 64.5 (range 6–153) months. All of them are of Indigenous background. Left sided valvular disease were the most common pathology (69%, n = 107) with isolated mitral regurgitation being the most common (32%, n = 50). Multi-valvular disease occurred in 41% (n = 63) with 16% (n = 24) had at least three valvular disease. Nearly one third (29%, n = 45) had valvular intervention. In the intervention cohort, mean age was 42 (range 16–76) with a female predominance (78%, n = 35). There were 90 valvular interventions with the most common valvular intervention was mechanical mitral valve replacement (34%, n = 31), in which all of them were prescribed vitamin K antagonist. Re-intervention occurred in 5 patients (3%). Most common complications in the intervention group were heart failure, 33% (n = 15), and atrial fibrillation, 8 (n = 18). Conclusion: RHD remains a significant burden of disease in rural and remote Indigenous especially in the young and female population. There is a high rate of valvular interventions, which poses challenging implications regarding ongoing follow-ups and management of related morbidities.