RISK of death is higher in patients with rheumatic heart disease (RHD) in low- and middle-income countries (LMICs), with nearly 15% of patients dying within three years, primarily due to heart failure or sudden cardiac death. The study highlights the urgent need for improved access to surgical and interventional care in these regions.
RHD continues to pose a significant public health challenge in LMICs. Despite the high prevalence, there is a lack of comprehensive data from multiple endemic countries. This study aimed to evaluate the risk of major clinical outcomes and identify predictors of mortality in patients with RHD. Conducted at 138 sites across 24 endemic countries, the prospective observational study recruited 13,696 patients between August 2016 and May 2022. The primary outcome measure was all-cause mortality, with secondary outcomes including cause-specific mortality, heart failure hospitalization, stroke, recurrent rheumatic fever, and infective endocarditis.
The median follow-up duration was 3.2 years, during which 1,943 patients died, equating to a mortality rate of 15% overall. Vascular causes, mainly heart failure or sudden cardiac death, accounted for the majority of deaths. Despite most patients experiencing symptoms, only 5% underwent valve surgery within three years. Predictors of increased mortality included markers of severe valve disease such as congestive heart failure, pulmonary hypertension, and atrial fibrillation. Conversely, corrective valve surgery and valvuloplasty were independently associated with a significantly reduced risk of death. Notably, higher country income levels were linked to lower mortality rates after adjusting for patient-level factors.
The high mortality rate among RHD patients highlights the critical need for enhanced healthcare infrastructure in endemic regions. While current strategies emphasize antibiotic prophylaxis and anticoagulation, this study reveals that improving the availability and accessibility of surgical and interventional treatments could substantially lower mortality rates. Future efforts should focus on integrating these services into existing healthcare systems to address the severe impact of RHD more effectively.
Reference
Karthikeyan G et al. Mortality and morbidity in adults with rheumatic heart disease. JAMA. 2024;DOI:10.1001/jama.2024.8258.
