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

Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospita...

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Published in:	European heart journal Vol. 36; no. 18; pp. 1115 - 1122
Main Authors:	Zühlke, Liesl, Engel, Mark E, Karthikeyan, Ganesan, Rangarajan, Sumathy, Mackie, Pam, Cupido, Blanche, Mauff, Katya, Islam, Shofiqul, Joachim, Alexia, Daniels, Rezeen, Francis, Veronica, Ogendo, Stephen, Gitura, Bernard, Mondo, Charles, Okello, Emmy, Lwabi, Peter, Al-Kebsi, Mohammed M, Hugo-Hamman, Christopher, Sheta, Sahar S, Haileamlak, Abraham, Daniel, Wandimu, Goshu, Dejuma Y, Abdissa, Senbeta G, Desta, Araya G, Shasho, Bekele A, Begna, Dufera M, ElSayed, Ahmed, Ibrahim, Ahmed S, Musuku, John, Bode-Thomas, Fidelia, Okeahialam, Basil N, Ige, Olukemi, Sutton, Christopher, Misra, Rajeev, Abul Fadl, Azza, Kennedy, Neil, Damasceno, Albertino, Sani, Mahmoud, Ogah, Okechukwu S, Olunuga, Taiwo, Elhassan, Huda H M, Mocumbi, Ana Olga, Adeoye, Abiodun M, Mntla, Phindile, Ojji, Dike, Mucumbitsi, Joseph, Teo, Koon, Yusuf, Salim, Mayosi, Bongani M
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 07-05-2015
Subjects:	Administration, Oral Adult Age Distribution Anti-Bacterial Agents - therapeutic use Antibiotic Prophylaxis Anticoagulants - administration & dosage Clinical Research Cross-Sectional Studies Developing Countries Evidence-Based Medicine Female Global Health Heart Valve Diseases - epidemiology Heart Valve Diseases - etiology Heart Valve Diseases - therapy Humans Male Penicillins - therapeutic use Pilot Projects Prospective Studies Rheumatic Heart Disease - complications Rheumatic Heart Disease - epidemiology Rheumatic Heart Disease - therapy Sex Distribution Stroke Atrial fibrillation Valvuloplasty Infective endocarditis Congestive heart failure Rheumatic heart disease Valve surgery
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Summary:	Rheumatic heart disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. 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. 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2 ObjectType-Feature-2
ISSN:	0195-668X 1522-9645
DOI:	10.1093/eurheartj/ehu449