Mortality and Morbidity in Adults With Rheumatic Heart Disease
Author:
Karthikeyan Ganesan12, Ntsekhe Mpiko3, Islam Shofiqul4, Rangarajan Sumathy4, Avezum Alvaro5, Benz Alexander6, Cabral Tantchou Tchoumi Jacques7, Changsheng Ma8, Chillo Philly9, Gonzalez-Hermosillo J. Antonio10, Gitura Bernard11, Damasceno Albertino12, Dans Antonio Miguel L.13, Davletov Kairat14, Elghamrawy Alaa15, ElSayed Ahmed16, Fana Golden Tafadzwa17, Gondwe Lillian18, Haileamlak Abraham1920, Kayani Azhar Mahmood21, Lwabi Peter22, Maklady Fathi23, Molefe-Baikai Onkabetse Julia24, Musuku John25, Ogah Okechukwu Samuel26, Paniagua Maria27, Rusingiza Emmanuel28, Sharma Sanjib Kumar29, Zuhlke Liesl30, Connolly Stuart4, Yusuf Salim4, , Goepamang Monkgogi31, Mwita Julius31, Ramos Auristela31, Tarasoutchi Flavio31, Paixao Milena Ribeiro31, Kirschbaum Marcelo31, Pezzute Lopes Mariana31, Avila Walkiria31, Maia Lilia31, Nakazone Marcelo31, Costa Osana31, Lemos Maria31, Oliveira Livia31, Ferreira Jose31, Saraiva Jose Francisco Kerr31, Costa Midia31, Marengo Marina31, Dutra Oscar31, Guimaraes Raphael31, Vaz Humberto31, Zimmerman Sergio Luiz31, Souza Weimar31, Queiroz Weimar31, Souza Adriana31, Vidotti Maria Helena31, de Paula Jose Guilherme31, Fazolli Guilherme31, Hernandes Mauro31, Torati Jose Luiz31, Pantano Grazielly31, Pelarin Vanessa31, Arantes Flavia31, Silva Rodrigo31, Cardoso Monique31, Reis Gilmar31, Franca Cesar31, Quadros Tulio31, Giorgeto Flavio31, Elmiro Resende31, Aguinaldo Silva31, Minelli Cesar31, Anshoma Helen Mbuoh31, Ambassa Jean Claude31, Mfevkev Kuate Liliane31, Nganou Gninotio Chris Nadege31, Ntep Gweth Ngo Youmba31, Anastase Dzudie31, Florent Armel Djomou Ngongang31, Keptukoua Lionel Nana31, Du Xin31, Hu Rong31, Wu Jiahui31, Lv Qiang31, Cui Jing31, Qing Yu31, Xudong Zhu31, Su Wei31, Xiaomei Wang31, Shiyi Chen31, Zhipeng Zhang31, Wang Qi31, Zheng Xin31, Pengfei Liu31, Rang Cheng31, Xie Sitao31, Liu Chongwen31, Wang Hailong31, Wang Shudong31, Zhang Xuxia31, Lian Yinzhu31, Wang Rui31, Mingfu Ma31, Li Lan Dou31, Tan Yunlian31, Zhang Shouyan31, Yunfei Gu31, Jianfeng Chen31, Hao Wang31, Pengyu Wu31, Hong Luan31, Fu Li31, Yongbin Xu31, Jundan Xiao31, Qingfu Li31, Sun Jinpo31, Pei Cui31, Niu Yanbo31, Wu Yidi31, Yang Honghua31, Li Xin31, Yang Chunyan31, Shi Yanhui31, Wu Chenglin31, Qu Yandong31, Zhao Mingzhong31, Cheng Yong31, Yuan Yiqiang31, Huang Qiong31, Kong Xiuzhen31, Zhao Zhizhong31, Heng Qixia31, Shi Xinjing31, Zhang Jing31, Ying Liu31, Xin Gao31, Yu Zhaoping31, Wu Xi31, Hunayu Guo31, Xiaoying Wang31, Zhang Wei31, Li Chichang31, Zhongtao Wang31, Ding Hao31, Huang Min31, Jinguo Zhao31, Yu Mingshui31, Cao Cuiling31, Zhu Xiaoli31, Shi Xiaoqin31, Eltamawy Khalid31, Arafa Osama31, Youssif Mahmoud31, Kassem Aly31, Saleh Omar31, Hussam Al Shair Mohamed31, Maghraby Khaled31, Shaheen Sameh31, Abouelhoda Aly Ahmed31, Gharib Suliman31, Sadek Ramadan31, Abd El Hady Yasser31, Asefa Elsah31, Gudina Esayas Kebede31, Habte Michael Ermias31, Dukessa Gemechu Tadesse31, Duguma Markos31, Yadeta Dejuma31, Alemu Berhanu N31, Abebe Sintayehu31, Assefa Tamrat31, Mekonnen Desalew31, Seleshi Tigist31, Fekadu Chala31, Hailu Abraha31, Tesfay Hagazi31, Hailu Berhane Yohannes31, Kahsay Hagos31, Gidey Kibreab31, Gebrehawaria Teklay31, Berhane Samuel31, Kamil Teshome Abegaz31, Shifa Tariku Egeno31, Hirigo Agete Tedewos31, Teshome Sisay Tesfaye31, Yirdaw Seyife Kibru31, Singh Sandeep31, Naik Nitish31, Siddharthan Deepti31, Yadav Satyavir31, Gupta Mohit31, MP Girish31, Sharma Ajay31, Pandit Bhagya Narayan31, Sudeep Kumar31, Aditya Kapoor31, Pradhan Akshyaya31, Sethi Rishi31, Chaudhry Gaurav31, Virendra Yaday31, Smriti Agarwal31, Manjnath Cholenahally31, Narayanappa Surya Prakash31, Satvic Cholenahally31, Devegowda Lachikarthman31, Meena Chandra Bhan31, Bagarhatta Rajiv31, Sharma Shashi Mohan31, Kunal Shekhar31, Kumar Nutan31, Mereke Alibek31, Ogola Elijah31, Sugut Wilson31, Barasa Felix31, Gikonyo Anthony31, Omondi Stephen31, Sinyiza Frank31, Chipolombwe John31, Phiri Tamara31, Rodriguez Chavez Laura Leticia31, Gutierrez Ernesto31, Mazon Flores Fransisco31, Rodriguez Edgar31, Lara Vaca Susano31, Cabra Juan31, Saavedra Sandra31, De los Rios Manuel31, Ruvalcaba Gilmer31, Lopez Esteban31, Alcocer Marco31, Ramirez Ana31, Llamas Guillermo31, Hernandez Paola31, Delgado Angelica31, Muholove Ana31, Mateus Angela31, Mocumbi Ana31, Agarwal Jyoti31, Chhetri Roshan31, Tripathi Prashant Mani31, Adhikari Chandra Mani31, Shakya Urmila31, Prajapati Dipanker31, Manandhar Reeju31, Nepal Rajesh31, Dhungana Sahadeb Prasad31, Ghimire Rinku31, Khanal Sunil Babu31, Gautam Samir31, Khan Mazhar31, KC Bishal31, Laudari Shankar31, Gupta Madhu31, Regmi Shyam Raj31, Dhital Bishnu Mani31, Regmi Sudhir31, Adhikari Krishna31, Koirala Bhagawan31, Gajurel Ratnamani31, Shrestha Hemant31, Thapa Sanjeev31, AKINTUNDE ADESEYE31, Olunuga Taiwo31, Adesina Julius31, Sani Mahmoud31, Bode-Thomas Fidelia31, Okeahialam Basil31, Yilgwan Christopher31, Amusa Ganiyu31, IGE Olukemi31, Danbauchi Solomon31, Adeoye Abiodun Moshood31, Umuerri Ejiroghene31, Mbakwem Amam31, Amadi Casmir31, Kushimo Oyewole31, Isa Muhammad31, Abdullahi Muhammad Awwal31, Oguanobi Nelson31, Zahid Zohaib Ullah31, Ali Jabar31, Hafizullah Mohammad31, Memon Feroz31, Kazi Shazia31, Kayani Azhar Mahmood31, Rehman Adeel31, Khan Faisal Abdul Wajid31, Tarique Aftab Ahmad31, Sattar Abdul31, Hayat Mallick Nadeem31, Ali Syed Asif31, Mayans Veronica31, Pereira Luciano31, Alderete Jose31, Galeano Javier31, Moran Salinas Alberto31, Falcón Rocío del Pilar31, Escalada Gustavo31, Cabral Luz31, Fatecha Liz31, Bogado de Atobe Gladys31, Gutierrez Carlos31, Delmas Cesar31, Coronel Claudine31, Ibarrola Dahiana31, Magno Jose Donato31, Evangelista Lauren Kay31, Abola Maria Teresa31, Padua Leahdette31, Mendoza-Reyes Christie31, Sulit Dennis Jose31, Mercado Ma Jojo31, Sigua Cabaddu Candy Angelica31, Cruz Josefina31, Ganza Gapira Jean Marie Vianney31, Dusingizimana Vincent31, Cupido Blanche31, Lawrenson John31, NAICKER KISHENDREE31, CIROTA JACQUELINE RACHELLE31, Karen Sliwa Hahnle31, Thomas Baby Mookenthottathil31, Thomas Kandathil Mathew31, KHULILE MOEKETSI31, Alomatu Samuel Yao31, MNTLA PINDILE31, MPHAHLELE MAKGOTSANE31, Ratsela Andrew31, Manga Pravin31, Fourie Doné31, Hemus Allana31, Makotoko Ellen M31, ALAM A K M NOWSHAD31, Nethononda Richard31, Nunkoo Theema31, Meel Ruchika31, Askar Elsadig31, Elfaki Amna31, Mohamed Lana31, ElSayed Mohammed31, Hagahmed Alia31, Mohammed Sumia31, Algaali Hiba31, Eltalib Khalid31, Badawe Tagwa S. I.31, Kbashi Inas Hassab Elrasoul31, Elhassan Huda Hamid31, Hamza Maysa31, Ahmed Molhim M.I.31, Elhussain Rayan31, Mutwali Rufaida31, Ahmed Medani Mohammad Qurashi31, Mohamed Nazar F.A.31, Elamin Hwida A.M.31, Elmadih Manal H.A.31, Abdelgader Maha31, Yousif Magdi (Gameel)31, Elfatih Tagwa31, Elshazali Osama Hafiz31, Esawi Elaf Esmaeel31, Mohammed Awad A.M.A.31, Hassan Omer I.A.31, Mahgoub Khansa31, Maki Maarib31, A.M.Abozaid Omaima31, Majani Naiz31, Mtullo Emmanuel Stephano31, Kabakama Clement31, Mwakyula Issakwisa31, Meda John31, Okello Emmy31, Chansa Pamela31, Mumba Ngosa31, Goma Fastone31, Musemwa Caroline31, Gwini Rudo31
Affiliation:
1. Department of Cardiology, All India Institute of Medical Sciences, New Delhi 2. Translational Health Science and Technology Institute, Faridabad, India 3. Division of Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa 4. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada 5. International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil 6. Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany 7. St. Elizabeth Catholic General Hospital, Shisong Cardiac Centre, Kumbo, Cameroon 8. Beijing Anzhen Hospital, Beijing, China 9. Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania 10. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico 11. Kenyatta National Teaching & Referral Hospital, Department of Cardiology, Nairobi, Kenya 12. Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique 13. College of Medicine, University of Philippines, Manila 14. Asfendiyarov Kazakh National Medical University, Health Research Institute, Almaty, Kazakhstan 15. Mehalla Heart Center, El Mahalla El Kubra, Egypt 16. Alzaiem Alazhari University, Khartoum, Sudan 17. University of Zimbabwe, College of Health Sciences, Harare 18. Kamuzu Central Hospital, Lilongwe, Malawi 19. College of Medicine and Health Sciences, University of Rwanda, Kigali 20. Jimma University Medical Center, Jimma, Ethiopia 21. Rawalpindi Institute of Cardiology, Rawalpindi, Punjab, Pakistan 22. Uganda Heart Institute, Kampala, Uganda 23. Department of Cardiology, Suez Canal University, Ismailia, Egypt 24. Princess Marina Hospital, University of Botswana, Gaborone 25. University Teaching Hospital, Lusaka, Zambia 26. Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Oyo State, Nigeria 27. College of Medicine Sciences, National University of Concepción, Concepción, Paraguay 28. University Teaching Hospital of Kigali, Kigali, Rwanda 29. B.P. Koirala Institute of Health Sciences, Dharan, Nepal 30. Medical Research Council of South Africa, Division of Pediatric Cardiology, Department of Pediatrics, Red Cross Children’s Hospital Faculty of Health Sciences, University of Cape Town, Cape Town 31. for the INVICTUS Investigators
Abstract
ImportanceRheumatic heart disease (RHD) remains a public health issue in low- and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries.ObjectiveTo assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD.Design, Setting, and ParticipantsMulticenter, hospital-based, prospective observational study including 138 sites in 24 RHD-endemic LMICs.Main Outcomes and MeasuresThe primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality, heart failure (HF) hospitalization, stroke, recurrent rheumatic fever, and infective endocarditis. This study analyzed event rates by World Bank country income groups and determined the predictors of mortality using multivariable Cox models.ResultsBetween August 2016 and May 2022, a total of 13 696 patients were enrolled. The mean age was 43.2 years and 72% were women. Data on vital status were available for 12 967 participants (94.7%) at the end of follow-up. Over a median duration of 3.2 years (41 478 patient-years), 1943 patients died (15% overall; 4.7% per patient-year). Most deaths were due to vascular causes (1312 [67.5%]), mainly HF or sudden cardiac death. The number of patients undergoing valve surgery (604 [4.4%]) and HF hospitalization (2% per year) was low. Strokes were infrequent (0.6% per year) and recurrent rheumatic fever was rare. Markers of severe valve disease, such as congestive HF (HR, 1.58 [95% CI, 1.50-1.87]; P < .001), pulmonary hypertension (HR, 1.52 [95% CI, 1.37-1.69]; P < .001), and atrial fibrillation (HR, 1.30 [95% CI, 1.15-1.46]; P < .001) were associated with increased mortality. Treatment with surgery (HR, 0.23 [95% CI, 0.12-0.44]; P < .001) or valvuloplasty (HR, 0.24 [95% CI, 0.06-0.95]; P = .042) were associated with lower mortality. Higher country income level was associated with lower mortality after adjustment for patient-level factors.Conclusions and RelevanceMortality in RHD is high and is correlated with the severity of valve disease. Valve surgery and valvuloplasty were associated with substantially lower mortality. Study findings suggest a greater need to improve access to surgical and interventional care, in addition to the current approaches focused on antibiotic prophylaxis and anticoagulation.
Publisher
American Medical Association (AMA)
Cited by
1 articles.
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