Pre-intervention wait time and survival in people with rheumatic heart disease in Uganda

Chang Yoon Doh, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Crystal An, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Andrew Y. Chang, Department of Epidemiology and Population Health, Stanford University, Stanford, California, USA; Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, California, USA; Center for Innovation in Global Health, Stanford University, Stanford, California, USA.
Joselyn Rwebembera, Department of Cardiology, Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda.
Tom P. Mwambu, Department of Cardiovascular Surgery, Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda; School of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda.
Andrea Z. Beaton, Department of Pediatric Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Doreen Nakagaayi, Department of Cardiology, Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda; Department of Pediatric Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Pablo F. Ruda Vega, Division of Cardiac Surgery, Harrington Heart & Vascular Institute Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Craig A. Sable, Department of Pediatric Cardiology, Children's National Hospital, Washington, D.C., USA; The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
Chris T. Longenecker, Department of Cardiology and Global Health, University of Washington, Seattle, Washington, USA. Electronic address: ctlongen@uw.edu.
Peter Lwabi, Department of Cardiology, Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda; School of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda.

Document Type

Journal Article

Publication Date

6-20-2024

Journal

The Annals of thoracic surgery

DOI

10.1016/j.athoracsur.2024.06.009

Abstract

BACKGROUND: There is an unmet surgical burden among people living with rheumatic heart disease (RHD) in Uganda. Nevertheless, risk factors associated with time to first intervention and preoperative mortality is poorly understood. METHODS: Individuals with RHD who met indications for valve surgery were identified using the Uganda National RHD Registry (Jan. 2010- Aug. 2022). Kaplan-Meier estimates and multivariable Cox proportional hazard models were utilized. RESULTS: 64% of the cohort with clinical RHD (1452 of 2269) met criteria for index operation. Of those, 13.5% obtained surgical intervention while 30.6% died before surgery. The estimated likelihood of first surgery was 50% at 9.3 years of follow up (95% CI 8.1-upper limit not reached). Intervention was more likely in men vs. women (hazard ratio [HR] 1.78; 95% CI 1.21-2.64), those with post-secondary education vs. primary school or less (HR 3.60; 95% CI 1.88-6.89), and those with history of atrial fibrillation (HR 2.78; 95% CI 1.63-4.76). Surgery was less likely for adults (vs. those <18 years; HR 0.49; 95% CI 0.32-0.77) and those with NYHA class III/IV (vs. I/II; HR 0.51; 95% CI 0.32-0.83). The median preoperative survival time among those awaiting surgery was 4.6 years (95% CI, 3.9-5.7). History of infective endocarditis, RV dysfunction, pericardial effusion, atrial fibrillation, and having surgical indications for multiple valves were associated with increased mortality. CONCLUSIONS: Our analysis revealed a prolonged time to first surgical intervention and high pre-intervention mortality for RHD in Uganda, with factors such as age, sex, and education level remaining barriers to obtaining surgery.

Department

Pediatrics

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