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Zühlke L, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, Mauff K, Islam S, Joachim A, Daniels R, Francis V, Ogendo S, Gitura B, Mondo C, Okello E, Lwabi P, Al-Kebsi MM, Hugo-Hamman C, Sheta SS, Haileamlak A, Daniel W, Goshu DY, Abdissa SG, Desta AG, Shasho BA, Begna DM, ElSayed A, Ibrahim AS, Musuku J, Bode-Thomas F, Okeahialam BN, Ige O, Sutton C, Misra R, Abul Fadl A, Kennedy N, Damasceno A, Sani M, Ogah OS, Olunuga T, Elhassan HHM, Mocumbi AO, Adeoye AM, Mntla P, Ojji D, Mucumbitsi J, Teo K, Yusuf S, Mayosi BM. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 2014; 36:1115-22a. [PMID: 25425448 DOI: 10.1093/eurheartj/ehu449] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 10/23/2014] [Indexed: 11/14/2022] Open
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.
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Affiliation(s)
- Liesl Zühlke
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Mark E Engel
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Pam Mackie
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Blanche Cupido
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Katya Mauff
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Alexia Joachim
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Rezeen Daniels
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Veronica Francis
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
| | - Stephen Ogendo
- Department of Surgery, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Bernard Gitura
- Cardiology Unit, Department of Medicine, Kenyatta National Teaching and Referral Hospital, Nairobi, Kenya
| | - Charles Mondo
- Cardiology Unit, Department of Medicine, Mulago Hospital, Kampala, Uganda
| | | | | | - Mohammed M Al-Kebsi
- Faculty of Medicine and Surgery, University of Sana'a, Al-Thawrah Cardiac Center, Sana'a, Yemen
| | - Christopher Hugo-Hamman
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa Paediatric Cardiology Service, Windhoek Central Hospital, Windhoek, Namibia
| | - Sahar S Sheta
- Department of Paediatrics, Division of Paediatric Cardiology, Faculty of Medicine, Cairo University Children's Hospital, Cairo, Egypt
| | - Abraham Haileamlak
- Department of Paediatrics and Child Health, Jimma University Hospital, Jimma, Ethiopia
| | - Wandimu Daniel
- Department of Paediatrics and Child Health, Jimma University Hospital, Jimma, Ethiopia
| | - Dejuma Y Goshu
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Senbeta G Abdissa
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Araya G Desta
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Bekele A Shasho
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Dufera M Begna
- Department of Internal Medicine, Faculty of Medicine, Addis Ababa, Ethiopia
| | - Ahmed ElSayed
- Department of Cardiothoracic Surgery, Al Shaab Teaching Hospital, Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan
| | - Ahmed S Ibrahim
- Department of Cardiothoracic Surgery, Al Shaab Teaching Hospital, Faculty of Medicine, Alzaiem Alazhari University, Khartoum, Sudan
| | - John Musuku
- Department of Paediatrics and Child Health, University Teaching Hospital, University of Zambia, Lusaka, Zambia
| | | | - Basil N Okeahialam
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Olukemi Ige
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria
| | - Christopher Sutton
- Department of Paediatrics and Child Health, University of Limpopo, Polokwane, South Africa
| | - Rajeev Misra
- Department of Internal Medicine, University of Limpopo, Polokwane, South Africa
| | | | - Neil Kennedy
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Mahmoud Sani
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Okechukwu S Ogah
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria Nigeria Ministry of Health, Umuahia, Abia State, Nigeria Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Taiwo Olunuga
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | | | - Ana Olga Mocumbi
- Instituto Nacional de Saúde and Eduardo Mondlane University, Maputo, Mozambique
| | - Abiodun M Adeoye
- Division of Cardiology, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Phindile Mntla
- Department of Cardiology, Dr. George Mukhari Hospital and University of Limpopo (MEDUNSA Campus), Tshwane, South Africa
| | - Dike Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Joseph Mucumbitsi
- Paediatric Cardiology Unit, Department of Paediatrics, King Faisal Hospital, Kigali, Rwanda
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Bongani M Mayosi
- The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, J Floor Old Groote Schuur Hospital, Groote Schuur Drive, Observatory 7925, Cape Town, South Africa
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