Highlights
- •Contemporary data on long term outcomes in patients with RF/RHD is limited.
- •The incidence of adverse outcomes is variable across countries with different socioeconomic states.
- •India contributes to about 40% of the global burden of RF/RHD.
- •The long term outcome in patients with RF/RHD have not been reported from India.
- •The HP-RF/RHD registry data of long term outcomes bridges this knowledge gap.
Abstract
Background
The long-term outcome data in patients with rheumatic fever/rheumatic heart disease
(RF/RHD) is limited. We report the cumulative incidence of adverse outcomes in a cohort
of RHD patients from a northern state of India at a median follow-up of 5.4 years.
Methods
1714 patients with RF/RHD diagnosed using clinical and echocardiographic criteria
were registered from 2011 to 2018, and their baseline clinical characteristics and
treatment practices were recorded. Patients were followed up annually for a median
of 5.4 years (range 1–8 years) for incident adverse outcomes. The cumulative incidence
of adverse composite outcomes, all-cause mortality, hospitalization for heart failure,
stroke, and/or peripheral embolism was estimated. The baseline clinical characteristics
were explored to identify the potential risk predictors using a multivariate cox proportional
hazard model.
Results
The cumulative incidence of adverse composite outcomes was 17.1% (15.3%–19.0%) at
a median follow-up of 5.4 years. The predictors for the adverse composite outcomes
(hazard ratio, 95% confidence interval) were age (1.03, 1.02–1.04), education status
below primary level (1.60, 1.23–2.05), severe valvular heart disease (1.74, 1.36–2.23),
NYHA class III/IV at enrollment (1.56, 1.18–2.07), right heart failure (4.48, 2.85–6.95),
history of stroke and/or peripheral embolism (3.7, 1.5–9.2) and mitral balloon valvuloplasty
(0.62, 0.40–0.96).
Conclusions
The incidence of adverse outcomes is substantial in patients with RF/RHD. Thus, early
detection of high-risk patients and their risk management is needed to improve outcomes.
Keywords
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Article info
Publication history
Published online: September 11, 2021
Accepted:
September 8,
2021
Received in revised form:
August 7,
2021
Received:
March 15,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
