Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study).
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Zühlke Liesl, Engel Mark E, Karthikeyan Ganesan, Rangarajan Sumathy, Mackie Pam, Cupido Blanche, Mauff Katya, Islam Shofiqul, Joachim Alexia, Daniels Rezeen, Francis Veronica, Ogendo Stephen, Gitura Bernard, Mondo Charles, Okello Emmy, Lwabi Peter, Al-Kebsi Mohammed M, Hugo-Hamman Christopher, Sheta Sahar S, Haileamlak Abraham, Daniel Wandimu, Goshu Dejuma Y, Abdissa Senbeta G, Desta Araya G, Shasho Bekele A, Begna Dufera M, ElSayed Ahmed, Ibrahim Ahmed S, Musuku John, Bode-Thomas Fidelia, Okeahialam Basil N, Ige Olukemi, Sutton Christopher, Misra Rajeev, Abul Fadl Azza, Kennedy Neil, Damasceno Albertino, Sani Mahmoud, Ogah Okechukwu S, Olunuga Taiwo, Elhassan Huda H M, Mocumbi Ana Olga, Adeoye Abiodun M, Mntla Phindile, Ojji Dike, Mucumbitsi Joseph, Teo Koon, Yusuf Salim, Mayosi Bongani M
Аннотация
METHODS AND RESULTS: This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular disease complicated by congestive heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent (n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% (n = 946) of patients with mechanical valves (n = 501), AF (n = 397), and high-risk mitral stenosis in sinus rhythm (n = 48). However, only 28.3% (n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12-51 years), only 3.6% (n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries.
CONCLUSION: Rheumatic heart disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.