- •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.
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.
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.
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).
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.
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- Echocardiographic prevalence of rheumatic heart disease in Indian school children using World Heart Federation criteria - a multi site extension of RHEUMATIC study (the e-RHEUMATIC study).Int. J. Cardiol. 2017; 249: 438-442
- Global, regional, and national burden of rheumatic heart disease, 1990–2015.N. Engl. J. Med. 2017; 377: 713-722
- Prevalence, risk determinants and consequences of atrial fibrillation in rheumatic heart disease: 6 years hospital based-Himachal Pradesh- Rheumatic Fever/Rheumatic Heart Disease (HP-RF/RHD) Registry.Ind. Heart J. 2018; 70: S68-S73https://doi.org/10.1016/j.ihj.2018.05.013
- Clinical characteristics, complications, and treatment practices in patients with RHD: 6-year results from HP-RHD registry.Glob. Heart. 2018; 13 (e2): 267-274
- Rheumatic fever & rheumatic heart disease: the last 50 years.Indian J. Med. Res. 2013; 137: 643-658
- Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study).Eur. Heart J. 2015; 36 (1115-22a)https://doi.org/10.1093/eurheartj/ehu449
- Rationale and design of a Global Rheumatic Heart Disease Registry: the REMEDY study.Am. Heart J. 2012; 163 (e1): 535-540
- Rheumatic heart disease in Uganda: predictors of morbidity and mortality one year after presentation.BMC Cardiovasc. Disord. 2017; 17 (Published 2017 Jan 7): 20
- Clinical outcomes in 3343 children and adults with rheumatic heart disease from 14 low- and middle-income countries: two-year follow-up of the global rheumatic heart disease registry (the REMEDY study).Circulation. 2016; 134: 1456-1466
- Long-term outcomes from acute rheumatic fever and rheumatic heart disease: a data-linkage and survival analysis approach.Circulation. 2016; 134: 222-232https://doi.org/10.1161/CIRCULATIONAHA.115.020966
- Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010.Circulation. 2013; 128: 492-501https://doi.org/10.1161/CIRCULATIONAHA.113.001477
- World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline.Nat. Rev. Cardiol. 2012; 9 (Published 2012 Feb 28): 297-309
- The 2015 revision of the Jones criteria for the diagnosis of acute rheumatic fever: implications for practice in low-income and middle-income countries.Heart Asia. 2015; 7 (Published 2015 Aug 19): 7-11
- Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.J. Am. Soc. Echocardiogr. 2003; 16: 777-802https://doi.org/10.1016/S0894-7317(03)00335-3
- Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice [published correction appears in J Am Soc Echocardiogr. 2009 May;22(5):442].J. Am. Soc. Echocardiogr. 2009; 22: 1-102
- 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014 Jun 10;129(23):e650].Circulation. 2014; 129: 2440-2492https://doi.org/10.1161/CIR.0000000000000029
- Infective endocarditis: innovations in the management of an old disease.Nat. Rev. Cardiol. 2019; 16: 623-635https://doi.org/10.1038/s41569-019-0215-0
- Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever.Pediatr. Rheumatol. Online J. 2010; 8 (Published 2010 Jul 26): 22
- Lessons to be learned: using National Immunisation strategies to improve adherence to acute rheumatic fever secondary prophylaxis.J. Paediatr. Child Health. 2019; 55: 1170-1176https://doi.org/10.1111/jpc.14596
- Adherence to secondary prophylaxis for acute rheumatic fever and rheumatic heart disease: a systematic review.Curr. Cardiol. Rev. 2017; 13: 155-166https://doi.org/10.2174/1573403X13666170116120828
Published online: September 11, 2021
Accepted: September 8, 2021
Received in revised form: August 7, 2021
Received: March 15, 2021
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