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Observational Study
. 2015 May 7;36(18):1115-22a.
doi: 10.1093/eurheartj/ehu449. Epub 2014 Nov 25.

Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)

Liesl Zühlke  1 , Mark E Engel  2 , Ganesan Karthikeyan  3 , Sumathy Rangarajan  4 , Pam Mackie  4 , Blanche Cupido  2 , Katya Mauff  5 , Shofiqul Islam  4 , Alexia Joachim  2 , Rezeen Daniels  2 , Veronica Francis  2 , Stephen Ogendo  6 , Bernard Gitura  7 , Charles Mondo  8 , Emmy Okello  9 , Peter Lwabi  9 , Mohammed M Al-Kebsi  10 , Christopher Hugo-Hamman  11 , Sahar S Sheta  12 , Abraham Haileamlak  13 , Wandimu Daniel  13 , Dejuma Y Goshu  14 , Senbeta G Abdissa  14 , Araya G Desta  14 , Bekele A Shasho  14 , Dufera M Begna  14 , Ahmed ElSayed  15 , Ahmed S Ibrahim  15 , John Musuku  16 , Fidelia Bode-Thomas  17 , Basil N Okeahialam  17 , Olukemi Ige  17 , Christopher Sutton  18 , Rajeev Misra  19 , Azza Abul Fadl  20 , Neil Kennedy  21 , Albertino Damasceno  22 , Mahmoud Sani  23 , Okechukwu S Ogah  24 , Taiwo Olunuga  25 , Huda H M Elhassan  26 , Ana Olga Mocumbi  27 , Abiodun M Adeoye  28 , Phindile Mntla  29 , Dike Ojji  30 , Joseph Mucumbitsi  31 , Koon Teo  4 , Salim Yusuf  4 , Bongani M Mayosi  32
Affiliations
Observational Study

Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study)

Liesl Zühlke et al. Eur Heart J. .

Abstract

Aims: Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment.

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.

Keywords: Atrial fibrillation; Congestive heart failure; Infective endocarditis; Rheumatic heart disease; Stroke; Valve surgery; Valvuloplasty.

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Figures

Figure 1
Figure 1
Age and gender distribution of 3339 children and adults with rheumatic heart disease.
Figure 2
Figure 2
Utilization of valve surgery and valvuloplasty in children and adults from low-income, lower-middle-income, and upper-middle-income countries.
Figure 3
Figure 3
The pattern of native rheumatic valve disease in 2475 children and adults with no percutaneous or surgical interventions. AVD, aortic valve disease; MAVD, mixed aortic valve disease; MMAVD, mixed aortic and mitral valve disease; MMVD, mixed mitral valve disease; MR, mitral regurgitation; MS, mitral stenosis.
Figure 4
Figure 4
Adherence to secondary prophylaxis with penicillin in low-income, low-middle-income, and upper-middle-income countries.
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References

    1. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group a streptococcal diseases. Lancet Infect Dis 2005;5:685–694. - PubMed
    1. Paar JA, Berrios NM, Rose JD, Cáceres M, Peña R, Pérez W, Chen-Mok M, Jolles E, Dale JB. Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol 2010;105:1809–1814. - PMC - PubMed
    1. Diao M, Kane A, Ndiaye MB, Mbaye A, Bodian M, Dia MM, Sarr M, Kane A, Monsuez J-J, Ba SA. Pregnancy in women with heart disease in Sub-Saharan Africa. Arch Cardiovasc Dis. 2011;104:370–374. - PubMed
    1. Koegelenberg CF, Doubell AF, Orth H, Reuter H. Infective endocarditis in the western cape province of south Africa: A three-year prospective study. QJM 2003;96:217–225. - PubMed
    1. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham heart study. Circulation 1998;98:946–952. - PubMed

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