Study indicates mortality in rheumatic heart disease is high

Mortality related to rheumatic heart disease (RHD) is high and is correlated with the severity of valve disease, according to a study published online June 5 in the Journal of the American Medical Association.

Ganesan Karthikeyan, D.M., from the All India Institute of Medical Sciences in New Delhi, and colleagues assessed the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD. Analysis included 13,696 patients in 24 low- and middle-income countries.

The researchers found that over a median duration of 3.2 years, 15% of patients died overall (4.7% per patient-year). Vascular causes accounted for most deaths (67.5%), mainly heart failure or sudden cardiac death. Both stroke (0.6% per year) and recurrent rheumatic fever was rare.

Higher mortality was seen with markers of severe valve disease, including congestive heart failure (hazard ratio [HR], 1.58), pulmonary hypertension (HR, 1.52), and atrial fibrillation (HR, 1.30). Lower mortality was seen with surgical treatment (HR, 0.23) or valvuloplasty (HR, 0.24). Lower mortality was also seen with higher country income level, when adjusting for patient-level factors.

“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,” the authors write.

Several authors disclosed ties to pharmaceutical companies, including Bayer, which funded the study.

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