Rheumatic Heart Disease Mortality Risk Factors

Mortality and Incidence of Rheumatic Heart Disease in Adults

Research Background

Rheumatic heart disease (RHD) causes over 300,000 deaths annually, primarily in low- and middle-income countries (LMICs). Due to a lack of high-quality epidemiological data, understanding of the incidence and mortality of RHD remains limited. Most studies on RHD involve a small number of patients and are often retrospective or limited to specific geographic areas or high-risk populations. In response, the World Health Organization passed a global resolution in 2018 calling for the collection of high-quality data to enhance the understanding of RHD epidemiology, thus helping to reduce the incidence and mortality of the disease.

Research Source

The authors of this paper include Ganesan Karthikeyan, Mpiko Ntsekhe, and Shofiqul Islam, affiliated with institutions such as All India Institute of Medical Sciences, University of Cape Town, and Population Health Research Institute. The paper was published online in the JAMA journal on June 5, 2024.

Research Design and Implementation Details

The study utilized a multi-center, hospital-based prospective observational design, covering 138 study sites across 24 LMICs where RHD is prevalent. A total of 13,696 patients were enrolled, with an average age of 43.2 years, and 72% were female. The primary aim of the study was to assess the all-cause mortality risk and its risk factors in these patients.

Patient Registration and Follow-Up

All patients were adults diagnosed with RHD through echocardiography. Eligible patients were enrolled consecutively and followed up every six months. During follow-up, detailed data on medication use, surgical or interventional treatments, and clinical outcomes were collected.

Study Results

Over a median follow-up period of 3.2 years, 1,943 patients died, accounting for 14.2% of the total (4.7% per patient-year). Of these, 67.5% (1,312 cases) of deaths were due to vascular causes, mainly heart failure or sudden cardiac death. The study also found that patients who underwent valve surgery or balloon dilation had significantly lower mortality rates, with surgery-related mortality being less than a quarter of that of ordinary patients. Specific data include:

• Heart failure hospitalization rate: 2% per year.
• Stroke incidence: 0.6% per year.
• Recurrent rheumatic fever: very rare.

Multivariable Cox regression analysis showed that markers of severe valvular disease, such as congestive heart failure (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 all associated with increased mortality.

Research Conclusion

The study indicates that mortality among RHD patients is high and closely related to the severity of valvular disease. Patients who underwent valve surgery and balloon dilation had significantly reduced mortality rates. The findings suggest that beyond existing antibiotic prevention and anticoagulant treatment strategies, there is a need to enhance the accessibility and affordability of surgical and interventional treatments.

Research Highlights

1. The largest global cohort of RHD patients: The study included 13,696 patients from 24 countries where RHD is prevalent.
2. Systematic data collection: Detailed records of medication use, surgical or interventional treatments, and clinical outcomes were kept.
3. Significant effects of surgery and balloon dilation: These treatments significantly reduced patient mortality, emphasizing the importance of providing these treatment options.
4. In-depth statistical analysis: The Cox regression model systematically assessed the impact of various variables on mortality.

Scientific and Practical Value of the Study

Scientific Value: Through a large-scale prospective multi-center study, this research provides crucial epidemiological data on RHD patients globally. These data contribute to a deeper understanding of the pathogenesis and clinical trajectory of RHD.

Practical Value: The study results highlight the importance of improving the accessibility of surgical and interventional treatments, which could save many lives. Additionally, the study provides important data support for current public health strategies and medical policies, giving policymakers a basis for decision-making.

By providing high-quality epidemiological data, this study comprehensively and systematically assesses the mortality and incidence of RHD and proposes feasible improvement directions for existing treatment strategies, offering valuable information for global RHD prevention and control.