Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda
Background: Chronic valvular heart disease is a well-known, long-term complication of acute rheumatic fever (ARF), which remains a major public health problem in low- and middle-income countries. Access to surgical management remains limited. Outcomes of the minority proportion of patients that acce...
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| Format: | Article |
| Language: | English |
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Ubiquity Press
2023-11-01
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| Series: | Global Heart |
| Subjects: | |
| Online Access: | https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1260 |
| _version_ | 1797382757820661760 |
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| author | Joselyn Rwebembera Andrew Y. Chang Samalie M. Kitooleko Gloria Kaudha Sarah de Loizaga Miriam Nalule Kenneth Ahabwe Wanzhu Zhang Emmy Okello Pranava Sinha Tom Mwambu Craig Sable Andrea Beaton Chris T. Longenecker |
| author_facet | Joselyn Rwebembera Andrew Y. Chang Samalie M. Kitooleko Gloria Kaudha Sarah de Loizaga Miriam Nalule Kenneth Ahabwe Wanzhu Zhang Emmy Okello Pranava Sinha Tom Mwambu Craig Sable Andrea Beaton Chris T. Longenecker |
| author_sort | Joselyn Rwebembera |
| collection | DOAJ |
| description | Background: Chronic valvular heart disease is a well-known, long-term complication of acute rheumatic fever (ARF), which remains a major public health problem in low- and middle-income countries. Access to surgical management remains limited. Outcomes of the minority proportion of patients that access surgery have not been described in Uganda. Objectives: To describe the volume and type of rheumatic heart disease (RHD) valvular interventions and the outcomes of operated patients in the Uganda RHD registry. Methods: We performed a retrospective cohort study of all valve surgery procedures identified in the Uganda RHD registry through December 2021. Results: Three hundred and sixty-seven surgical procedures were performed among 359 patients. More than half were among young (55.9% were ≤20 years of age), female (59.9%) patients. All patients were censored at 15 years. The median (IQR) follow up period was 43 (22,79) months. Nearly half of surgeries (46.9%) included interventions on multiple valves, and most valvular operations were replacements with mechanical prostheses (96.6%). Over 70% of the procedures were sponsored by charity organizations. The overall mortality of patients who underwent surgery was 13% (47/359), with over half of the mortalities occurring within the first year following surgery (27/47; 57.4%). Fifteen-year survival or freedom from re-operation was not significantly different between those receiving valve replacements and those receiving valve repair (log-rank p = 0.76). Conclusions: There has been increasing access to valve surgery among Ugandan patients with RHD. Post-operative survival is similar to regionally reported rates. The growing cohort of patients living with prosthetic valves necessitates national expansion and decentralization of post-operative care services. Major reliance on charity funding of surgery is unsustainable, thus calling for locally generated and controlled support mechanisms such as a national health insurance scheme. The central illustration (Figure 1) provides a summary of our findings and recommendations. |
| first_indexed | 2024-03-08T21:10:06Z |
| format | Article |
| id | doaj.art-119e0d79230f43278b3cba2691e90e78 |
| institution | Directory Open Access Journal |
| issn | 2211-8179 |
| language | English |
| last_indexed | 2024-03-08T21:10:06Z |
| publishDate | 2023-11-01 |
| publisher | Ubiquity Press |
| record_format | Article |
| series | Global Heart |
| spelling | doaj.art-119e0d79230f43278b3cba2691e90e782023-12-22T06:33:31ZengUbiquity PressGlobal Heart2211-81792023-11-01181626210.5334/gh.12601241Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in UgandaJoselyn Rwebembera0https://orcid.org/0000-0001-8453-818XAndrew Y. Chang1Samalie M. Kitooleko2Gloria Kaudha3Sarah de Loizaga4Miriam Nalule5Kenneth Ahabwe6Wanzhu Zhang7Emmy Okello8Pranava Sinha9Tom Mwambu10Craig Sable11Andrea Beaton12Chris T. Longenecker13Uganda Heart Institute, KampalaDepartment of Epidemiology and Population Health, Stanford University School of Medicine; Center for Innovation in Global Health, Stanford University; Stanford Cardiovascular Institute, Stanford UniversityUganda Heart Institute, KampalaUganda Heart Institute, KampalaCincinnati Children’s Hospital Medical Center, The Heart Institute, Cincinnati, OH 45229; School of Medicine, University of Cincinnati, Cincinnati, OH 45229Uganda Heart Institute, KampalaUganda Heart Institute, KampalaUganda Heart Institute, KampalaUganda Heart Institute, Kampala; Department of Internal Medicine, College of Health Sciences, Makerere University, KampalaPediatric Cardiology, Children’s National Hospital, Washington, District of ColumbiaUganda Heart Institute, KampalaPediatric Cardiology, Children’s National Hospital, Washington, District of ColumbiaCincinnati Children’s Hospital Medical Center, The Heart Institute, Cincinnati, OH 45229; School of Medicine, University of Cincinnati, Cincinnati, OH 45229Department of Global Health and Division of Cardiology, University of Washington, Seattle, WABackground: Chronic valvular heart disease is a well-known, long-term complication of acute rheumatic fever (ARF), which remains a major public health problem in low- and middle-income countries. Access to surgical management remains limited. Outcomes of the minority proportion of patients that access surgery have not been described in Uganda. Objectives: To describe the volume and type of rheumatic heart disease (RHD) valvular interventions and the outcomes of operated patients in the Uganda RHD registry. Methods: We performed a retrospective cohort study of all valve surgery procedures identified in the Uganda RHD registry through December 2021. Results: Three hundred and sixty-seven surgical procedures were performed among 359 patients. More than half were among young (55.9% were ≤20 years of age), female (59.9%) patients. All patients were censored at 15 years. The median (IQR) follow up period was 43 (22,79) months. Nearly half of surgeries (46.9%) included interventions on multiple valves, and most valvular operations were replacements with mechanical prostheses (96.6%). Over 70% of the procedures were sponsored by charity organizations. The overall mortality of patients who underwent surgery was 13% (47/359), with over half of the mortalities occurring within the first year following surgery (27/47; 57.4%). Fifteen-year survival or freedom from re-operation was not significantly different between those receiving valve replacements and those receiving valve repair (log-rank p = 0.76). Conclusions: There has been increasing access to valve surgery among Ugandan patients with RHD. Post-operative survival is similar to regionally reported rates. The growing cohort of patients living with prosthetic valves necessitates national expansion and decentralization of post-operative care services. Major reliance on charity funding of surgery is unsustainable, thus calling for locally generated and controlled support mechanisms such as a national health insurance scheme. The central illustration (Figure 1) provides a summary of our findings and recommendations.https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1260rheumatic heart disease (rhd)valvesurgeryrepairprofileoutcomes |
| spellingShingle | Joselyn Rwebembera Andrew Y. Chang Samalie M. Kitooleko Gloria Kaudha Sarah de Loizaga Miriam Nalule Kenneth Ahabwe Wanzhu Zhang Emmy Okello Pranava Sinha Tom Mwambu Craig Sable Andrea Beaton Chris T. Longenecker Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda Global Heart rheumatic heart disease (rhd) valve surgery repair profile outcomes |
| title | Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda |
| title_full | Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda |
| title_fullStr | Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda |
| title_full_unstemmed | Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda |
| title_short | Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda |
| title_sort | clinical profile and outcomes of rheumatic heart disease patients undergoing surgical valve procedures in uganda |
| topic | rheumatic heart disease (rhd) valve surgery repair profile outcomes |
| url | https://account.globalheartjournal.com/index.php/up-j-gh/article/view/1260 |
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