Clinical outcomes of children with rheumatic heart disease

Authors

Meghan Zimmerman, Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA meghan.s.zimmerman@hitchcock.org.
Samalie Kitooleko, Cardiology, Uganda Heart Institute, Kampala, Uganda.
Emmy Okello, Cardiology, Uganda Heart Institute, Kampala, Uganda.
Nicholas Ollberding, Rehabilitation, Exercise, and Nutrition Sciences, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Pranava Sinha, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Tom Mwambu, Cardiology, Uganda Heart Institute, Kampala, Uganda.
Craig Sable, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Andrea Beaton, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Chris Longenecker, Cardiovascular Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Peter Lwabi, Cardiology, Uganda Heart Institute, Kampala, Uganda.

Document Type

Journal Article

Publication Date

4-1-2022

Journal

Heart (British Cardiac Society)

Volume

108

Issue

8

DOI

10.1136/heartjnl-2021-320356

Keywords

cardiac surgical procedures; echocardiography; epidemiology; global health; heart valve diseases

Abstract

OBJECTIVE: To evaluate the long-term clinical outcomes of children with rheumatic heart disease (RHD) in Uganda, and determine characteristics that predict adverse outcomes. METHODS: This retrospective cohort study evaluated the risk of death in Ugandan children with clinical RHD from 2010 to 2018; enrolling children aged 5-18 years old from an existing registry. Demographic data and clinical data (baseline complications, RHD severity, cardiac interventions) were collected. The primary outcome was survival. Univariable and multivariable hazard ratios (HR) were obtained from Cox proportional hazards regression. Survival probabilities were developed using Kaplan-Meier curves; log-rank tests compared survival based on cardiac interventions, disease severity and time of enrolment. RESULTS: 612 cases met inclusion criteria; median age 12.8 years (IQR 5.3), 37% were male. Thirty-one per cent (187 of 612) died during the study period; median time to death 7.8 months (IQR 18.3). In univariable analysis, older age (HR 1.26, 95% CI=1.0 to 1.58), presence of baseline complications (HR 2.06, 95% CI=1.53 to 2.78) and severe RHD (HR 5.21, 95% CI=2.15 to 12.65) were associated with mortality. Cardiac intervention was associated with a lower risk of mortality (HR 0.06, 95% CI=0.02 to 0.24). In multivariable models, baseline complications (HR 1.78, 95% CI=1.31 to 2.41), severe RHD (HR 4.58, 95% CI=1.87 to 11.23) and having an intervention (HR 0.05, 95% CI=0.01 to 0.21) remained statistically significant. Kaplan-Meier survival curves demonstrated >25% mortality in the first 30 months, with significant differences in mortality based on intervention status and severity of disease. CONCLUSIONS: The mortality rate of children with clinical RHD in Uganda exceeds 30%, over an 8-year time frame, despite in-country access to cardiac interventions. Children at highest risk were those with cardiac complications at baseline and severe RHD.

APA Citation

Zimmerman, Meghan; Kitooleko, Samalie; Okello, Emmy; Ollberding, Nicholas; Sinha, Pranava; Mwambu, Tom; Sable, Craig; Beaton, Andrea; Longenecker, Chris; and Lwabi, Peter, "Clinical outcomes of children with rheumatic heart disease" (2022). GW Authored Works. Paper 281.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/281

Department

Pediatrics