South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde · 2023
The severe presentation and poor outcomes of rheumatic heart disease in Namibia: Lessons from the REMEDY study.
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Auala T, Zühlke L, Sikwaya L, Du Toit H, Karthikeyan G, Teo K, Yusuf S, Engels M E, Mayosi B M, Hugo-Hamman C T
Аннотация
BACKGROUND: This paper reports the baseline characteristics and outcomes of 266 Namibian patients in the Global Registry of Rheumatic Heart Disease.
OBJECTIVE: To describe clinical findings and outcomes in a cohort of children and adults with rheumatic heart disease in Namibia.
METHODS: Prospective study of all patients with rheumatic heart disease at Windhoek Central Hospital between January 2010 and November 2012.
RESULTS: A total of 266 patients were enrolled; median age was 22 years, 72.6% were <30 years old and 60.5% female. The majority (62.8%) had moderate-severe disease; 48.9% were in congestive cardiac failure. Secondary antibiotic prophylaxis was used by 34.2%. Warfarin was used by 75.3% (n=64/85) with clinical indications. Forty-seven (17.6%) had previous valve interventions, of whom 40 (15.0%) had mechanical valve replacements. Over a 2-year follow-up period 19.1% of patients died. Severe valve involvement at enrolment was independently associated with mortality (24.6% v. 5.1% in those without severe disease; hazard ratio 4.9; 95% confidence interval 1.50 - 15.98). Sixty-five (29.8%) of the 218 without previous intervention had valvular intervention after enrolment.
CONCLUSIONS: In Namibia rheumatic heart disease affects young people who present with severe disease and have a high case fatality rate. Rates of secondary prevention were low. These findings have informed the National Programme for Prevention and Control of Rheumatic Heart Disease in Namibia.
OBJECTIVE: To describe clinical findings and outcomes in a cohort of children and adults with rheumatic heart disease in Namibia.
METHODS: Prospective study of all patients with rheumatic heart disease at Windhoek Central Hospital between January 2010 and November 2012.
RESULTS: A total of 266 patients were enrolled; median age was 22 years, 72.6% were <30 years old and 60.5% female. The majority (62.8%) had moderate-severe disease; 48.9% were in congestive cardiac failure. Secondary antibiotic prophylaxis was used by 34.2%. Warfarin was used by 75.3% (n=64/85) with clinical indications. Forty-seven (17.6%) had previous valve interventions, of whom 40 (15.0%) had mechanical valve replacements. Over a 2-year follow-up period 19.1% of patients died. Severe valve involvement at enrolment was independently associated with mortality (24.6% v. 5.1% in those without severe disease; hazard ratio 4.9; 95% confidence interval 1.50 - 15.98). Sixty-five (29.8%) of the 218 without previous intervention had valvular intervention after enrolment.
CONCLUSIONS: In Namibia rheumatic heart disease affects young people who present with severe disease and have a high case fatality rate. Rates of secondary prevention were low. These findings have informed the National Programme for Prevention and Control of Rheumatic Heart Disease in Namibia.