Clinical outcomes of children with rheumatic heart disease

被引:13
作者
Zimmerman, Meghan [1 ,2 ]
Kitooleko, Samalie [3 ]
Okello, Emmy [3 ,4 ]
Ollberding, Nicholas [5 ,6 ]
Sinha, Pranava [7 ,8 ]
Mwambu, Tom [3 ,4 ]
Sable, Craig [7 ,8 ]
Beaton, Andrea [6 ,9 ]
Longenecker, Chris [10 ,11 ]
Lwabi, Peter [3 ,4 ]
机构
[1] Dartmouth Hitchcock Med Ctr, Pediat, Lebanon, NH 03766 USA
[2] Dartmouth Coll, Geisel Sch Med, Hanover, NH 03755 USA
[3] Uganda Heart Inst, Cardiol, Kampala, Uganda
[4] Makerere Univ, Kampala, Uganda
[5] Cincinnati Childrens Hosp Med Ctr, Rehabil Exercise & Nutr Sci, Cincinnati, OH 45229 USA
[6] Univ Cincinnati, Coll Med, Cincinnati, OH USA
[7] George Washington Univ, Sch Med & Hlth Sci, Washington, DC 20052 USA
[8] Childrens Natl Hosp, Pediat Cardiol, Washington, DC USA
[9] Cincinnati Childrens Hosp Med Ctr, Pediat Cardiol, Cincinnati, OH 45229 USA
[10] Univ Hosp Cleveland, Med Ctr, Cardiovasc Med, Cleveland, OH 44106 USA
[11] Case Western Reserve Univ, Sch Med, Cleveland, OH USA
基金
美国国家卫生研究院;
关键词
REGISTRY; BURDEN; RISK;
D O I
10.1136/heartjnl-2021-320356
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:633 / 638
页数:6
相关论文
共 18 条
[1]  
Aliku TO, 2017, ANN PEDIAT CARDIOL, V10, P50, DOI 10.4103/0974-2069.197069
[2]   Latent Rheumatic Heart Disease Identifying the Children at Highest Risk of Unfavorable Outcome [J].
Beaton, Andrea ;
Aliku, Twalib ;
Dewyer, Alyssa ;
Jacobs, Marni ;
Jiang, Jiji ;
Longenecker, Chris T. ;
Lubega, Sulaiman ;
McCarter, Robert ;
Mirabel, Mariana ;
Mirembe, Grace ;
Namuyonga, Judith ;
Okello, Emmy ;
Scheel, Amy ;
Tenywa, Emmanuel ;
Sable, Craig ;
Lwabi, Peter .
CIRCULATION, 2017, 136 (23) :2233-2244
[3]   Echocardiography Screening for Rheumatic Heart Disease in Ugandan Schoolchildren [J].
Beaton, Andrea ;
Okello, Emmy ;
Lwabi, Peter ;
Mondo, Charles ;
McCarter, Robert ;
Sable, Craig .
CIRCULATION, 2012, 125 (25) :3127-3132
[4]   Clinical outcomes for young people with screening-detected and clinically-diagnosed rheumatic heart disease in Fiji [J].
Engelman, Daniel ;
Mataika, Reapi L. ;
Kee, Maureen Ah. ;
Donath, Susan ;
Parks, Tom ;
Colquhoun, Samantha M. ;
Carapetis, Jonathan R. ;
Kado, Joseph H. ;
Steer, Andrew C. .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 2017, 240 :422-427
[5]   The REDCap consortium: Building an international community of software platform partners [J].
Harris, Paul A. ;
Taylor, Robert ;
Minor, Brenda L. ;
Elliott, Veida ;
Fernandez, Michelle ;
O'Neal, Lindsay ;
McLeod, Laura ;
Delacqua, Giovanni ;
Delacqua, Francesco ;
Kirby, Jacqueline ;
Duda, Stephany N. .
JOURNAL OF BIOMEDICAL INFORMATICS, 2019, 95
[6]  
Institute for health metrics and evaluation, 2017, GBD RES TOOL
[7]   Severe adverse events following benzathine penicillin G injection for rheumatic heart disease prophylaxis: cardiac compromise more likely than anaphylaxis [J].
Marantelli, Shannon ;
Hand, Robert ;
Carapetis, Jonathan ;
Beaton, Andrea ;
Wyber, Rosemary .
HEART ASIA, 2019, 11 (02)
[8]   Impact of regionalisation of a national rheumatic heart disease registry: the Ugandan experience [J].
Okello, Emmy ;
Longenecker, Chris T. ;
Scheel, Amy ;
Aliku, Twalib ;
Rwebembera, Joselyn ;
Mirembe, Grace ;
Sable, Craig ;
Lwabi, Peter ;
Beaton, Andrea .
HEART ASIA, 2018, 10 (01)
[9]   Rheumatic heart disease in Uganda: predictors of morbidity and mortality one year after presentation [J].
Okello, Emmy ;
Longenecker, Chris T. ;
Beaton, Andrea ;
Kamya, Moses R. ;
Lwabi, Peter .
BMC CARDIOVASCULAR DISORDERS, 2017, 17
[10]   Handheld echocardiographic screening for rheumatic heart disease by non-experts [J].
Ploutz, Michelle ;
Lu, Jimmy C. ;
Scheel, Janet ;
Webb, Catherine ;
Ensing, Greg J. ;
Aliku, Twalib ;
Lwabi, Peter ;
Sable, Craig ;
Beaton, Andrea .
HEART, 2016, 102 (01) :35-U4